Health Care System

The United States health care system encompasses a mixture of private and public entities that are either non-profit or for-profit. Health care coverage may be financed through federal and state government programs or can be purchased through the health insurance marketplace. In contrast, a smaller proportion of the U.S. population is uninsured. The resulting effects of a decentralized system has led to considerable challenges for provider organizations—including cost pressures, a push towards alternative payment models, and market consolidation. Despite these challenges, there are opportunities for provider organizations in reducing excess costs and utilization, particularly as payers look for innovative approaches that can demonstrate a return-on-investment in terms of cost and consumer outcomes.

Latest Resources

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• Mergers & Financial Sustainability: The Cornerstone Montgomery Case Study
• Dana-Farber Cancer Institute Launches Neuro-Inclusive Program That Integrates Palliative & Behavioral Health Care
• Contract Awards Change The Florida Medicaid MCO Landscape
• UCI Health Acquires Four Hospitals From Tenet Healthcare  
• Walgreens Plans To Close More VillageMD Locations  
• Family Hospital System Closes Two Nebraska Hospitals  
• Oregon Adopts Legislation On ‘Physician Associate’ Title  
• Oklahoma Seeks TRICARE Services
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• Colorado Medicaid eConsult – FAQ
• Private Payers Deny 15% Of Medical Claims, Even Some That Were Pre-Approved
• 25% Of Health Care Provider Organizations Plan To Deploy Generative AI To Enhance Consumer Engagement
• Praia Health Raises $20 Million, Spins Out From Providence  

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Spying The Health Care Megatrends

New digital health company Praia Health, which is focused on offering individualized health solutions at scale, raised $20 million in investment funding and spun out of the Providence Digital Innovation Group incubator. Investors included Frist Cressey Ventures, SignalFire, Epsilon Health Investors and Providence Ventures.   The Praia Health Consumer Platform manages data exchange between the solution, a health system’s electronic medical record solution and other health system data sources. The company said the platform’s low-code ecosystem… Read

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