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

• Medicare Enrollees Left Acute-Care Hospitals Against Medical Advice At Increasing Rates
• Harbor Health Raises $130 Million To Expand Insurance Plans, Grow Clinical Footprint & Specialty Services
• January Health Company Announces Virtual Concierge Care Services For Postpartum & Perimenopause
• Court Approves CenterWell Senior Primary Care’s Winning Bid To Acquire Assets Of The Villages Health
• 26 States Actively Preparing To Apply For The $50 Billion Federal Rural Health Transformation Program, Other States Taking A Less Formal Approach
• The Federal Budget Reconciliation Bill Affects Eligibility & Enrollment In ACA Health Insurance Marketplace Plans
• HHS Expands Access To Marketplace Catastrophic Health Plans For Upcoming Plan Year
• Evernorth Health Services Invests $3.5 Billion In Shields Health Solutions
• Remedy Meds To Acquire Thirty Madison, Expanding Telehealth Capabilities
• HonorHealth To Acquire Evernorth Care Group In Phoenix, Arizona
• Encompass Health Plans To Build A 50-Bed Inpatient Rehabilitation Hospital In Haslet, Texas
• Memorial Healthcare System Leverages DrFirst To Drive Medication Adherence And Enhance Outcomes
• Nearly 6,500 Health Care Provider Organizations Opted Out Of The BCBS Antitrust Settlement To Sue BCBS Again
• CMS Preparing To Accept State Applications For The $50 Billion Rural Health Transformation Program
• Medicare Advantage Organization SCAN Health Plan Launches ‘Health Insurance Is Broken’ Campaign

See All

Federal Budget Bill Brings Major Administrative & Financing Changes To Medicaid, ACA Marketplace & Medicare 

On July 4, 2025, President Trump signed the 2025 federal budget reconciliation package called the One Big Beautiful Bill (OBBB) Act, which enacts significant administrative and financing changes to health care policy affecting Medicaid, Medicaid expansion plans, Affordable Care Act (ACA) Healthcare Marketplace plans, and Medicare. An early analysis by the Congressional Budget Office (CBO) projected that the overall number of uninsured people will increase and health insurance premiums will likely increase as a result.   Medicaid … Read

• In Re: Blue Cross Blue Shield Antitrust Litigation Settlement Agreement
• Virginia Awards $3 Million Grant To Support Civica’s Affordable Insulin Programs
• Real Physician Revenue Down 33.6% Since 2016 Due To Medicare & Medicare Advantage Reimbursement Trends & Inflation
• Bon Secours Mercy Health Inc., et al., v. Blue Cross Blue Shield Association, et al.
• The Autism Metrics

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