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

• Medicaid Upper Payment Limit Supplement For Skilled Nursing Facilities Audit Report For The Period July 1, 2016 Through June 30, 2024
• Athenahealth Names Relatient As Preferred Solution Partner For Intelligent Scheduling
• Regen Therapy Partners With Stealth Health To Bring Specialized Telemedicine Services & Longevity Programs To 3,000 Clinics
• Function Acquires Getlabs, Bringing Health Care Directly To The Consumer
• CVS Health Plans To Open 20 Pharmacy-Only Locations Across The Country In 2026
• Carina Health Network Partners With Innovaccer To Advance Value-Based Care For Over 1.5 Million Colorado Residents
• Physicians With Disabilities More Than Twice As Likely To Consider Leaving Medicine, Study Finds
• Bain Capital & Evergreen Medical Properties Acquire Portfolio Of Six Medical Outpatient Facilities In The Atlanta Metropolitan Area
• MedArrive Acquires Key Assets From Inbound Health To Expand Home Care Operations Platform
• The Concierge Competitive Edge
• Annual Survey Finds 62% Of Health Care Executives Considering Leaving Their Organizations
• CMS Center For Program Integrity Crushing Fraud: Annual Report 2025 January 1 – December 31, 2025
• CMS Request For Information (RFI) Related To Comprehensive Regulations To Uncover Suspicious Healthcare (CRUSH)
• Otsuka Pharmaceutical To Acquire Transcend Therapeutics
• Sage Health Secures Investment To Expand As A Medicare-Focused, Full-Risk Primary Care Provider Organization

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Maryland Expands Advanced Primary Care To Medicare & Medicaid Members

On January 21, 2026, the Maryland Department of Health announced that the state expanded its advanced primary care delivery system to cover approximately 1.2 million residents enrolled in Medicare and Medicaid. The expansion, which took effect January 1, aims to improve preventive care and reduce unnecessary hospital visits by focusing on coordinated care and addressing social determinants of health. The state now operates three advanced primary care programs designed to give care teams more time… Read

• TenderHeart Advances Value‑Based Durable Medical Equipment Models Aligned With CMS Priorities To Reduce Fraud, Waste & Abuse
• PointClickCare Launches The Study Buddy Research Platform To Deliver Instant, Grant Submission-Ready Evidence From Its Long-Term Care Data
• $400,000 Investment From Blue Cross & Blue Shield Expands Ohio University Rural Health Care Training
• Bots Should Handle Volume, Humans Should Handle Reality
• RxWallet Goes Live On FDB Vela, Expanding Real-Time Prescription Price Transparency For Consumers

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