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

• Nearly Half Of U.S. Adults Concerned About Health Care Costs In The Coming Year
• North Texas Sees Ongoing Challenges Facing Children & Families
• Northwell Health & K Health Launch AI-Powered Virtual Primary Care Platform
• Sustaining Growth in an Era of Consolidation – Smarter M&A Strategies For Long-Term Stability: A Discussion with Nelson Gomes, EVP of Corporate Growth and Partnerships at Medicus IT
• Talkspace Acquires Wisdo Health To Expand AI-Powered Social Health & Peer Support Solutions
• Wysa Acquires Kins Physical Therapy To Close Gaps In U.S. Health Care
• BrentCare Behavioral Health Holdings Announces Acquisition Of Modern Recovery Network
• Function Health Raised A $298 Million Series B Round, Launches Medical Intelligence Lab
• Outpatient Follow-Up Within 30 Days Of Discharge Is Associated With Lower Risk Of Readmission
• Diagnosis Added To Some Medicare Advantage Enrollees’ Chart Review Record Led To Increased Federal Payments
• Therap Services Adds New Sleep Tracking Option
• Waltz Health & Serve You Rx Delivering Millions in Specialty Pharmacy Savings To Health Plans, Employers & Patients
• NewBeingNutrition.com Launches In Florida To Connect Patients With Integrated Doctor-Dietitian Care Teams
• Framework Proposed To Align Health System SDOH Initiatives With EHR & Value-Based Models
• Kansas Audit Flags Issues In KanCare Oversight, MCO Claim Denial

See All

California To Phase Out Prior Authorization For Health Care Services With Approval Rates Of 90% Or Higher

New legislation in California, signed on October 6, 2025, directs health plans and health insurers to phase out prior authorization for health care services with approval rates of 90% or higher by January 1, 2028. The legislation is supported by the California Medical Association (CMA). The goal is to reduce the administrative burden on health care provider organizations and to reduce delays in care for consumers, according to the CMA. The legislation does not apply… Read

• Senior Living Companies Account For 15 Of 48 Health Care Company Bankruptcies In 2025
• Secure Medical Launches TelehealthCash, Enabling Entrepreneurs To Build Branded Telehealth Platforms
• Cigna Creates New Copay-Centric Insurance Model, Backed By AI Care Coordination
• Medicaid Managed Care Organization Contract Extension Request JLCB – November 2025 LDH Legislative Fact Sheet
• Florida Awards Children’s Medical Services Program Contract To Molina Healthcare

To sign-up for monthly Health Care System alerts, you must be signed in to your account.