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

• HHS & CMS Announce Nationwide Medicare & Medicaid Fraud Prevention Strategies
• Azara Healthcare Launches Smart Summary AI To Streamline Workflows & Surface Critical Consumer Insights
• Women & Infants Hospital’s Community Mobile Health Clinic To Provide Postpartum Care In Rhode Island
• The Peer Question
• Peer Support Services: North Carolina Results First Program Evaluation
• What Is The ‘Value’ Of Health Care?
• Health Care Leaders Reject Autonomous AI, Favor Hybrid Intelligence For Accuracy & Trust, New Survey Finds
• The Budget & Economic Outlook: 2026 To 2036
• U.S. & State Of Ohio v. OhioHealth Corporation
• Insurance Carrier Employment Falls For First Time Since COVID-19, Down 29,000 In 2025
• Atrium Health’s Meaningful Medicine Program Transforms Access To Care, Expands Economic Mobility Through Early Career Opportunities
• OhioHealth To Scale Abridge AI Platform Across More Than 200 Ambulatory Sites
• Blue Shield Of California Promise Health Plan Sponsors $80,000 For Medical Assistant Training Scholarships In San Diego County
• Hawaii Medicaid Rebids $60 Million BHO Contract For Adult Community Mental Health Services
• Telemedicine Linked To 23% Fewer Follow-Up Visits Over 30-Day Episode

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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

• New Federal Legislation Streamlines Out-Of-State Medicaid Enrollment For Pediatric Provider Organizations
• Recovery Centers Of America Agrees To Pay $2 Million To Resolve Allegations That It Mishandled Controlled Substances and Provided Inadequate Treatment Services
• WellSky Joins Epic Toolbox To Improve Consumer Care Transitions and Coordination Through The Community Resource Network
• Humana Report Finds Value-Based Care Associated With 13.4% Fewer Emergency Department Visits
• Choice Health At Home Completes Acquisition Of Family Tree Private Care, Expanding Full Continuum Of Home-Based Care

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