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

• SPARK Peer Learning Center – Winning Proposal & Contract For Statewide Behavioral Health Youth Network Services To Washington State Health Care Authority, 2024
• California Seeks Medi-Cal Third-Party Administrator Services
• Lumeris Raises $100 Million To Expand Partnerships, Technologies  
• Kontakt.io Raises $47.5 Million To Boost AI Development, Expansion In U.S. Hospitals  
• ABOUT Healthcare Acquires AI Analytics Platform Company Edgility  
• Clarity Pediatrics Expands Virtual ADHD Platform, Gains $10 Million Funding   
• DrFirst Acquires Myndshft Technologies 
• Medicus IT Acquires BlueNovo, To Support Community Health Centers
• Included Health Expands Virtual Specialty Care Clinic 
• Louisiana Seeks Primary Care Network Services
• Walmart Health To Close All Health Centers & Virtual Care Service
• Acadia Healthcare & Uber Health Partner To Provide Transportation To Acadia’s Comprehensive Treatment Centers
• 23% Of People Who Lost Medicaid Coverage During Unwinding Remain Uninsured
• Community Health Systems To Sell Tennessee Hospital To Hamilton Health Care System
• Post-COVID Billing Of Medicare E-Visits Low

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Spying The Health Care Megatrends

After Medicare launched coverage of e-visits in early 2020, billed e-visits rose from less than 50 claims per 100,000 beneficiaries per month to peak at more than 700 claims per 100,000 per month in March and April. Billed e-visits declined steeply from April to June 2020, to about 200 claims per 100,000 beneficiaries per month. After June 2020 and through December 2022, Billed e-visits remained below 200 claims per 100,000 beneficiaries per month. These findings… Read

• Orange County Health Authority DBA CalOptima Health – Winning Contract Documents For Be Well OC Wellness Hub Services To Orange County Health Care Agency, 2024
• Risant Health Completes Acquisition Of Geisinger Health System 
• Elevance Health Partners With Clayton, Dublier & Rice To Advance Primary Care Delivery  
• Netsmart Launches Netsmart Marketplace With Interoperability & Integration Offerings  
• Core Solutions Launches Symptom Tracking AI Solution