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

• From Research To Action: Optimizing Payer Relationships For Strategic Growth
• Reframing The Provider/Payer Relationship For Long-Term Competitiveness
• The ‘Business Of Business’ Is Relationships
• Personal Care Aides In Adult Day Services Centers & Residential Care Communities: United States
• Federal 2025 Budget Bill Estimated To Cut Medicaid Spending In Rural Areas By $137 Billion Over 10 Years
• Abacus & Medicus IT Merge To Launch A Financial Services & Health Care-Focused IT Managed Services Provider
• Priority Health Expands Into Wisconsin As Governing Member Of Group Health Cooperative Of Eau Claire
• 15% Median Premium Increase Requested By ACA Marketplace Insurers For 2026 Plan Year
• Brown University Launches AI Research Institute With $20 Million National Science Foundation Grant 
• Core Solutions Unveils AI-Powered EHR Platform Behavioral Health Clinical Support 
• Ohio I/DD Provider Organization I Am Boundless Launches Leadership Podcast 
• Uncertainty & Opportunity
• Physician Exit Rates From Traditional Medicare Accelerated From 2010 To 2023
• HHS & DOJ False Claims Act Working Group Targets Health Care Fraud
• Trinity Capital Provides $20 Million In Growth Capital To b.well Connected Health

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

• Ambience Healthcare Raises $243 Million To Scale Its AI Platform For Health Systems 
• Pennsylvania Multistate Licensure Compacts To Expand Job Opportunities & Cut Red Tape For Physicians, Nurses & Physical Therapists
• Physician Burnout: Causes, Consequences & Cures
• Illinois Implements Laws To Oversee PBMs & Ban Health Plan Use Of Prior Authorization For Outpatient & Partial Hospitalization Mental Health Services 
• Doceree Launches Co-Pay.Com To Support Point-Of-Care Access To Insurance Benefits Checks & Medication Cost Assistance Programs 

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