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

• Psychiatry, OB/GYN & Primary Care Have Higher Clinical Attrition Rates Than Other Medical Specialties
• Hennepin County, Minnesota, Assumes Control Of Hennepin Healthcare System Amid Financial Difficulties
• Final Medicare Physician Fee Schedule For 2026 Includes Policies To Address Undervaluation Of Time-Intensive Services
• Vermont, Utah & Minnesota Top-Ranked States For Medicare Performance
• California Hospitals Must Screen Uninsured & Underinsured For Financial Assistance Eligibility
• Chaptered California Assembly Bill 1312 (Chapter 450): Hospital Pricing
• UM Health-Sparrow Opens Youth Health Clinic With East Lansing Public Schools, Second In The Region
• Hospice Of The Western Reserve Selects Netsmart To Enhance Care Delivery For Hospice & Palliative Care
• Qualifacts Becomes The First EHR Solution Provider Organization To Earn AI Management Systems Certification ISO 42001:2023
• A $10 Million Donation To St. Joseph’s Healthcare Foundation Will Help Develop AI For Blindness Caused By Common Chronic Eye Diseases
• Kyruus Health & Healthgrades Partner To Improve Patient Access & Digital Presence For Health Care Provider Organizations
• Final Rule For Medicare & Medicaid Programs; CY 2026 Payment Policies Under The Physician Fee Schedule, And Other Changes
• Revelstoke Capital Partners Invests In Griffin Concierge Medical
• Briya Partners With Tanner Health To Accelerate Clinical Innovation In Alabama & Georgia
• PrimeRx Launches First-Ever Real-Time Marketplace Integration In The Dispensing Workflow

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

• Nevada Health Link Insurance Marketplace Launches ‘Battle Born’ Public Health Insurance Option
• What A Difference A State Makes
• California To Phase Out Prior Authorization For Health Care Services With Approval Rates Of 90% Or Higher
• Final Nevada 1332 Waiver Application Addendum
• Final Nevada 1332 Application

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