Navigating the US healthcare system can be daunting. Decoding the US Healthcare System offers practical guidance and actionable strategies to help healthcare and business professionals to steer a path through the system now in order to achieve their business objectives.
The book offers a comprehensive and insightful exploration of how to adapt to policy and how the various healthcare stakeholders can combine to determine which medicines and technologies reach patients. It describes the complex relationships and role of the key players – pharmaceutical and medical device manufacturers, healthcare providers, insurance companies, and intermediaries – and provides a clear guide to someone working in one of these industries on how they can interact with their counterparts in different parts of the ecosystem who often have very different backgrounds, interests, and incentives. It includes frameworks for building partnerships, overcoming barriers to innovation, and adapting to policy changes. Readers will gain an understanding of why the system functions as it does today, and how to operate more effectively within the system and to drive meaningful change in their respective roles.
This illuminating book is ideal for healthcare and business professionals along with readers seeking to understand and deal with business-to-business transactions in the US healthcare system.
Table of Contents:
1 Introduction; 2 The Healthcare Landscape; 3 Patients: The Humans at the Center of Healthcare; 4 Payers: Corporate Giants Writing the Rules; 5 Organized Providers: Patient Care at Scale; 6 Physicians: Mainstay of Evolving Healthcare; 7 Pharmaceuticals and Medical Devices: The Industry of Innovation; 8 Intermediaries: The Glue that Holds It All Together; 9 The Journey of Healthcare Data: Records to Revolution; 10 The Costs and Challenges of Reform; 11 Reflections on the Road Ahead
About the Author :
Joe Stevens is a leading expert in commercializing pharmaceutical and medical technologies that fill unmet clinical needs and improve patient outcomes. His work focuses on helping companies understand complex market dynamics, develop value strategies, and design commercial models to engage effectively with life sciences’ organized customers. Joe is a principal in the ZS San Francisco office and leads the firm’s pharmaceutical market trends and policy analysis team.
Anush Khandelwal is a global market access expert who advises pharmaceutical and healthcare organizations on strategies to improve patient access and enhance affordability. His work focuses on payer and provider strategy, managed care and commercial insights, data-driven analytics, and digital transformation to help life sciences companies deliver impact. Anush is a principal in the ZS Pune office and a leader in business-to-business access and value realization practice.
Review :
“This book is a practical and timely guide for anyone trying to understand the US healthcare system, including career switchers looking to enter the field, professionals seeking a better understanding of their customers and suppliers, and patients navigating a confusing landscape.” David Ridley, Faculty Director, Center for Health Sector Management, Duke University’s Fuqua School of Business
“This book provides great insights into current complexity of interactions and likely future developments under influence of cost pressures and AI opportunities. A must read!” Ed Schoonveld, Author, The Price of Global Health
“From negotiating payer contracts to scaling specialty services, this book delivers the contextual intelligence every health executive needs to make informed, strategic decisions —and why alignment matters.” Jorge J. García, Assistant Vice President, System Oncology Pharmacy Services, Baptist Health South Florida
“A must-read for anyone involved in healthcare. By illuminating the priorities and pain points of each key player, this book paves the way for meaningful collaboration and better patient outcomes.” Shweta Sahani, Associate Director, Market Access Analytics, Johnson & Johnson Innovate Medicine
“The book offers a compelling narrative of how healthcare data has evolved, from paper to digital, from silos to emerging ecosystems, and why we must accelerate integration to realize its full value.” Jennifer Mueller, Senior Vice President, American Health Information Management Association
