Health Policy and Intelligence Institute

Healthcare at 250

October 19, 2026

The structural choices that shaped American health and the decisions defining the next era

Key takeaways

American healthcare was built by local institutions and independent physicians, yet it is now evaluated on national cost trends, consistent quality, and compliance with standardized payment models, all while still being expected to deliver care locally and personally. That tension, not any single policy or technology, is the throughline behind every challenge in this paper.
The system faces seven distinct but connected challenges, spanning consumer expectations, care coordination, innovation speed, regional divergence, chronic care, national infrastructure, and technology adoption.
Each of these seven structural challenges have a clear historical parallel, from 19th-century public health reform to the rise of AI, showing these are patterns, not new problems.
The real bottleneck isn’t invention, it’s adoption that challenges the conventional norms and barriers that keep proven solutions from reaching scale. Time and again, technology and care models have proven themselves years or decades before the system used them.
The next era won't be measured by activity, it'll be measured by impact. The organizations that win will likely be judged by how much healthier people became, not how many visits, procedures, or dollars were logged along the way.

Introduction The next American healthcare system is being built today.

Two hundred and fifty years ago, the Founding Fathers signed the Declaration of Independence and established a nation. In the years since, American healthcare has been defined by new demands and reinvention required to meet those demands. As the nation marks its 250th anniversary, this moment provides a rare vantage point: Not only to celebrate what was built, but to understand how it was built, and what that means for us today as we consider the challenges of the moment.

American healthcare was built to serve one of the most diverse populations in the nation's history, but not as a participatory system.¹ It is becoming one, and the organizations that enable real participation will define the next era. Today that system is also under real strain, with population health needs evolving faster than the structures built to meet them, and with technology capable of far more than the system has yet adopted: shifting demographics, rising chronic disease burden, and cost pressures that legacy models were never designed to absorb.²

Addressing this moment will likely take more than incremental adjustment; it may require transformative thinking about how care is organized, delivered, and financed. History does not offer a blueprint, but it does offer an important perspective: how transformation has happened before, how it has been adopted, and how the next one can be designed deliberately, rather than left to accumulate by accident.

Section I Seven structural challenges of today’s system with lessons from 250 years of medicine

Seven structural challenges now define the horizon: some rooted in the industrialization of medicine itself, how care is organized, financed, and governed, others in how the pace of medical and pharmaceutical innovation is outstripping the systems built to deliver it, and still others rooted in how long it takes the system to adopt technology that has already proven itself. Together they mark inflection points where legacy assumptions are breaking down fastest and where decisions made now will help shape market position, operating resilience, and long-term relevance.

Each of these challenges has historical precedents which helps provide lessons and reflection on how we take on the challenges of the day. Each precedent highlights a structural mismatch that could not be resolved incrementally; a moment when the right response required decisive organizational choice, or a lesson that has not lost relevance with the passage of time.

The organizations that act with clarity and conviction in the years to come will help determine what American healthcare looks like in the next era.

Today’s challenge: Consumers expect agency and participation

Consumers increasingly expect agency, personalization, and continuous engagement across access, price, and experience, yet the system remains difficult to navigate for anyone without deep familiarity with how it works. But many legacy systems were built to support claims adjudication and reimbursement, not patient engagement; that constraint doesn’t go away by adding a better interface. The real task isn’t choosing between patient experience and compliance; it’s about understanding the consumer and redesigning the workflow underneath so consumer expectations, privacy, clinical safety, reimbursement, and licensure requirements can all be met by the same system rather than traded off against each other.

Historic milestone: 1990s–2000s
Pharmacies expanded access by redesigning the vaccination model

Vaccination once sat almost entirely with physician offices, which limited access for anyone who couldn’t easily get an appointment. Many pharmacies closed that gap not by being more convenient to visit, but by changing what a pharmacy could do: securing the authority to immunize, building standardized training and CDC-aligned protocols, and operating under new practice and liability frameworks, modernizing the rules where they didn’t yet allow it. The model worked because it put the vaccine closer to where people already were, and it shows up in the outcome: adult immunization rates rose meaningfully as pharmacy-based delivery scaled nationally, while enhancing market opportunity across the value chain¹¹.

Takeaway

The winners will redesign around the patient, not just the interface. Pharmacy immunization proved the model: it worked because the operating model changed to meet patients where they were, not because the experience got a facelift. As healthcare consumer demographics and expectations shift, the ecosystem should be responsive to both their care needs and how they engage with the industry.

Today’s challenge: From ownership to orchestration

For decades, the answer to complexity was to own more of the system. But today's problems now sit outside any one organization: the data that connects them is fragmented across competitors, and consolidation alone is no longer sufficient. No provider, payer, or manufacturer can build fast enough to meet consumer expectations on their own; speed now comes through orchestration, not ownership.

Historic milestone: 1850s–1870s
Coordination held because authority backed it

Epidemic disease was killing city populations faster than medicine could treat it, but its causes lay in contaminated water, sewage, and overcrowded housing, systems no single actor controlled. Public health boards brought sanitation, water, and housing under one coordinated effort, and cities achieved population-level gains only once those boards had real authority to enforce it, not just cooperation across departments that had none. Coordination is what solved the problem; authority is what made the coordination hold.¹²

Takeaway

Owning a piece of the system may no longer be enough. The advantage goes to organizations that take accountability for outcomes across the whole system, not just their own part of it, and orchestration only holds when it comes with real authority to act, not just cooperation. Rising scrutiny of consolidation only sharpens the case: build that authority now, on your own terms, before regulators force it later.

Today’s challenge: Medical innovation is advancing faster than the system can deliver it

Historically, the bottleneck in medicine was science. It isn’t anymore. Cell and gene therapies, AI-enabled diagnostics, and next-generation metabolic agents are reaching patients faster than many payment models, care infrastructure, and workforce pipelines can absorb them, and consumer demand is only widening that gap. Organizations that model out cost, access, and long-term outcomes before these technologies scale, rather than reacting once reimbursement is already strained, will capture the value; those that wait will spend it managing shortages and backlash instead.

Historic milestone: 1890s–1900s
Diphtheria antitoxin proved the science was only the beginning

Diphtheria antitoxin was the first effective treatment for a disease killing children at scale - but much of the system lacked capacity to manufacture, distribute, finance and administer it. Those that built the infrastructure to operationalize access, not just those that made the discovery, turned it into lives saved and defined the market that followed.¹³

Takeaway

Science may no longer be the bottleneck, delivery is. The diphtheria antitoxin only saved lives once manufacturing and financing caught up to it, and the same test now applies to GLP-1s and AI. The organizations that win will treat delivery as the strategy, not a support function.

Today’s challenge: A uniform national model no longer fits a diverging map

Care needs are diverging by geography, and a once-uniform national operating model may no longer fit. Rural, urban, and suburban communities face fundamentally different constraints, and many organizations chasing growth are strained trying to serve all three inside an increasingly fragmented environment. State-level capital programs like the $50B Rural Health Transformation Program (RHTP) are already directing resources regionally, and new care models, payment structures, and delivery pathways are emerging state by state rather than nationally.¹⁴ Payers and providers that stay responsive to regional needs, rather than waiting for policy to standardize again, are positioned to succeed.

Historic milestone: 1970s
National Health Service Corps: access followed the incentive, not the need

By the late 1960s, physician shortages had left large parts of rural and urban America without reliable access to care, severely impacting health outcomes in those geographies. The National Health Service Corps, created in 1970, established meaningful incentives that enabled more individuals to pursue medical education and commit to serving in these communities. This enabled improved access to care and community health outcomes.^15,16

Takeaway

Growth will likely increasingly depend on tailoring products, networks, investments, and operating models to distinct state and local market needs rather than applying a uniform national strategy. The National Health Services Corp shows us that well designed incentives enable this to happen.

Today’s challenge: The burden is shifting from acute to chronic and behavioral

Today’s workforce and infrastructure were designed for acute, episodic care, yet chronic conditions, behavioral health, and social needs are now the dominant burden. These require continuous, distributed management, the current model was never built to deliver. Organizations that build that capacity now will manage cost and outcomes proactively; those that don't will keep absorbing the burden later as expensive, avoidable crises.

Historic milestone: 1970s
Midwifery gave way to a model built for acute risk, not continuity

For most of American history, midwives managed pregnancy and birth as a continuous relationship, tracking a woman’s health, nutrition, and home circumstances over months, not just the delivery itself. Through the early-to-mid 20th century, obstetrics displaced midwifery as the dominant model, organized around acute delivery risk, and it improved outcomes for complicated births. But it left behind the longitudinal, wraparound view that a purely acute model was never built to carry, a gap that renewed demand for doulas, midwives, and integrated prenatal support is only now starting to close.¹⁷

Takeaway

Behavioral health utilization has risen 62% since 2018, while workforce capacity has not kept pace.¹⁸ Success will require expanding capacity through workforce innovation and technology that enables more patients to be served.

Today’s challenge: Infrastructure-level importance without infrastructure-level governance

Healthcare is increasingly treated as national infrastructure, tied to cybersecurity, supply-chain resilience, data privacy, and workforce capacity, but it is governed and funded like a collection of independent businesses rather than a system the country depends on. Ransomware attacks have shut down emergency departments for weeks at a time, concentrated points of failure in pharmaceutical and device manufacturing have triggered national drug shortages, and health data breaches now routinely affect tens of millions of patients at once, even as public funding for resilience moves in the opposite direction of the risk.^19,20,21 Organizations that build governance and investment to match the stakes will likely absorb the next disruption; those that don't will become its next headline.

Historic milestone: 1980s
Organ transplantation was nationalized after access broke down

Through the late 1970s, organ allocation ran as a patchwork of local and regional programs with no shared waiting list, no consistent medical criteria, and no oversight connecting them. Patients died waiting in one city while a matching organ went unused in another, and survival often depended more on where a patient lived, or who their doctor knew, than on medical urgency. The 1984 National Organ Transplant Act ended that patchwork, creating a single national waiting list, standardized medical criteria, and one federally overseen network responsible for the entire system.²² Access became a function of medical need for the first time, not geography or connections.

Takeaway

Governance built after the crisis always costs more than governance built before it. Organ allocation shows that fragmented systems undermine access and trust. Similarly, it is imperative for industry leaders to take an active position in shaping cyber, supply chain, and data standards, capabilities, and governance models. Waiting for the mandate means paying for the crisis first and the regulation second.

Today’s challenge: Technology works but adoption lags.

Healthcare has a long history of adopting new technology far slower than the technology itself is ready. The pattern is consistent: quick to pilot, slow to scale, little to no value measurement. This creates a gap that adds cost and leaves behind tech-debt laden ecosystems rather than realized value. AI, remote patient monitoring, and robotic-assisted surgery are only the latest technologies facing this same question, not whether they work, but how long it will take the system to adopt them, while transforming workflow, at the pace and scale needed to realize their value.

Historic milestone: 1950s - 1970s
Telemedicine technology was proven in 1959. It wasn't adopted at scale until 2020.

In 1959, the University of Nebraska used two-way television, one of the first working demonstrations of telemedicine technology anywhere, to conduct real-time neurological exams between campus and a state hospital.²³ The technology kept improving for decades. Adoption at scale did not follow. It took the global COVID-19 pandemic, six decades later, to make video-visit technology a routine part of American healthcare.²⁴

During this same milestone period, telemedicine and computer-aided diagnosis as early as 1968 demonstrated better capabilities decades before they integrated as standard practices, and each time, the value sat unrealized until adoption finally caught up.²⁵

Takeaway

Technology proving it works has never been the bottleneck, adoption at scale has. AI and other technologies available today are arriving in the same position, its capability outpacing the institutions built to trust and use it. The winners will scale deliberately with a clear view of value, risk, and return. They will pair the technology with the operating model and workflow redesign it actually requires, rather than piloting indefinitely without ever realizing it.

The common thread

These seven challenges are interconnected, each reflecting a common tension: a healthcare system historically built around local delivery is increasingly expected to operate at a national scale while preserving the personal nature of care. They also underscore a shared risk: a solution that solves one era's problem can turn into the next era's constraint if it isn't built to bend. Meeting them takes coordinated, strategic action, not seven separate fixes; the shifts and actions for each follow below.

Section II Mindset shifts and strategic actions for the next era

Uncertainty about where policy, technology, or the economy land next is real, but it isn't a reason to wait. What's needed now is a mindset shift, from managing today's model to building the next one, paired with strategic, coordinated action taken before the landscape forces it.

Mindset shift needed: From payment rules to patient agency

Boardroom questions

Are we built for where our consumers are headed, not just where they are today?
Where do current workflows force trade-offs and how can we eliminate them?
Are we building a unified consumer engagement capability or funding disconnected point solutions?

No-regret actions

Redesign the operating model around patient agency rather than layering tools over the current payment and workflow rules.
Treat price transparency as a strategic capability that informs contracting and positioning, not a compliance exercise.
Meet patients across continuous touchpoints: wearables, remote monitoring, digital therapeutics, all underpinned by data governance and interoperability.

Mindset shift needed: From ownership to orchestration

Boardroom questions

Which capabilities should we continue to own, and where would partnerships deliver greater speed, reach, or value?
Do we have the data-sharing, governance, and decision rights needed to orchestrate effectively?
Are our incentives rewarding ownership and consolidation when competitive advantage increasingly depends on orchestration?

No-regret actions

Map ecosystem dependencies; identify strategic gaps in the partnership architecture.
Identify two to three capabilities where partnership or acquisition outperforms internal build.
Concentrate where you uniquely lead and collaborate deliberately across the rest, so you can move at market speed without building every piece.

Mindset shift needed: From innovation velocity to delivery capacity

Boardroom questions

Which innovations are most likely to scale faster than our current infrastructure is equipped for?
Have we modeled out the full cost and long-term outcomes of these technologies before adoption accelerates to make sure we realize value?
What investments should be made now to capture value rather than wait until shortages, financial pressure, and stakeholder scrutiny force the change?
What regulatory and structural barriers can be challenged strategically and legally to improve access and drive affordability?

No-regret actions

Map affordability and access barriers across geography, coverage status, site of care, and readiness for AI-enabled and other fast-moving innovation; prioritize measurable near-term wins.
Rebuild delivery and financing around how innovation arrives now: agentic AI, single-pivotal-trial approvals, oral GLP-1s, not the last generation's model.
Pilot outcomes-based and value-based arrangements for high-cost therapies, backed by longitudinal outcomes data.
Engage industry and government policy makers to proactively challenge regulatory constraints and drive a change agenda rooted in consumer benefit.

Mindset shift needed: From a national model to regional resolution

Boardroom questions

Where does our national operating model break down against state-level variation?
Which regions should we prioritize, redesign, or exit and what evidence is guiding those choices?
Do we have the governance and local capabilities to respond to state-level variation in funding, payment models, and care pathways?

No-regret actions

Build the capability to see and act at regional resolution; embed flexibility into pricing, network, and benefit design.
Establish governance to track state funding priorities and secure catalytic dollars where eligible, with clear ROI and compliance oversight.
Reassess footprint, divestitures, and M&A through a regional-economics lens rather than a national one.

Mindset shift needed: From care delivery to health management

Boardroom questions

How are we shifting capital and leadership attention from episodic care delivery to continuous management of chronic, behavioral, and social needs?
Where are workforce, technology, and operating model constraints limiting us from taking a health-management approach?
How are our incentives and performance measures shifting to align with new care demands?

No-regret actions

Invest in longitudinal patient-data infrastructure now: you cannot manage what you cannot see across time.
Develop a metabolic health and GLP-1 strategy before it reshapes your utilization economics.
Build continuous-care capacity that stays flexible as it scales, rather than hardening into the next high-cost bottleneck.

Mindset shift needed: From voluntary participant to infrastructure steward

Boardroom questions

Are cyber, supply chain resilience, data privacy, and workforce capacity being managed as enterprise level risks or within functional silos?
How are we funding resilience and continuity at scale in an environment of declining public investment?
What known vulnerabilities are we carrying and what would a failure in these areas cost in financial, operational, and consumer-impact terms?

No-regret actions

Quantify the cost of waiting: model breach, shortage, and workforce-gap exposure against the cost of proactive stewardship.
Reengineer supply chains for resilience-first; diversify manufacturing and reduce concentration risk.
Assess incident response, disaster recovery, and crisis plans through live testing, not just documentation.

Mindset shift needed: From volume of use cases as the milestone to scaled adoption for value as the milestone

Boardroom questions

Are we investing in technology faster than redesigning the operating model needed to realize its value?
What underlying data governance and quality standards do we have in place to make sure that we can trust in the AI capabilities we are employing?
How will we know, at the board level, if our investments in emerging technologies like AI, robotics, and remote monitoring are creating measurable enterprise value versus another layer of technology debt?

No-regret actions

Make value realization the gate – not just deployment. Define the expected outcomes up front and measure success not by deployment but realization of expected outcomes.
Invest in workflow transformation alongside the technology implementation—not just as a change-management exercise post-go-live.
Define the foundational changes necessary to make the next technology easier to adopt such as fixing fragmented data, brittle integrations, rationalizing applications, and establishing technology governance.

Section III Key takeaways by subsector

Meet patients where retail already has (Challenge 1). Retail health, telehealth, and DTC pharma are already redefining where care starts; providers who don't own that first touchpoint become the referral endpoint instead of the front door.
Build durable regional capability, not a one-time grant (Challenge 4). Use programs like the $50B RHTP as a lever to fund the shift, but the real goal is footprint, service lines, and payer mix built around regional economics that outlast any single funding cycle.
Scale clinical capacity through new care models (Challenge 5). Build home-based, virtual, and behavioral capacity ahead of demand (behavioral utilization up 62% since 2018) by scaling the clinical workforce through new practice models, not just adding sites of care, and keep the model flexible so it doesn't harden into the next cost bottleneck.
Modernize infrastructure as stewardship, not just defense (Challenge 6). With healthcare treated as national infrastructure, invest in modernizing cybersecurity, supply chains, and workforce systems to strengthen stewardship broadly, not just to avoid a mandate; proactive modernization costs less than absorbing the crisis and the regulation after.
Set adoption strategies, not pilot programs (Challenge 7). AI-assisted documentation and diagnostic support have already cleared clinical validation in many settings; the risk isn't whether the technology works, it's running it alongside the old manual process indefinitely instead of committing to the switch.

Orchestrate, don't own (Challenge 2). One of the largest national payers has already pulled back this year after its ownership bet strayed from its original intent, the live case study for why risk performance depends on coordinating across members’ social, behavioral and post-acute care needs, not owning every piece of the delivery chain.³⁵
Manage to regional resolution, not a national average (Challenge 4). State-level Medicaid variation, work requirements, and ICHRA adoption are splintering risk pools; price, design benefits, and decide where to compete market by market, based on where demographics and risk are heading, not just where they stand today.^36,37
From care delivery to health management (Challenge 5). As chronic and behavioral burden replaces acute volume, invest in longitudinal data, prevention, and continuous engagement; you cannot manage what you cannot see across time.
Move proven AI from pilot to production (Challenge 7). Claims adjudication, prior authorization, and fraud detection tools have already demonstrated accuracy gains in testing; the constraint now is organizational trust and audit readiness, not the technology's capability.

Own the direct-to-consumer relationship (Challenge 1). TrumpRx, LillyDirect, and telehealth are rerouting the patient journey around PBMs and insurers; build DTC infrastructure, adherence, and care coordination across your Pharmaceutical and Life Sciences verticals.³⁸
Close the gap between innovation and the payment model (Challenge 3). One-time, high-cost curative therapies strain financing built for recurring costs; pilot outcomes-based arrangements now, backed by longitudinal outcomes data.
Plan for permanent, multi-layered price pressure (Challenge 6). MFN, IRA maximum fair price, CMMI international benchmarks, and PBM reform are what mandated governance looks like once it arrives after the fact; prioritize the portfolio and reset global strategy now, before the next layer of regulation sets the terms for you.
Don't let proven technologies sit in R&D indefinitely (Challenge 7). AI-driven molecule screening and trial design tools have already shown they can compress timelines; the barrier now is validating and institutionalizing them across the full development pipeline, not proving they work³⁹.

Close the device reimbursement gap (Challenge 3). AI-enabled diagnostics and connected devices are clearing FDA review faster than CPT coding and coverage determinations can catch up; build the clinical and economic evidence case now so reimbursement isn't the bottleneck once the technology is ready to scale.^40,41
Govern to infrastructure-level standards (Challenge 6). As FDA shifts from premarket review to post-market performance and safety, invest in surveillance, data governance, and lifecycle accountability before stricter standards close the gap for you.⁴²
Become the interoperable partner others build on (Challenge 2). Advantages go to connected, intelligent systems spanning hospital and home, orchestrate across the ecosystem rather than trying to build every capability alone.
Design for adoption, not just approval (Challenge 7). AI-enabled devices are clearing FDA review faster than health systems are integrating them into clinical workflows; build the implementation and training pathway into the product itself, not as an afterthought.

Every recommendation above traces back to the same seven shifts: patient agency over interface, orchestration over ownership, delivery over invention, regional precision over national averages, continuous care over episodic care, infrastructure-grade governance over voluntary patchwork compliance, and adoption over proof of capability.

Health in America at 500

Two hundred and fifty years of American healthcare has largely measured itself by activity: patients treated, procedures performed, dollars spent, technologies trained on. That measure will not be enough for what comes next. The organizations that shape the next era will likely be the ones that measure themselves by impact, not interactions; how much disease was prevented rather than how many visits occurred; how much healthier a population became rather than how much was spent trying.

The seven challenges in this paper are distinct, but many trace back to a shared tension: American healthcare was built at a local scale, yet it is increasingly asked to operate at a national scale while still acting locally and personally. History shows that organizations that met their era's version of this challenge did so by taking ownership of an outcome, not just a piece of the process, and by redesigning the model rather than adding an interface on top of it.

If the last 250 years were about building a system capable of reaching nearly everyone, the next 250 should be about ensuring it works for them. That is the standard worth setting now, so that when American healthcare marks its 500th year, the story it tells is not how much care was delivered, but how much healthier the nation became because of it.

¹ Institute of Medicine (US) Committee on Employment-Based Health Benefits. Origins and Evolution of Employment-Based Health Benefits. Washington, DC: National Academies Press, 1993

² Watson, K.B., Wiltz, J.L., Nhim, K., Kaufmann, R.B., Thomas, C.W., Greenlund, K.J. "Trends in Multiple Chronic Conditions Among US Adults, by Life Stage, Behavioral Risk Factor Surveillance System, 2013–2023." Preventing Chronic Disease. 2025;22:E15.

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¹¹ Goode, J.V., et al. "Pharmacy-Based Immunization Delivery: A Comprehensive History and Current Challenges." JACCP: Journal of the American College of Clinical Pharmacy, 2026

¹² Blake, John B. "The Origins of Public Health in the United States." American Journal of Public Health, vol. 38, no. 11, 1948, pp. 1539–1550.

¹³ Diphtheria Treatments and Prevention." National Museum of American History, Smithsonian Institution. https://americanhistory.si.edu/collections/object-groups/antibody-initiative/diphtheria

¹⁴ Centers for Medicare & Medicaid Services. "Rural Health Transformation (RHT) Program: Overview." U.S. Department of Health and Human Services.

¹⁵ Health Resources and Services Administration. "NHSC Timeline." National Health Service Corps. https://nhsc.hrsa.gov/about-us/timeline.

¹⁶Pathman, D.E., et al. "National Health Service Corps Staffing and the Growth of the Local Rural Non-NHSC Primary Care Physician Workforce." Family Medicine. Found that rural counties staffed by NHSC clinicians saw non-NHSC primary care physician growth at more than double the rate of similar counties without NHSC clinicians, 1981–2001.

¹⁷ Wertz, Richard W., and Dorothy C. Wertz. Lying-In: A History of Childbirth in America. Expanded ed. Yale University Press, 1989.

¹⁸ Trilliant Health. "2026 Behavioral Health Report." Trilliant Health, 2026.

¹⁹ Health care's biggest cybersecurity vulnerability is structural." STAT News, April 17, 2026

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²⁴ U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. "National Survey Trends in Telehealth Use in 2021." HHS ASPE, 2021

²⁵ Hoffman, P.J., Slovic, P., & Rorer, L.G. "An Analysis-of-Variance Model for the Assessment of Configural Cue Utilization in Clinical Judgment." Psychological Bulletin, vol. 69, no. 5, 1968, pp. 338–349

²⁶ Blake, John B. "The Origins of Public Health in the United States." American Journal of Public Health, vol. 38, no. 11, 1948, pp. 1539–155

²⁷ "Diphtheria Treatments and Prevention." National Museum of American History, Smithsonian Institution.

²⁸ Wertz, Richard W., and Dorothy C. Wertz. Lying-In: A History of Childbirth in America. Expanded ed. Yale University Press, 1989.

²⁹ "UNMC a Pioneer in Telemedicine." University of Nebraska Medical Center Newsroom, 2015.

³⁰ Hoffman, P.J., Slovic, P., & Rorer, L.G. "An Analysis-of-Variance Model for the Assessment of Configural Cue Utilization in Clinical Judgment." Psychological Bulletin, vol. 69, no. 5, 1968, pp. 338–349.

³¹ Health Resources and Services Administration. "NHSC Timeline." National Health Service Corps.

³² Health Resources and Services Administration. "About the OPTN." U.S. Department of Health and Human Services.

³³ Goode, J.V., et al. "Pharmacy-Based Immunization Delivery: A Comprehensive History and Current Challenges." JACCP: Journal of the American College of Clinical Pharmacy, 2026

³⁴ U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. "National Survey Trends in Telehealth Use in 2021." HHS ASPE, 2021.

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⁴⁰ "Radiology dominates FDA-cleared AI, but reimbursement lags far behind." Radiology Business, December 18, 2025

⁴¹ "Machine Learning-Enabled Medical Devices Authorized by the US Food and Drug Administration in 2024." PMC, 2025.

⁴² U.S. Food and Drug Administration. "Artificial Intelligence in Software as a Medical Device." FDA, updated 2025