Abstract: Improving the quality, affordability and accessibility of breast care in the USA remains a high priority among health care leadership, the lay public, and those in elected office. The formulation of public policy in the USA, including federal and state legislation, is informed by a wide variety of public and private advisory and advocacy interests. Private-sector advocacy groups positively influence access, public awareness, and research prioritization. Evolving breast-specific clinical and administrative leadership models have facilitated an emerging management focus on quantifiable attributes of service, professional performance, clinical outcomes, and value. The diversity of breast care delivery environments in the USA adds considerable complexity to the task of improving value and access to care. With robust merger and affiliation activity among hospitals and clinics, health systems and alliances are evolving regionally and nationally to provide performance-based breast-centric management models across diverse populations and geographies.