Healthcare Analytics for Alabama Hospitals and Clinics

Alabama operates approximately 105 acute care hospitals across a state with deep structural healthcare challenges. UAB Medicine in Birmingham functions as the academic anchor of the state's healthcare system, a nationally recognized research center and Level I trauma system serving the entire state's most complex cases. Infirmary Health in Mobile operates five hospitals in the Gulf Coast region. Huntsville Hospital Health System anchors North Alabama. Ascension St. Vincent's serves the Birmingham metro alongside UAB, and DCH Health System provides regional care in West Alabama from its Tuscaloosa base. These systems serve populations with obesity rates above 38%, diabetes prevalence among the highest in the nation, and maternal mortality rates that have attracted national attention as a public health crisis.

Alabama Medicaid has not been expanded under the ACA, and Alabama is among a shrinking group of states that has declined expansion since 2010. The result is a coverage gap affecting an estimated 370,000 Alabama adults — primarily working adults who earn too little to afford ACA marketplace plans but too much to qualify for traditional Alabama Medicaid, which has some of the most restrictive eligibility thresholds in the nation. Alabama Medicaid covers children and certain categories of adults through a primarily fee-for-service structure, with managed care limited to certain populations under the Primary Care Case Management (PCCM) model and limited behavioral health managed care through the PASSE (Provider-Led Alabama Shared Savings Entity) model. This means Alabama lacks the robust MCO analytics infrastructure present in expansion states, and providers must manage fee-for-service Medicaid reporting alongside commercial payer requirements without the quality metric alignment that managed care creates.

Alabama Medicaid is administered by the Alabama Medicaid Agency primarily through a fee-for-service model for most populations, with limited managed care through the PASSE model for individuals with complex behavioral health and intellectual disability needs. Alabama's non-expansion status means the state lacks the robust MCO quality reporting infrastructure that has become standard in expansion states — creating a reporting environment where providers must build their own quality analytics rather than relying on MCO-generated data.

Alabama hospitals face significant disproportionate share hospital (DSH) reporting obligations tied to their high uncompensated care volumes. MIPS quality reporting applies to Alabama physician practices, and CMS Hospital Readmissions Reduction Program penalties create significant financial exposure for Alabama facilities given the state's elevated rates of chronic disease readmissions. UAB Medicine's academic status creates additional research reporting requirements under CMS and NIH funding structures.