Healthcare Analytics for Iowa Hospitals and Clinics

Iowa operates approximately 120 acute care hospitals — with 90+ of them designated as critical access hospitals, the second-highest count in the United States behind only Texas. UnityPoint Health, headquartered in West Des Moines, operates 32+ hospitals across Iowa, Illinois, and Wisconsin — one of the largest regional health systems in the Midwest. MercyOne, a network of Catholic-affiliated hospitals, operates 38+ hospitals across Iowa's primary markets, including the Des Moines metro and Cedar Rapids. University of Iowa Health Care in Iowa City provides the state's academic medical center and operates as a national reference center for complex cases. Genesis Health System serves the Quad Cities market straddling the Iowa-Illinois border.

Iowa's commercial insurance market is defined by Wellmark Blue Cross Blue Shield, which holds approximately 72% of the commercial insurance market in Iowa — a concentration of payer dominance without parallel in any other US state. This means that Iowa's health systems effectively live or die by their Wellmark contract terms, and Wellmark's data quality expectations, claims submission preferences, and quality metric standards shape every provider analytics workflow in the state. Iowa Medicaid manages approximately 750,000 enrollees through UnitedHealthcare, Amerigroup/Anthem, and Molina Healthcare under managed care contracts that were the subject of significant controversy when the state transitioned from fee-for-service to managed care in 2016 — a transition that generated significant claims backlog, provider payment delays, and enrollment analytics chaos that took years to stabilize. Iowa's aging rural population — the state has among the highest percentages of residents over 65 outside of Florida and Maine — and its agricultural workforce create distinct occupational health and chronic disease burden analytics challenges.

Iowa Medicaid — Iowa Health and Wellness Plan — is administered by the Iowa Department of Health and Human Services through managed care organizations. UnitedHealthcare, Amerigroup/Anthem, and Molina Healthcare hold risk contracts for approximately 750,000 Iowa Medicaid enrollees, including both traditional Medicaid and ACA expansion populations. Iowa MCOs impose HEDIS quality reporting and encounter data submission requirements on contracted providers, with quality withholds tied to performance benchmarks.

Iowa's 90+ critical access hospitals operate under Medicare cost-based reimbursement administered through CMS, with annual cost reports determining payment rates. CAH cost reporting creates a distinct compliance workflow separate from standard prospective payment reporting. MIPS quality reporting applies to Iowa physician practices, and University of Iowa Health Care's academic status creates significant research reporting obligations under CMS and NIH programs. Iowa's agricultural workforce creates specific occupational health reporting requirements for facilities serving farming communities with high rates of occupational injury and chemical exposure.