Healthcare Analytics for Missouri Hospitals and Clinics

Missouri operates approximately 115 acute care hospitals across a state geographically and economically divided between two major metro systems and a vast rural interior. BJC HealthCare — affiliated with Washington University School of Medicine in St. Louis — operates 14 hospitals across the greater St. Louis region and is among the most prominent academic medical systems in the Midwest. Mercy Health spans St. Louis, Springfield, and three additional states with more than 40 hospitals. SSM Health operates 24 hospitals primarily in the St. Louis and Kansas City markets. On the Missouri side of Kansas City, Saint Luke's Health System provides the primary independent system alternative. CoxHealth anchors Southwest Missouri from its Springfield base.

Missouri MO HealthNet — the state's Medicaid program — expanded in October 2021 following a contentious ballot initiative and subsequent legal challenges that delayed implementation. The expansion added 275,000+ adults who had previously been uninsured, but the administrative complexity of rapidly onboarding a large new population created enrollment verification, eligibility determination, and managed care attribution challenges that are still rippling through provider revenue cycles. The MCOs managing MO HealthNet expansion — Centene, UnitedHealthcare, and Anthem — each implement the coverage differently, requiring providers to maintain parallel analytics workflows. Rural Missouri counties, particularly in the Ozarks and the Bootheel, have infant mortality rates roughly double those of Kansas City and St. Louis, reflecting a concentration of poverty, limited prenatal access, and inadequate behavioral health resources.

Missouri MO HealthNet is administered by the Department of Social Services through managed care organizations for most beneficiary populations. The 2021 Medicaid expansion under Amendment 2 required rapid implementation under CMS oversight, and MCOs — Centene, UnitedHealthcare Community Plan, and Anthem — hold risk contracts that impose HEDIS quality reporting and encounter data submission requirements on contracted providers. Missouri's traditional Medicaid predating expansion serves children, families, and individuals with disabilities through the same MCO framework.

Missouri providers participate in CMS value-based care programs, and the state's academic medical centers carry significant research reporting obligations. The BJC/Washington University affiliation creates particularly complex IRB and CMS reporting intersections. MIPS quality reporting applies to Missouri physician practices, and Missouri's high rural burden of chronic disease creates significant readmission penalty exposure for rural facilities managing patients with limited access to post-discharge follow-up care.