Healthcare Analytics for Oklahoma Hospitals and Clinics

Oklahoma operates approximately 110 acute care hospitals across a state that has seen 22 rural hospital closures since 2010 — leaving agricultural communities in western and central Oklahoma without local inpatient care access. INTEGRIS Health, headquartered in Oklahoma City with 15 hospitals, is the state's largest system. OU Health, the academic medical center system of the University of Oklahoma, anchors the Oklahoma City health corridor alongside INTEGRIS. In Tulsa, Saint Francis Health System and Ascension St. John provide the primary hospital competition, with Mercy Health Oklahoma serving Tulsa and surrounding communities. These systems serve a population with among the highest rates of opioid dependency in the South-Central US and a Native American population whose health outcomes have been documented as significantly worse than the state average.

Oklahoma SoonerCare — the state's Medicaid program — expanded via State Question 802 in 2021, adding coverage for adults up to 138% FPL. Oklahoma's managed care transition launched in 2023 under the SoonerSelect brand, with Aetna Better Health, Humana Healthy Horizons, and UnitedHealthcare Community Plan holding risk contracts for approximately 800,000 enrollees. This transition from a predominantly fee-for-service Medicaid to a full managed care model in 2023 created an enrollment analytics challenge of the highest complexity — providers accustomed to fee-for-service billing suddenly needed to navigate MCO credentialing, MCO-specific prior authorization, and MCO encounter data submission simultaneously. Oklahoma's 39 federally recognized tribes add a layer of sovereign health system complexity: Cherokee, Chickasaw, Choctaw, Creek (Muscogee), and Osage Nation health systems, among others, provide care to tribal members and may coordinate benefits with SoonerCare — creating coordination of benefits analytics that require specific tribal enrollment data linkages.

Oklahoma SoonerCare is administered by the Oklahoma Health Care Authority (OHCA) through the SoonerSelect managed care program launched in 2023. Aetna Better Health of Oklahoma, Humana Healthy Horizons Oklahoma, and UnitedHealthcare Community Plan hold risk contracts for approximately 800,000 enrollees and impose HEDIS quality reporting and encounter data submission requirements on contracted providers. Oklahoma's tribal health systems operate under separate federal IHS and tribal 638 contract frameworks that intersect with SoonerCare through complex coordination of benefits and eligibility determination processes.

Oklahoma providers participate in CMS value-based care programs, and OU Health's academic status creates significant research reporting obligations. The state's high opioid burden has generated specific 1115 waiver reporting requirements tied to substance use disorder treatment capacity. MIPS quality reporting applies to Oklahoma physician practices, and rural Oklahoma hospital cost reporting under the Medicare critical access program creates additional federal compliance obligations for facilities operating as the sole community providers in their areas.