Healthcare Analytics for Texas Hospitals and Clinics

Texas operates 650+ acute care hospitals across a state larger than France, serving a population with the highest uninsured rate in the United States. Because Texas has not adopted Medicaid expansion under the ACA, more than 4.8 million Texans lack coverage — generating more than $2.1 billion annually in uncompensated care costs that hospital systems must absorb or shift onto insured patients. HCA Healthcare, the largest private employer in the state, operates dozens of facilities and faces the same uncompensated care analytics burden as non-profit systems like Baylor Scott & White (the largest non-profit health system in Texas), Memorial Hermann, Texas Health Resources, and UT Southwestern Medical Center.

Texas Medicaid operates under the STAR (managed care for children and pregnant women) and STAR+PLUS (managed care for adults with disabilities and chronic conditions) programs, administered through MCOs including Molina Healthcare, UnitedHealthcare, and Centene's Superior Health Plan. These programs require detailed encounter data and quality metric reporting that demands dedicated analytics capacity. Meanwhile, rural Texas has seen 30+ hospital closures since 2010 — the most of any state — leaving communities in West Texas, the Panhandle, and South Texas without access to inpatient care. Analytics teams at surviving rural facilities must model financial sustainability continuously to avoid being the next closure.

Texas Medicaid, administered by the Texas Health and Human Services Commission (HHSC), operates almost entirely through managed care. STAR covers low-income children and pregnant women; STAR+PLUS covers adults with physical disabilities and complex conditions; STAR Kids serves children with disabilities. Each program operates through MCO contracts with Molina, UnitedHealthcare, Centene (Superior Health Plan), and others who impose their own encounter data and quality reporting standards on contracted hospitals and physician groups.

Texas providers also navigate the Delivery System Reform Incentive Payment (DSRIP) Waiver — Texas's 1115 waiver program — which requires regional healthcare partnerships to demonstrate transformation milestones tied to quality and utilization data. CMS readmission penalties, MIPS quality reporting for physician practices, and HHSC's Medicaid Managed Care quality reporting requirements create a multi-layered compliance environment that demands integrated analytics to manage efficiently.