Healthcare Analytics for Wisconsin Hospitals and Clinics

Wisconsin operates approximately 130 acute care hospitals across a state where the healthcare landscape is dominated by a recently consolidated giant. Advocate Aurora Health — formed from the merger of Advocate Health Care and Aurora Health Care, and now further merged into Advocate Health — operates 27 Wisconsin hospitals, making it the single largest health system in the state by a wide margin. Marshfield Clinic Health System, with 11 hospitals and a deep roots in rural Wisconsin, represents the most prominent system focused explicitly on the state's agricultural heartland. Froedtert Health's nine Milwaukee-area hospitals anchor Southeast Wisconsin's urban market alongside a partnership with the Medical College of Wisconsin. SSM Health operates facilities in the Madison market, and Aspirus Health serves Northern Wisconsin and Michigan's Upper Peninsula.

Wisconsin BadgerCare Plus covers approximately 900,000 Wisconsinites — primarily children and families up to 100% of the federal poverty level. Wisconsin's decision not to expand Medicaid to 138% FPL has created a coverage gap where roughly 80,000 adults earn too much for BadgerCare Plus (which for adults caps at 100% FPL) but cannot afford marketplace insurance. This gap concentrates in rural communities where agricultural and manufacturing workers often lack employer-sponsored coverage and fall in the eligibility gap. BadgerCare Plus managed care is administered through WPS Health Insurance, Molina Healthcare, and Managed Health Services — each with separate encounter data systems and quality reporting formats that fragment provider analytics. Wisconsin's rural counties, particularly in the North, have seen opioid epidemic impacts compound with dairy farm economic stress, creating behavioral health demand that outstrips available treatment resources.

Wisconsin BadgerCare Plus is administered by the Department of Health Services through managed care organizations that hold risk contracts for most Medicaid-eligible populations. Wisconsin's decision to cover adults only up to 100% FPL rather than the ACA's 138% threshold — while accepting enhanced FMAP for its existing BadgerCare population — creates a unique funding and eligibility structure that differs from expansion and non-expansion states alike. MCOs impose HEDIS quality reporting and encounter data requirements on contracted Wisconsin providers.

Wisconsin providers participate in CMS value-based care programs, and the state's BadgerCare managed care framework includes quality withhold provisions that create financial stakes around HEDIS performance. MIPS reporting applies to Wisconsin physician practices, and Wisconsin's hospital readmission rates — particularly for rural facilities serving populations with limited post-discharge follow-up access — create significant exposure under CMS Hospital Readmissions Reduction Program penalties.