The study outlines a series of potential changes that are likely to draw fire from the health care industry, as well as advocates who fear the state could be cutting off services to vulnerable populations.

For example, the study said the state could save as much as $270 million if it were to adjust a decades-old system of reimbursing nursing homes for care.

The report also notes the state could save money if it improves health care offerings in rural parts of the state, where recipients may go to hospitals for basic services instead of lower cost clinics and doctor’s offices.

And the report notes that Missouri paid $186 million last year to reimburse care by out-of-state patients.

Under one recommendation, the study says more than 15 percent of hospital costs may be associated with potentially avoidable complications, such as going to the emergency room for an asthma problem or being readmitted to a hospital when a surgical wound gets infected.

“(I)mproving the coordination and quality of care can significantly reduce the volume and costs of” complications, the study notes.