Iowa Wellness Plan

Program Location: 
Des Moines, IA
Payer Type: 

On May 23, 2013, the Iowa Legislature enacted the “Iowa Health and Wellness Plan”. This plan is a compromise between the Governor’s Healthy Iowa Plan and Medicaid Expansion. Beginning January 1, 2014, the Iowa Health and Wellness Plan covers all Iowans age 19-64 with income up to and including 133 percent of the Federal Poverty Level. The Plan provides a comprehensive benefit package and provider network, along with important program innovations that will improve health outcomes and lower costs. According to a 2015 Leavitt Partners report, "Regionally defined ACOs are responsible for coordinating beneficiaries’ care through PCP-led medical homes. ACOs and PCPs are eligible for three bonuses: meeting performance metrics, patients who receive physical exams, and outreach programs."

The program includes care coordination and management by Accountable Care Organizations (ACOs). 

  • ACO’s are accountable under a contract for a set of quality and cost outcomes for the population attributed to them. 
  • ACOs assist members by coordinating care through medical homes, engaging in proactive health care, preventive services, and member outreach. This will in turn increase quality outcomes and lower costs. 
  • If the ACO is successful in meeting the quality and cost measures, they can receive a share of the savings that was achieved. 
  • The program also provides incentives for members to engage in health and wellness activities through being able to have their monthly premiums waived. 

Related News & Resources

Payment Model: 

The State has aligned the financial incentives for providers with those for enrollees – for example, enrollees get rewarded for receiving a health assessment and providers can receive financial bonuses if a pre-determined percentage of their attributed patients receive a health assessment.

Providers in the Iowa Health and Wellness Plan will be reimbursed FFS for the services provided. Primary care providers will also be paid a PMPM rate (currently anticipated to be $4.00) for each Iowa Health and Wellness Plan member assigned to them. Primary care providers will have an opportunity to earn additional incentive payments, including a $10.00 per member per year (PMPY) Wellness Exam Incentive and up to a $4.00 PMPM Performance Bonus for performance on VIS measure (the system Wellmark uses). 

Last updated April 2019
Go to top