Study Evaluates Iowa Health & Wellness Plan in First Year


A recent study by the Public Policy Center evaluated provider adequacy during the first year of the Iowa Health and Wellness Plan.  


3,057 primary care providers (PCPs) – including family and general practitioners, internists, and OB/GYNs – were contracted with the Iowa Medicaid Enterprise (IME) to provide services to members of both Medicaid State Plan (MSP) and Wellness Plan (WP) during 2014. Among these contracted providers, 8% submitted claims for care provided to MSP members and 9% submitted claims for care provided to WP members during 2014. 48% of these were also contracted with Coventry

2,710 PCPs were contracted with Coventry during 2014. Among these contracted providers, 33% submitted claims for care provided to Marketplace Choice members during 2014.

1,765 licensed mental health providers were contracted with IME (MSP and WP) during 2014. There were no licensed mental health providers contracted with IME in four counties: Lyon, Worth, Mitchell, and Taylor. For this report, PCPs were not evaluated as a source of mental health services. Data about Coventry mental health providers were not available at
the time of this evaluation.

MSP and WP members have access to 159 hospitals in Iowa compared to 116 hospitals in the Coventry network.

58 Federally Qualified Health Centers and 308 Rural Health Clinics provide medical services in Iowa.

On average, MSP members lived 2.2 miles (3.8 minutes) from the nearest PCP. By comparison, WP members lived 2.4 miles (4.1 minutes) from the nearest PCP, while Coventry members lived 4.2 miles (6.7 minutes) from the nearest PCP.

The Health Resources and Services Administration guidelines for access to primary medical care consider travel time >30 minutes to be “excessively distant”. Approximately 2% of MSP and WP members and 5% of Coventry members lived >30 minutes from the nearest PCP.

Among members with a qualifying ambulatory or preventive visit to a PCP during 2014, 14% of MSP members, 16% of WP members, and 13% of Coventry members travelled >30 minutes.

To read the full report, click here.