Evaluation of Provider Adequacy in the Iowa Health and Wellness Plan During the First Year

McKernan, S.C.; Pooley, M.J.; Ingleshwar, A.; Damiano, P.C.; Momany, E.T.
07/2015

Abstract

The Iowa Health and Wellness Plan (IHAWP) is an expansion of health care, allowed as part of the Affordable Care Act (ACA), primarily to single adults ages 19-64 with incomes below 133% of the Federal Poverty Level (FPL) not otherwise eligible for Medicaid. The program is divided into two components: 1) the Wellness Plan, providing health care coverage to Iowans with incomes at or below 100% FPL through the Medicaid program (public option) and 2) the Marketplace Choice Plan, providing care for Iowans with incomes from 101-133% FPL through the health insurance marketplace (private option). Wellness Plan (WP) members have access to a network of providers enrolled specifically for this plan, but are also able to access a majority of Medicaid-enrolled providers. Marketplace Choice (MPC) members are able to access providers through a select group of insurers.

This report, part of an evaluation of the IHAWP program being conducted by the University of Iowa Public Policy Center (UI PPC), presents information about the initial provider network available to IHAWP members, with a comparison made to the network of providers available to adults in the Medicaid State Plan, administered by the Iowa Department of Human Services. Within MPC two

private insurers were available during 2014: Coventry Care of Iowa (Coventry) and CoOportunity Health. Because CoOportunity Health only operated from January 1, 2014-November 31, 2014, ceasing to accept new MPC members after October 31, 2014, information about their network is not included in this report. Thus this report only compares the provider networks for Coventry, Wellness Plan and the Medicaid State Plan.

Wellness Plan members have access to medical services, including hospital and mental health services, through the Medicaid provider network. Members of Coventry receive services through the plan’s provider network. As of December 2014, all new Marketplace Choice members were assigned to Coventry, with the option to switch to Wellness Plan. Previous members of CoOportunity Health were auto-enrolled into Wellness Plan on December 1, 2014.

Within this report, we evaluate the networks for primary care, specialty care, hospitals, and mental health services, including safety net providers. Provider networks were identified for these analyses in two ways: 1) the list of providers with whom there was a signed contract to provide care, and 2) contracted providers who had submitted at least one claim (an indication of activity for primary care providers ONLY).

This baseline assessment of the IHAWP provider network is one component of the UI PPC’s evaluation of the IHAWP program. Additional reports about the IHAWP program will present or have presented findings from surveys of members and providers, outcomes analyses, and cost analyses.