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).
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).