Ensuring you have
access to care
At Wellmark Health Plan of Iowa, we understand how important it is that you have access to appropriate types of health care providers within a reasonable distance of your home. We set goals and standards to ensure the availability of primary care providers (PCPs), OB/GYNs, high-volume specialties, and hospitals are available to you. In 2011, Wellmark Health Plan of Iowa met all of its availability standards.
Setting the bar high and reaching goals
Primary Care Provider (PCP) and hospital standards |
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Health care providers eligible for PCP status are: general practice, family practice, internal medicine and pediatrics. In some areas, physician assistants (PAs), and advanced registered nurse practitioners (ARNPs) may be available for selection as a PCP. |
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| Category | Standard | Goal |
| Distance to PCP | 1 PCP every 20 miles* |
100% |
Number of PCPs per member |
1 PCP per 500 members* | 100% |
| Hospital Services | 1 hospital every 45 miles | 100% |
| OB/GYN Provider | ||
| Providers eligible for this status include: obstetricians, gynecologists, ARNPs, certified nurse midwives, and certified PAs. | ||
| Category | Standard |
Goal |
Distance to OB/GYN provider |
1 OB/GYN provider every 45 miles* |
100% |
Number of OB/GYN providers per member |
1 OB/GYN provider per 2,000 members* |
100% |
| Specialty Services | ||
| On an annual basis, we review data to determine high-volume specialties. High-volume specialties for 2011 were orthopedic surgery, dermatology, otolaryngology, ophthalmology, psychiatry, psychology, and social work. | ||
| Category | Standard |
Goal |
Distance to high-volume specialty and behavioral health services providers |
1 practitioner in each identified specialty every 45 miles* |
100% |
Number of high-volume specialists and behavioral health providers per member |
1 practitioner in each identified specialty per 3000 members* |
100% |
*Practitioners must accept new patients/members to be counted within the compliance ratio.
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