Quality management program summary | Wellmark
Skip to main content

Wellmark's Quality Story

Quality at Wellmark is a part of everything we do. We continuously work to improve the health of all our members and the communities we serve. Our goal is to make it easier for you to get healthy and stay healthy. Wellmark is committed to quality by working with providers to keep you healthy, creating healthy communities and providing tools, resources and programs to help you manage your health and spending.

Working with providers to keep you healthy

We believe that higher-quality outcomes and sustainable health care costs can be achieved.

Rather than paying your doctor for the number of tests and services you receive — whether they're needed or not — we're shifting the focus to compensating physicians for keeping you healthy and providing effective, efficient care using specific quality measures. This approach aims to transform health care from a system that treats disease to one that prevents disease.

Creating healthy communities

Healthy HometownSM Powered by Wellmark helps Iowa and South Dakota communities make the healthy choice the easy choice by implementing ways to eat well, move more and feel better.

Healthy Hometown has helped over 50 communities in Iowa and South Dakota, impacting more than 800,000 people by identifying and supporting community improvements including community gardens, new bike trails, complete streets, walking school buses, nicotine-free public spaces and healthy food options at restaurants and work. Read about some community successes in Cedar Rapids, Mason City, Sioux City, Fort Pierre, Rapid City, and Sioux Falls.

Giving you tools to manage your health

Members have a number of tools available at their fingertips online. In addition to calling the Customer Service phone number on the back of your ID card for help with your insurance questions, you can also access these other resources.

myWellmark logo

myWellmark® is the secure website that gives you a transparent look into your health care usage. You can check claims details, view health care spending, find an in-network doctor, get clear-cut coverage details and more. Sign up for or log in to myWellmark today.

Find a Provider helps you locate doctors, dentists and facilities in your plan's network. Look for member-generated star ratings and quality scores for local doctors to choose care that's right for you.

BeWell 24/7SM gives you access to real help from real people. With BeWell 24/7, services exclusively for Wellmark members, you have access to health advocacy, nurse support and care navigation. Simply call .

Helping you stay healthy

Wellmark members have access to programs that ensure safe and effective outcomes and provide assistance in navigating complex health conditions.

Pharmacy program focused on safe and effective prescription drug coverage

Wellmark's pharmacy program ensures you have access to safe and effective prescription drugs that support your health conditions. Wellmark's Value-Based Pharmacy Pilot emphasizes the important relationship between you, your pharmacist, and your doctor. The program shifts the pharmacist's focus to you rather than the prescriptions they dispense and helps reduce unnecessary care and costs. Between July 2017 and June 2018, members filling the majority of their prescriptions at a pharmacy participating in the pilot had fewer admissions and emergency room visits compared to members using a non-participating pharmacy.

The opioid addiction epidemic is a leading cause of shortened life expectancy in the United States. Wellmark implemented the Opioid Management Program to help reduce unnecessary opioid prescriptions and ensure smaller quantities of opioids are dispensed for acute pain needs. Early results for 2018 show the total number of opioid prescriptions decreased by 13 percent amounting to a total of 1,400 fewer opioid prescriptions.

Coaching and support for complex health issues

The Advanced Care Management program has nurses available who provide individualized coaching and support to those who have severe or complex health conditions. To understand the role of an Advanced Care nurse, consider these real life examples:

  • An Advanced Care nurse stayed in touch with a 58-year-old member, who was diagnosed with stage four bile-duct cancer. The nurse helped the member by giving tips to ease the side effects from chemotherapy treatment and preparing the member for doctor's appointments, and providing a list of questions to ask about the condition and treatment.
  • An Advanced Care nurse used an interpreter to help a 44-year old, Spanish-speaking member, who was diagnosed with thyroid cancer overcome a language barrier and help the member develop questions for doctor's appointments.

What you tell us matters

We are always evaluating new ways to connect with you. We do this by reviewing the services and programs other Blue Cross Blue Shield Plans and other industry leaders offer their members, but we want to hear from you, too.

Your feedback helps us improve the quality of health care services you receive and your health care outcomes. Should you be selected to participate in one of Wellmark's surveys, we encourage you to share your thoughts. You can also contact Customer Service to share your ideas by calling the number on the back of your ID card.