Wellmark ACO: Wellmark® Blue Cross® and Blue Shield® of Iowa

AI and Data, Case Study

October 25, 2017

Wellmark Blue Cross and Blue Shield is a mutual healthcare insurer providing health coverage to more than two million people across Iowa and South Dakota, it is part of the Blue Cross Blue Shield Association, a trusted national network that covers more than 100 million US lives.

Recognising that everyone deserves affordable and sustainable health insurance options Wellmark’s focus is to reduce the rate of health care cost increases to equal the rate of inflation. After 18 months of development, Wellmark Blue Cross and Blue Shield of Iowa launched a ground-breaking Accountable Care Organisation (ACO) shared savings payment model in early 2012—one of the first commercial ACOs in the Midwest.

The goals of Wellmark’s ACO strategy:

Quality outcomes. Keeping healthy people well and improving the outcomes for Wellmark members when they need care.
Better experience/more informed members. Ensuring that all appropriate care is received in a timely manner, that members are actively engaged in the care they receive and that they understand the costs.
Reducing the rate of increase. Supporting participating providers’ efforts in lowering costs.