Priority Health

Priority Health hmo: see schedule opriority Health hmopriority Health is an integral part of corewell Health, an integrated not-for-profit Health system serving communities throughout Michigan. Priority Health's mission, led by its community board, strives to return value to the communities served beyond the provision of Health care to its members. Priority Health has built a long history of offering Michigan employers and individuals progressive products and innovative programs intended to keep costs down and members healthy. Its broad portfolio of products and services includes traditional medical plans as well as hsa's, hra's and other consumer-driven products. Priority Health has consistently maintained accredited status with a 4.5 out of 5 star rating for its hmo products from the national committee for quality assurance (ncqa), an independent managed care accrediting body. Priority Health has also maintained an "a" (excellent) financial strength rating for seven consecutive years from a.m. best, a Health insurance ratings agency, recognizing the financial strength of the organization and focus on managing the cost of Health care for its community.in early 2020, Priority Health became the sole member of total Health care, inc., a Health plan based in southwest Michigan. The medicaid business was integrated into Priority Health choice, inc. While the commercial business was integrated into Priority Health in 2022. As part of this transaction, a foundation was established to which Priority Health committed $25 million to focus on improving Health in detroit area communities. The foundation will support and invest in Health care initiatives that increase access, improve outcomes, and having a meaningful impact on the lives of the people in and around the city of detroit. To date, the Priority Health total Health foundation has given more than $14 million to more than 90 organizations serving the detroit and southeast Michigan areas.priority Health's majority shareholder, corewell Health is a not-for-profit Health system that provides care and coverage with an exceptional team of 65,000+ dedicated people-including more than 12,000 physicians and advanced practice providers in 21 hospitals, 300+ outpatient locations and several post-acute facilities. Corewell Health provided over $1 billion in community benefit during calendar year 2023.the affordable care act (aca) added new requirements that hospital organizations must satisfy in order to maintain tax exempt status under irc section 501(c)(3). One of the requirements under this act is to conduct a community Health needs assessment (chna) and adopt an implementation strategy at least once every three years. Corewell Health completed several implementation plans identifying the community Health needs and implementation plan goals for each corewell Health hospital. One need identified in the chna's is access to Health care, which includes improving access to affordable Health care for all community members. In addition, all community members should have access to preventive care and medical home care, including the uninsured and low-income working individuals. Corewell Health works closely with Priority Health to achieve the identified needs and goals.priority Health pursues initiatives that support the triple aim of enhancing the quality and experience of care for the patient, improving the Health of populations, and reducing the costs of healthcare. In the tax year, Priority Health lowered Health costs across all lines of business by over $20 million in incremental savings through new or expanded managed care initiatives and chronic disease management programs. These programs influence physician practices, promote appropriate Health care utilization and increase quality, which extends beyond Priority Health's members. In addition to the managed care savings above, Priority Health pursues initiatives to prevent individuals from developing chronic diseases, as well as initiatives to better manage individuals who already have chronic diseases.priority Health has been a leader in patient-centered care and has a proven record of working with physicians to improve Health outcomes. Through its partners in performance program, Priority Health encourages and rewards the quality care provided by primary care physicians. The physicians and practices selected for the Priority Health quality awards have achieved the highest overall scores for ensuring patients receive preventive care, control chronic disease and have a good experience. Each award recipient is selected by analyzing the results of the Priority Health primary care provider incentive program, a program that tracks clinical quality measures against national standards and evidence-based medicine.priority Health paid primary care providers more than $52 million in 2024 based on their performance in 2023 (lines of business). The program's success is clearly demonstrated by the number of Priority Health medicare members who receive preventive screenings. In 2023, more than 81% of Priority Health medicare members received routine colorectal cancer screening exams compared to a national average of 69%. 83% of medicare members received recommended breast cancer screening compared to the national average of 71%. Priority Health shares risk with providers and employers by offering these incentives and other risk sharing arrangements. This promotes lower overall Health care costs and improved quality to the community.in 2015, Priority Health launched a cost estimator tool to help members calculate their out-of-pocket costs to find the most affordable services. The online cost estimator tool displays Priority Health specific fees for 300 common Health care procedures. The cost estimator recommends lower-cost doctor/facility options to help ensure members get the highest-quality care at the best price. This innovative tool supports Priority Health's continued market leadership in transparency and lowers the cost of care to the community. Since launching in 2015, the cost estimator has resulted in cumulative shared savings of more than $17 million.the Priority Health third party liability (tpl) team has consistently improved outcomes by increasing savings through audit, analysis, and thorough account evaluation. With emphasis on improving both member and provider satisfaction, program improvements were made at the end of 2019 to expedite liability determinations by focusing on cost containment efforts and driving continuous improvement in all areas of the department, the tpl team has been able to create efficiencies while realizing program savings of over $29 million.the Michigan department of insurance and financial services (difs) adopted the obama administration's extension of the transitional "as is" policy. This decision allows insurers to decide whether they would continue offering policies that are not compliant with the aca, which became permissible when the federal government delayed the required shift to aca-approved insurance coverage. While major competitors have shut down plans, Priority Health continues to offer an extension of its pre-aca individual and Health plans to subscribers as long as permitted by regulatory guidance. The decision to extend plans is consistent with Priority Health's commitment to provide individuals with flexibility and choice.

Priority Health wellness: see schedule oprevention and wellness have been the foundation of Priority Health's approach to Health care. Priority Health provides wellness tools and resources via an online wellbeing platform within its commercial standard Health plans. It also offers a standardized, best-in-class wellbeing engagement program named prioritywell to empower their employees to pursue healthier lifestyles. In addition to the Health plan offerings, Priority Health participates in, and sponsors, wellness programs for the community at large to improve the Health of all people, not just members. Priority Health's wellness programs addresses the overall wellbeing of its members. Employers are able to support the overall wellbeing of their employees and improve engagement, satisfaction and productivity, ultimately resulting in improved talent retention and a healthier workforce. Priority Health partners with employers to help them deliver targeted, smart programs that effectively improve employee physical and emotional Health while also improving workplace morale and reducing overall Health costs with a personalized wellbeing approach. Additionally, disease prevention and intervention programs are available to members through a digital engagement environment.priority Health offers a wellbeing hub, which offers a personalized online wellness experience tailored to each employee's individual needs. The wellbeing hub, available to all Priority Health members, offers members access to content and tools centered on supporting stress management, nutrition, weight loss, quitting tobacco, chronic condition management, financial support, sleep Health and more. Priority Health sponsors many community education programs, Health fairs, walks/runs/triathlons and newsletters.priority Health has developed an innovative digital member outreach program that relies on thousands of datasets and predictive analytics to help educate and inform our members. Using this data-driven approach, Priority Health is able to gain insights into challenges our members may face and identify actions they can take to improve or protect their Health. Based on this information, Priority Health delivers personalized messaging on a variety of platforms to help members get the most from their plan. As an example, during the covid-19 pandemic, Priority Health targeted unvaccinated members to encourage them to get the vaccine, resulting in a significant increase in vaccinations for those who received the message. Additionally, the Health plan delivered educational news through printed pieces to medicare members, the medicare quick start guide and the Health journal.

Priority Health senior markets (medicare advantage and medicare supplement): see schedule opriority Health began offering medicare advantage plans in july 2005 and medicare advantage plans with prescription drug coverage in january 2006. Its medicare advantage plans vary in price based on where members live and what benefits they need. More than 246,000 michiganders have a Priority Health medicare advantage plan, and nearly 17,500 chose a Priority Health medicare supplement plan, also known as medigap.as a result of Priority Health's work with the community and dedication to delivering high quality coverage, its medicare advantage hmo-pos and ppo plans were accredited with the national center for quality assurance (ncqa), with our hmo-pos plans earning a 4.5 rating out of 5. Priority Health's medicare advantage plans with prescription drug coverage were also awarded 5 out of 5 stars by the centers for medicare and medicaid services (cms). The medicare star ratings indicate how well a Health plan performs overall; the better the star rating, the higher quality care and experience is delivered. Of the 42 quality and improvements metrics used to determine our overall quality rating of 4.0, approximately 75% of the metrics were either 4 or 5 stars. Priority Health is able to provide its members high quality medicare advantage plans while remaining among the lowest cost plans in the country.medicare advantage members can enroll either individually, or through an employer group. During the 2023 medicare annual enrollment period (aep). Priority Health's medicare advantage enrollment includes about 246,000 individual advantage members of the total individual medicare advantage market, making Priority Health the leader in Michigan. Priority Health individual medicare advantage plans are offered in all 68 counties in Michigan's lower peninsula, with 9 out of 10 primary care providers and all major hosptial systems in our network in the lower peninsula. With 98% of providers, including all major hospital systems, in our network. Priority Health's network has nearly 45,000 providers.in 2012, Priority Health launched home based primary care (hbpc) as a pilot with our affiliate, corewell Health medical group (chmg). Hbpc brings the care team into the home of patients that are at the far end of the population Health continuum, the advanced chronically ill, whose multiple medical conditions are complicated by functional and/or cognitive limitations that make it difficult for them to adequately access the traditional ambulatory physician office. In addition to Priority Health changing how the patient accesses their care, there is now a team based model of care to meet all the needs of the patient. Priority Health continued its engagement with patients having advanced illness in partnership with corewell Health medical group and two other contracted providers which resulted in over $22.3 million in savings by reaching members enrolled in hbpc programs.chronic conditions are leading contributors to rising Health care costs nationwide. To address this, Priority Health launched the medication therapy management (mtm) pilot program with its medicare members. The mtm pilot program offered Priority Health medicare members the opportunity to meet one-on-one with pharmacists to review all of their medications including prescriptions, over-the-counter drugs, and herbal and vitamin supplements. Complex medication regimens create significant challenges for patients living with chronic illness, their caregivers, Health care providers and the Health care system as a whole. The impact of medication-related problems can be minimized through a structured mtm program that uses pharmacists collaborating with the patient and the patient's Health care providers. Retail and office-based pharmacists will collaborate with patients and providers to address drug-related problems and complete comprehensive medication reviews.in 2015, Priority Health expanded its mtm program to commercial and medicaid members. With this move, Priority Health became the first Health plan in the state to expand the program to both its medicare and employer-sponsored Health plans.in 2017, Priority Health received a pinnacle award for its medicare care management hybrid program. The care management team understands and acknowledges that social determinants of Health impact disease management. While data science continues to evolve and improve in its ability to identify these non-claims driven indicators of risk, it is difficult for the usual methods of care management to identify and address them.priority Health launched its hybrid program as an at-home care management program to address the full burden of illness and socio-demographic risk factors for medicare members. As a result, Priority Health has observed lower admission rates than state and national averages thanks in part to interdisciplinary teams that provide a quick response to condition destabilization.in 2018, Priority Health added additional functionality to its cost estimator tool enabling medicare advantage members to access real-time cost information on prescription drugs, helping members pay less by switching to a lower priced alternative, using a preferred pharmacy, or opting for mail order. More than 6,000 prescriptions are available via the cost estimator tool including pills, chewables, and capsule drugs. When a medication is priced through the tool, members have the option to view more affordable alternatives and see exact costs at their preferred pharmacies, which could provide significant savings to those members who require some of the most expensive drugs in the market.