PRIORITY HEALTH CHOICE INC

PRIORITY HEALTH OFFERS MEDICAID, INCLUDING MICHILD, HEALTHY MICHIGAN PLAN AND CHILDREN'S SPECIAL HEALTH CARE SERVICES (CSHCS) PLANS FOR INDIVIDUALS AND THEIR FAMILIES IN MICHIGAN. PRIORITY HEALTH CHOICE, INC. PROVIDES MORE THAN 211,000 LOWER INCOME AND/OR DISABLED RESIDENTS IN 37 MICHIGAN COUNTIES WITH ACCESS TO QUALITY AND AFFORDABLE HEALTH CARE SERVICES. IT PROMOTES AND INCENTIVIZES OPEN ACCESS TO PROVIDERS.OUR MEDICAID PLANS OFFER EXCELLENT HEALTH COVERAGE AND ARE RATED AS TOP-QUALITY PLANS BY THE MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES. OUR SERVICE AREA INCLUDES WEST MICHIGAN, NORTHERN MICHIGAN AND THE METRO DETROIT AREA.PRIORITY HEALTH CHOICE, INC. RECEIVED A RATING OF 3.0 OUT OF 5 FROM THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA). THE RATING WAS BASED ON CLINICAL QUALITY, MEMBER SATISFACTION AND NCQA ACCREDITATION SURVEY RESULTS WHICH WERE CONDUCTED ON MORE THAN 1,000 HEALTH INSURANCE PLANS. IN ADDITION TO THIS RECOGNITION FROM NCQA, THE 2024 MEDICAID HEALTH PLAN CONSUMER GUIDE FROM THE MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES HAS AWARDED PRIORITY HEALTH CHOICE, INC. WITH THE HIGHEST OVERALL RATING. THE OVERALL RATING INCLUDES ALL 5 CATEGORIES IN ADDITION TO HOW THE MEMBERS FEEL ABOUT THEIR PLAN AND THE HELP THE MEMBERS RECEIVE FROM THEIR PLAN.AS A RESULT OF THE RECENT MEDICAID REBID, PRIORITY HEALTH CHOICE, INC. HAS UNDERGONE SIGNIFICANT CHANGES THAT WILL IMPACT PROVIDERS IN NORTHERN AND SOUTHWEST MICHIGAN. EFFECTIVE OCTOBER 1, 2024, PRIORITY HEALTH CHOICE, INC. WILL MAINTAIN ACCESS TO REGIONS 4 (WEST MICHIGAN) AND 10 (DETROIT METRO), GAIN ACCESS TO REGIONS 2 AND 3 (NORTHERN MICHIGAN), AND LOSE ACCESS TO REGION 8 (SOUTHWEST MICHIGAN). THIS REBID, CONDUCTED BY THE MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES (MDHHS), DETERMINES WHERE HEALTH PLANS CAN OFFER THEIR MEDICAID PRODUCTS ACROSS MICHIGAN'S 10 PROSPERITY REGIONS. PROVIDERS IN THE NEWLY ACQUIRED REGIONS ARE ENCOURAGED TO JOIN PRIORITY HEALTH'S NETWORK AND ASSIST MEDICAID MEMBERS DURING THIS TRANSITION. MEMBERS WILL RECEIVE LETTERS FROM MDHHS WITH INSTRUCTIONS ON SELECTING NEW PLANS IF THEIR CURRENT PLAN EXITS THEIR REGION. PROVIDERS WILL GUIDE THEIR PATIENTS THROUGH THIS PROCESS AND UTILIZE AVAILABLE RESOURCES TO ENSURE A SMOOTH TRANSITION.CHILDREN'S SPECIAL HEALTH CARE SERVICES (CSHCS) IS A SPECIALTY PROGRAM OFFERED BY THE STATE OF MICHIGAN TO PROVIDE CARE FOR CHILDREN AND SOME ADULTS WITH CHRONIC HEALTH CONDITIONS. IN ADDITION, THE CSHCS PROGRAM OFFERS SUPPORT TO THE FAMILIES AND CAREGIVERS OF THE MEMBER. CSHCS PROGRAM ELIGIBILITY IS BASED ON MORE THAN 2,700 MEDICAL DIAGNOSES. THE MAJORITY OF THE CSHCS POPULATION IS ENROLLED IN A MEDICAID HEALTH PLAN. PRIORITY HEALTH CHOICE, INC. HAS A SPECIALTY CARE MANAGEMENT PROGRAM FOR THIS UNIQUE POPULATION. A DEDICATED CARE MANAGEMENT TEAM ENSURES CSHCS MEMBERS ARE ESTABLISHED WITH A PRIMARY CARE MEDICAL HOME WHILE ALSO PROVIDING CARE COORDINATION BETWEEN THEIR PRIMARY CARE / SPECIALTY CARE PROVIDERS AND ANY ANCILLARY PROVIDERS. THIS TEAM INCLUDES CARE MANAGERS, COMMUNITY HEALTH WORKERS, FIELD SERVICE REPRESENTATIVES, AND OTHER KEY PARTNERS, INCLUDING COUNTY HEALTH DEPARTMENTS, EARLY ON, EARLY HEAD START, THE INTERMEDIATE SCHOOL DISTRICTS, SPECIALTY PROVIDERS, AND MEDICAL SUPPLIERS. THE CARE MANAGEMENT TEAM ALSO FACILITATES ACCESS FOR FAMILIES TO THE FAMILY CENTER FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS, AND THE CHILDREN'S SPECIAL NEEDS FUNDS IN LANSING. AS OF DECEMBER 31, 2024, PRIORITY HEALTH CHOICE, INC. HAD 5,443 MEMBERS ENROLLED IN THE CSHCS PROGRAM AN INCREASE OF 9% FROM THE PRIOR YEAR.THE HEALTHY MICHIGAN PLAN ENCOURAGES HEALTHY BEHAVIORS AND PERSONAL RESPONSIBILITY, HELPS LOW-INCOME MICHIGAN RESIDENTS ACCESS AFFORDABLE HEALTH COVERAGE, AND REDUCES UNCOMPENSATED CARE THAT SHIFTS COSTS ONTO BUSINESSES AND TAXPAYERS. AS OF DECEMBER 31, 2024, PRIORITY HEALTH CHOICE, INC. HAD 61,051 MEMBERS ENROLLED IN THE HEALTHY MICHIGAN PLAN.PRIORITY HEALTH CHOICE, INC. MAKES OUTREACH CALLS TO EACH HEALTHY MICHIGAN MEMBER. DURING THE CALL, MEMBERS ARE PROVIDED WITH BENEFIT EDUCATION AS WELL AS ASSISTANCE IN MAKING THEIR INITIAL PRIMARY CARE PROVIDER ("PCP") APPOINTMENT. DURING THAT INITIAL PCP APPOINTMENT, THE MEMBER COMPLETES A HEALTH RISK ASSESSMENT, WHICH IDENTIFIES CURRENT BEHAVIORS, A MEMBER'S READINESS TO CHANGE, KEY HEALTH METRICS, AND THE PCP ATTESTATION.THE COMMUNITY HEALTH CARE ACCESS PROGRAM (CHAP), IS A COMMUNITY COLLABORATIVE. THE PRIMARY GOAL OF THE CHAP PROGRAM IS TO IMPROVE HEALTH OUTCOMES AMONG CHILDREN ON MEDICAID WHILE BETTER UTILIZING EXISTING RESOURCES AND DECREASING COSTS. THIS PARTNERSHIP BETWEEN PRIORITY HEALTH CHOICE, INC., HELEN DEVOS CHILDREN'S HOSPITAL, CHERRY STREET HEALTH SERVICES, PRIVATE PEDIATRIC PRACTICES, NUMEROUS HUMAN SERVICE AGENCIES, AND PRIVATE FOUNDATIONS COVERS MORE THAN 12,500 CHILDREN IN KENT COUNTY. CHAP CONTRACTED WITH PCP'S, PROVIDING CARE COORDINATION AND ASSISTANCE WITH KEY HEDIS METRICS. PCP'S WERE REIMBURSED AT A HIGHER RATE IN EXCHANGE FOR THEIR WILLINGNESS TO OPEN UP ACCESS, ESPECIALLY SAME DAY ACCESS TO MEMBERS. CHAP PROVIDED SAME DAY TRANSPORTATION TO URGENT PCP APPOINTMENTS AS NEEDED. IN ADDITION, CHAP PROVIDED MEMBER/FAMILY EDUCATION REGARDING APPROPRIATE EMERGENCY ROOM AND URGENT CARE UTILIZATION. IN 2014, CHAP DEVELOPED ITS OWN IDENTITY AS HEALTH NET OF WEST MICHIGAN. AT THE SAME TIME, THE FOCUS OF INTERVENTION EXPANDED TO ADULTS AS WELL AS CHILDREN. HEALTH NET PARTNERED WITH ADULT PRIMARY CARE PRACTICES TO WORK WITH ADULT MEMBERS REGARDING EMERGENCY ROOM AND URGENT CARE USE, WHILE ALSO PROVIDING EDUCATION REGARDING SPECIFIC MEMBER INPATIENT UTILIZATION. IN ADDITION, HEALTH NET HAS PARTNERED WITH OB-GYN RESIDENCY CLINICS TO FACILITATE THE MATERNAL INFANT HEALTH PROGRAM (MIHP) ENROLLMENT FOR PREGNANT WOMEN. HEALTH NET REPORTS A 53% RETURN ON INVESTMENT; FOR EVERY $1 INVESTED IN CHAP SERVICES, $1.53 WAS SAVED IN HEALTH COSTS.PRIORITY HEALTH CHOICE, INC. CONTINUES TO BE RECOGNIZED FOR THEIR DEVELOPMENT OF PROGRAMS THAT HAVE LED TO INCREASED EFFICIENCY AND PATIENT CARE, HELPING LOWER COSTS, AND INCREASE SERVICE TO ITS MICHIGAN PATIENTS BY THE MICHIGAN ASSOCIATION OF HEALTH PLANS. PRIORITY HEALTH CHOICE, INC. WAS AWARDED A PINNACLE AWARD IN A PRIOR YEAR FOR ITS CENTERING PREGNANCY PROGRAM. THE GOAL WAS TO CREATE A COLLABORATIVE MODEL OF SUPPORT FOR MEDICAID MEMBERS WHICH RESULTS IN IMPROVED HEALTH OUTCOMES FOR MOTHERS AND THEIR BABIES, ENHANCED HEALTH EXPERIENCES, AND LOWER COSTS. PRIORITY HEALTH PARTNERED WITH COREWELL HEALTH IN SUPPORT OF THE CENTERING PREGNANCY PROGRAM FOR EXPECTANT MEDICAID MEMBERS AND THEIR BABIES. THROUGH THIS PARTICULAR COLLABORATION, FOCUS WAS PLACED ON MEDICAID MOTHERS AND BABIES; HOWEVER, THE MODEL IS SCALABLE TO OTHER PRODUCTS AND PROVIDERS WITHIN THE PRIORITY HEALTH NETWORK. THE COLLABORATIVE TEAM'S EFFORT RESULTED IN A NEW METHOD OF ENHANCED REIMBURSEMENT TIED TO EACH MEMBER AND EACH VISIT. THE PROGRAM IS AN ADDED BENEFIT TO PRIORITY HEALTH MEDICAID MEMBERS, PROVIDES A PRIORITY HEALTH CARE MANAGER AT THE CLINIC SITE WHO WORKS CLOSELY WITH HIGH-RISK PATIENTS AND REINFORCES CENTERING EDUCATION, AND SUPPORTS AND ENCOURAGES PARTICIPATION IN THE MATERNAL INFANT HEALTH PROGRAM.IN A PRIOR YEAR, THE MAHP AWARDED PRIORITY HEALTH CHOICE, INC. WITH A PINNACLE AWARD RECOGNIZING THE INNOVATIVE MEDNOW APPROACH. PRIORITY HEALTH CHOICE, INC. PARTNERED WITH MEDNOW TO VIRTUALLY CONNECT MEDICAID RECIPIENTS AND PROVIDERS. MEDNOW PROVIDES MEDICAID RECIPIENTS WITH ACCESS TO A COMPUTER IN-HOME, REAL-TIME ACCESS TO PRIMARY CARE PROVIDERS FOR NON-LIFE-THREATENING CONDITIONS, INCLUDING VIDEO VISITS FOR THOSE WITH A WEBCAM AND A STRONG INTERNET CONNECTION. IT HAS PROVIDED EFFECTIVE HEALTH CARE SERVICES TO BENEFICIARIES AT MEASURABLE COST SAVINGS. VIDEO-ENABLED VIRTUAL VISITS USE DATA ANALYTICS TO MEASURE UTILIZATION AND SATISFACTION. IN 2024, PRIORITY HEALTH CHOICE, INC. HAD 177,733 MEDNOW ENCOUNTERS WITH THE MEDICAID POPULATION.