MMIT Payer Portrait: Priority Health

Priority Health is the insurance unit of BHSH Health, a health system of 22 hospitals based in Grand Rapids, Michigan. BHSH Health is the temporary name for the combined entity formed by the merger of Spectrum Health (the original owner of Priority Health) and Beaumont Health, which was finalized in February 2022. It is the second-largest health insurer in Michigan, serving members across the spectrum of insurance products, including Michigan’s managed Medicaid program and the Affordable Care Act exchanges. Cigna Corp.’s Express Scripts serves as Priority Health’s primary pharmacy benefits manager, while Accredo Health Group, Inc. (a unit of Express Scripts) manages specialty pharmacy.

As a result of its recent merger, Priority Health’s parent company is now the largest health system in Michigan, and Priority Health itself remains the largest provider-sponsored insurer in the state. “Together, we will leverage our complementary strengths to innovate and make a positive impact for our communities and their health,” Tina Freese Decker, president & CEO of the system, said in a Jan. 31 news release. “We look forward to working with our physicians, team members, patients, health plan members and partners across our state to provide health care and coverage that is accessible, affordable, equitable and exceptional.” BHSH now employs more than 11,500 providers and 15,000 nurses in Michigan.

About half (44%) of Priority Health’s members are enrolled in risk-based commercial products. The organization in May unveiled that it is launching the first virtual primary care plan for employer groups in Michigan, with the goal of increasing access to primary care physicians. Pointing out increased levels of deferred care caused by the COVID-19 pandemic, the insurer said it hopes to use its tiered benefit system to encourage members to make routine virtual visits a habit, ultimately improving access to care and health outcomes. In April, Priority Health partnered with Accolade to improve its virtual care infrastructure.

In addition to enhancing its commercial offerings, Priority Health has also increased its focus on Medicare Advantage (MA). The insurer performed well in both the 2022 and 2021 Open Enrollment Period and covered more than 218,000 MA members as of June 2022 despite Michigan’s competitive MA market. Priority Health told AIS’s Radar on Medicare Advantage that it has doubled down on efforts toward member retention and offering supplemental benefits such as meal services and enhanced dental coverage. Samia Brown, director of senior markets and product development with Priority, told AIS that its goal is to “create personal relationships early, so we’ve worked to enhance our new member onboarding with materials that are clear and easier to digest.”

SOURCE: AIS’s Directory of Health Plans as of June 2022; MMIT Analytics as of 2Q 2022.

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