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Priority Health unveils special needs plan

PriorityMedicare D-SNP will be available to 300,000 people who are eligible for Medicare, Medicaid.

November 8, 2019
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Priority Health is launching a Dual Eligible Special Needs Plan in all 68 counties of Michigan’s Lower Peninsula.

The plan, named PriorityMedicare D-SNP, goes into effect Jan. 1 and will be available to the 300,000 people ages 21 or older who are eligible for both Medicare and Medicaid.

Priority Health serves more than 1 million members every year with 123,000 of those being on Medicaid and more than 170,000 on Medicare.

This more integrated plan “will improve ease of use for eligible members and drive down overall costs,” said Guy Gauthier, vice president of state markets for Priority Health.

The D-SNP is meant for those with high rates of multiple chronic conditions and disabilities, such as medical conditions, behavioral health diagnoses, physical disabilities, intellectual or developmental disabilities, as well as functional and/or cognitive limitations.

Priority Health said this population faces many social risk factors that contribute to poor health and outcomes, including housing instability and homelessness, food insecurity, isolation, inadequate or no access to transportation, and disparities in other social determinants of health.

Priority Health said it has designed a model of care that is tailored to each individual and that addresses issues across the continuum of health, behavioral health and social services.

“We want to help reduce the burden of navigating the health care system and make sure that these people feel supported,” Gauthier said.

As the dual-eligible population grows and Priority Health has developed the infrastructure to serve them, Gauthier said it was a natural next step for the health insurer. This type of plan is becoming more prevalent throughout the industry, he added.

Priority Health has one of the highest-rated Medicaid health plans in the state by the National Committee for Quality Assurance’s Medicaid health insurance plan rankings. The health insurer’s HMO-POS Medicare Advantage plan also is the only Medicare Advantage plan in Michigan to earn 4.5 stars out of five from the Centers for Medicare and Medicaid Services.

Every member of the plan will have a dedicated interdisciplinary team that creates an individualized care plan and quality improvement plan, as is the requirement by the Centers for Medicare and Medicaid Services for this type of product. 

The care plan and the care coordination will then be managed by a team of case managers, primary or specialty clinicians, behavioral health specialists and others as needed.

An initial health risk assessment will help determine how much involvement each patient needs to have with their care team, Gauthier said.

Priority Health will determine, verify and track eligibility of D-SNP members in a manner consistent with all state and federal standards, regulations and legal requirements.

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