Priority Health outperforms the majority of Medicare

In a new analysis comparing Priority Health and a group of similar private plans to traditional fee-for-service Medicare, Priority Health had significantly lower rates of unnecessary hospitalizations than traditional Medicare. Priority Health offers Medicare Advantage plans in 23 Michigan counties and will expand its Medicare service area this fall.

The study, from researchers at Johns Hopkins University and the Alliance of Community Health Plans (ACHP), examined hospital readmissions, preventable hospital admissions and emergency room visits.

Lower hospital readmissions

The analysis showed that Priority Health’s readmission rate was 6.94% compared to the 18.6% readmission rate for traditional Medicare.
Hospital readmits account for more than $17 billion of the $102.6 billion in hospital payments from Medicare in 2004 making this issue a top priority for health reform.
"Priority Health recognizes the importance of helping our members post-hospitalization," said Jim Byrne, MD, vice president and chief medical officer. "Our Care Transitions Initiative has shown excellent results in reducing readmission rates for cardiovascular patients. This program includes outreach to the member within two days of their discharge and again at days 7, 14 and 28 to address the member’s need for ongoing education and self-management strategies."

Preventable hospital admissions and emergency room visits

Preventable hospital admissions and ER visits were also lower among PriorityMedicareSM members when compared to the national average of traditional Medicare.
While PriorityMedicare members averaged less than 1.0 preventable ER visits per 100 member months, Medicare fee-for-service had 15.5 such visits in the same time period.
Similarly, PriorityMedicare members’ preventable hospital admissions were 1.07 per 100 member months compared to 19.0 for traditional Medicare.
"As we look at ways to reduce health care costs, the Medicare Advantage model provides an excellent example of how private plans can offer quality care and affordable rates to individuals," said Byrne. "Keeping patients healthy and avoiding unnecessary hospitalizations and ER visits are essential to the coordinated care provided by PriorityMedicare and other ACHP member plans."
The analysis of Priority Health is part of a larger report, authored by Johns Hopkins University researcher Gerard Anderson, PhD and commissioned by ACHP, a Washington-based membership organization of 19 non-profit, community-based and regional health plans and provider organizations from across the country. These plans are similar to Priority Health because they all focus on improving the health of the communities they serve through integrated and coordinated care delivery.

The report documented that it's possible to improve quality and lower costs in the Medicare program if the delivery system is structured differently. Like Priority Health, the other regional, community-based health plans that are ACHP members are able to keep more of their Medicare patients out of the hospital and avoid unnecessary costs because they invest in delivering the kind of coordinated, patient-centered medical care that traditional fee-for-service Medicare – in its current state – cannot consistently provide.

About Priority Health:

Priority Health is an award-winning health plan nationally recognized for creating innovative solutions that impact health care costs while maximizing customer experience. It offers a broad portfolio of products for employer groups and individuals including Medicare and Medicaid beneficiaries. As a nonprofit company, Priority Health serves more than 600,000 people and continues to be rated among the best health plans in the nation by the National Committee for Quality Assurance.