Health management services

Health management is Priority Health's term for keeping costs down by keeping people healthier. The sickest 5% of all employees covered by Priority Health plans use 52% of the health care dollars their employers spend; helping people avoid that top 5% category can save thousands of dollars each in costs.

Health management services focus on health value
PriorityHealthManagement^SM programs integrate claims data from employees, wellness programs, and provider incentives to identify the most effective treatment paths.

The four PriorityHealthManagement focus areas are:

• HealthyEncounters wellness classes
  
• Utilization and referral management
• Case management
• Clinical pharmacy management

HealthyEncounters^SM
We encourage our members to take the best possible care of their health through a group of programs called HealthyEncounters. They include:

• Free or low-cost wellness classes on a variety of health topics, at work or in the community
• Information on our website about managing asthma, diabetes, and other long-term conditions
  
• Personal reminder mailings when members need check-ups and tests
• Personal disease management coaching to help manage chronic conditions
• Wellness programs for pregnancy, immunizations and physical exams
• Clinical best practice guidelines, performance reports and more for physicians

Utilization and referral management
These programs monitor and manage the use of diagnostic services, surgeries and other services to help us make sure members are getting the tests they need, but none that they don't need. We use national benchmarks and criteria to:

• Determine medical necessity for tests and services
  
• Coordinate out-of-network services
• Manage inpatient hospitalizations
• Track referrals and follow-up care

Case management
Our case managers counsel patients at risk for, or diagnosed with, specific health conditions such as asthma, diabetes, or cardiovascular diseases. Counseling includes:

• Educating patients about their conditions
• Explaining medication instructions and clinical services
• Encouraging healthy behaviors

Read some of our latest success stories here.


Clinical pharmacy management
Priority Health compares pharmaceutical data with medical data to make sure our members are taking the most effective medications for their health conditions.