Health Management Services

PriorityHM^SM (Health Management) is a group of services designed to help your employees achieve optimum health and productivity while controlling costs.From worksite wellness classes to professional assistance managing chronic and acute conditions, PriorityHM combines education, advocacy, self-management techniques and care coordination to keep employees healthy and on the job.

Health management services focus on health value
Our Health Management programs integrate claims data from employees, wellness programs, and provider incentives to use the most effective treatment paths.

The four focus areas are:

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

HealthyEncounters^SM
At Priority Health, 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
We compare pharmaceutical data with medical data to make sure your employees take the most effective medications for their health conditions. Our program:

• Provides recommendations about safety, effectiveness and cost-savings to prescribing physicians
• Promotes compliance with our evidence-based medicine formulary (approved prescription drugs)
• Leads the industry in integrating medical, laboratory and prescription claims data