Priority Health first insurer in Michigan to offer provider-based incentives for tracking SDoH data

(Grand Rapids, Mich. – October 6, 2020) Priority Health announced today its plans to pilot new incentives for providers who screen patients and submit information on Social Determinants of Health (SDoH), making them the first insurer in the state to financially support this type of data tracking. According to the Centers for Disease Control and Prevention, SDoH are conditions in the places where people live, learn, work and play that affect a wide range of health and quality-of-life risks and outcomes. The new incentives for eligible providers will begin on January 1, 2021.

“We understand that to effectively manage the health and wellness of a patient population, you need to look outside of the clinic walls. Being able to reward providers who are identifying these specific needs based on social factors is a step in the right direction,” said Mike Jasperson, Senior Vice President of Provider Network Strategy at Priority Health. “Having access to this type of data will eventually allow for both providers and payers to increase the quality of care that is delivered, reduce total cost of care for members, and directly address the needs of vulnerable populations.”

To be eligible for this incentive, practices must:

  • Be recognized as a Patient-Centered Medical Home in the program year (Priority Health accepts PCMH designation from several health care accreditation organizations
  • Use an approved tool to screen patients seen by the practice during the performance year for the presence of SDoH
  • Complete the SDoH survey attestation
  • Submit z-codes on claims for all SDoH discovered during screening
  • Provide at least one z-code on at least 5% of unique members seen during the measurement year

Approved SDoH screening tools will help providers quickly and efficiently screen their patient base and offer insight into social factors that may be impacting health outcomes, like access to housing, food, transportation and child care, or employment status, personal safety and finances. The increased reimbursement rate for the SDoH tracking incentives applies to all Priority Health Medicare and Medicaid members.

“By implementing these types of incentives, we are empowering providers to shift toward a more value-based approach and take the time needed to identify factors that ultimately influence health outcomes,” Jasperson noted. “We are proud to be able to offer incentives to providers who focus on innovation and risk mitigation. Working together to harness this data will allow us to more effectively manage patient populations.”

About Priority Health:

With over 30 years in business, Priority Health is the second largest health plan in Michigan, offering an extensive portfolio of health benefits options for employer groups and individuals, including Medicare and Medicaid plans. Serving more than 1.3 million members each year and offering a broad network of primary care physicians in Michigan, Priority Health continues to be recognized as a leader for quality, customer service, transparency and product innovation. Learn more about affordable, quality health coverage options from Priority Health