Priority Health supports vulnerable populations with launch of new PriorityMedicare Dual Eligible Special Needs Plan
(Grand Rapids, Mich. – Nov. 6, 2019) Michigan-based Priority Health announced today the launch of their new Dual Eligible Special Needs Plan (D-SNP) that will go into effect on January 1, 2020. Priority Health will now be the only health plan to offer a D-SNP throughout the entire lower peninsula. The plan, named PriorityMedicare D-SNP, will serve those who are 21 years of age and older who are Full Benefit Dual Eligible beneficiaries in the 68 counties in which Priority Health currently operates their Medicare Advantage plan. Over the years, Priority Health has continuously demonstrated the capability to manage the most vulnerable populations, and the introduction of the new D-SNP was a natural next step for the health insurer.
“Priority Health understands the complex needs of the D-SNP population and we have the infrastructure and experience necessary to properly support these individuals,” said Guy Gauthier, vice president of state markets at Priority Health. “Through a more integrated and coordinated approach to care, this plan will improve ease of use for eligible members and drive down overall costs.”
The D-SNP is meant for those with high rates of multiple chronic conditions and disabilities including medical conditions, behavioral health diagnoses, physical disabilities, intellectual or developmental disabilities, as well as functional and/or cognitive limitations. The 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.
Leveraging the experience of Priority Health’s existing Medicare and Medicaid teams, the D-SNP will be uniquely qualified to address the complex and diverse needs of members. Priority Health 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.
Priority Health is considered one of the best Medicaid health plans in the state according to the National Committee for Quality Assurance’s (NCQA’s) Medicaid Health Insurance Plan Rankings. The health insurer’s HMO-POS Medicare Advantage plan is also the only Medicare Advantage plan in Michigan to earn 4.5 Stars (out of 5) from the Centers for Medicare and Medicaid Services (CMS).
“Based on our current Medicare and Medicaid rankings, we know that Priority Health is one of the few plans in the state that is best positioned to manage the needs of the dual eligible population,” said Gauthier. “We want to help reduce the burden of navigating the health care system and make sure that these people feel supported.”
Every PriorityMedicare D-SNP member will have a dedicated interdisciplinary team that creates an individualized care plan and quality improvement plan. The care plan and the care coordination will then be managed by a team of case managers, clinicians (primary or specialty), behavioral health specialists, and others as needed.
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.