Keeping your patients healthy beyond their standard benefits

Member programs and outreach

We're committed to keeping our providers informed and our patients healthy and engaged. Below is a menu of additional health benefits, wellness opportunities and discounts available to the patients you serve.

Note
: where commercial plans are marked eligible, not all member plans may qualify, depending on whether or not employer groups opted out of said programs.

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Health and condition management benefits

Program Eligible plans Criteria About the program Cost to member How is the member informed?
Behavioral health self care  
  • Commercial
  • D-SNP
  • Individual
  • Medicaid
  • Medicare
  An online mental health tool powered by Teladoc Health that offers coping tools, inspirational resources, community support and one-on-one coaching for depression, anxiety, substance abuse, stress and chronic pain.  $0 Members sign up on their own or their care manager may refer them
Care after inpatient admission
  • Commercial
  • D-SNP
  • Individual
  • Medicaid
  • Medicare
 Members with a risk of 8-10%+ of having a 30-day unplanned readmission A 30-day program aimed at preventing readmission by connecting members to PCPs for follow-up and providing education on condition and medication.  $0 Outreach by Priority Health care manager
Care management  
  • Commercial
  • D-SNP
  • Individual
  • Medicaid
  • Medicare
 

Members are proactively targeted using Johns Hopkins ACG model. All D-SNP members have a care manager.

Children with special needs who need extra support

Care managers educate patients with complex medical needs on disease self-management, assist with coordination of care and navigating the health care system, and connect patients with social, medical and behavioral health care to reduce avoidable hospital admissions, readmissions and emergency department visits. 

 $0 Priority Health care manager
Community Care Management  
  • Commercial
  • D-SNP
  • Individual
  • Medicare
Members who are at risk of rehospitalization and/or have experienced psychosocial barriers accessing outpatient therapy.

Community Care Management is a program that offers individuals and families time-sensitive treatment and support to help avert a crisis or allow for a successful transition back home after a mental health hospitalization.

Based on members’ outpatient mental health benefit. Priority Health care manager
Companion care  
  • D-SNP
  • Medicare
  Papa connects college students (Papa Pals®) to Medicare members with chronic conditions who need assistance with transportation, house chores, technology, companionship and other services.  $0 Priority Health care manager
Diabetes management program
  • Commercial
  • Individual
  • Medicare
Members 18 or older with type 2 diabetes who are not pregnant   A digital diabetes management program called Livongo®, now owned by Teladoc Health, that provides a personalized experience for our members to better manage their type 2 diabetes. It includes telephonic health coaching, an app with 24/7 monitoring and support, a blood glucose meter that offers real-time feedback and unlimited test strips, a Bluetooth-connected weight scale and a blood pressure cuff.    $0 Referral email, Priority Health care manager
Diabetes prevention program
 
  • Commercial
  • Individual
  • Medicare
  • Medicaid

Members diagnosed with pre-diabetes. Learn more.  A one-year virtual program that helps patients with healthy lifestyle changes like eating healthy, exercising and managing stress. The program provides a coach, lessons and access to a peer support group. Virtual DDP programs are available to commercial and individual members, which also provide a scale.   $0 Program outreach email, Priority Health care manager
In-home chronic disease care  
  • Commercial
  • D-SNP
  • Individual
  • Medicaid
  • Medicare
Members in advanced stages of chronic disease In-home care management and care coordination through Tandem365® to help patients in advanced stages of chronic disease remain in their home for as long as safely possible.   $0 Priority Health care manager or Tandem365 care team
In-home health assessments
 
  • Individual
  • Medicaid
  • Medicare
  A health care provider visits the member in their home and reviews medical history, medications and answers questions. All results from the visit are shared with their primary care provider.  $0 Member information or outreach from Signify Health to schedule a visit
Over-the-counter allowance
 
  • D-SNP
  • Some Medicare members (not all Medicare plans offer OTC benefits)
   

D-SNP members get $222 per quarter to spend on over-the-counter items.

D-SNP Advantage members get $106 per month to spend on over-the-counter items. 

Some Medicare members get $40-100 per quarter or $26-35 per month, depending on their plan. 

$0

Advanced illness care
  • Commercial
  • D-SNP
  • Individual
  • Medicaid
  • Medicare
Members in advanced stages of chronic disease A variety of Advanced Illness Care programs provide in-home care, services and supports are available to members in advanced stages of chronic disease. 

$0

 

Priority Health care manager or Advanced Illness Program care team member

 
Pathways Community Connections
 
  • D-SNP
  • Medicaid
  • Medicare

Community health workers connect high risk patients to medical, social and behavioral health services to reduce risk factors. 
$0
Priority Health care manager
Personal emergency response for falls
 
  • D-SNP
  • Commercial
  • Individual
  • Medicare
Members with high risk for falls or a history of falling.
Members who are at high risk of falling receive a device that detects if they fall, and alerts an emergency contact of their choice, or 911. This benefit package includes in-home or mobile GPS equipment, installation support, onboarding welcome call, 24/7 monitoring, and member services that include social care.  $0
Priority Health care manager
Pregnancy support
 
  • Fully-funded groups
Pregnant members
PriorityMOM™ supports expectant mothers in their pregnancy journey. The goal is to reduce OB costs, preterm births, postpartum readmissions and improve health outcomes for mom and baby.
$0
 
Prescription discount program
  • Commercial
  • Individual
  Price Assure® ensures our commercial members get the lowest available price for their prescriptions automatically, without the hassle of discount cards or coupons. Learn how it works    
Priority Health Connect  
  • Commercial
  • D-SNP
  • Individual
  • Medicare

With attention to social determinants of health, this program connects members with free and reduced-cost programs and social services. Members can search for resources like housing support, legal assistance, access to health foods and childcare, within their zip code. This online platform is powered by Aunt Bertha®
$0
Priority Health care manager
Remote health condition monitoring
  • Commercial 
  • D-SNP
  • Individual
  • Medicare
 Members who meet clinical criteria for telemonitoring (i.e. congestive heart failure, COPD, diabetes) Members who need close clinical monitoring are provided devices specific to their illness, like a blood pressure cuff, scale or pulse oximeter.   $0 Priority Health care manager
Second medical opinions
  • Commercial
Available for select procedures, depending on the member's plan. 2nd.MD® provides members a second medical opinion for certain procedures or surgeries. Members get peace of mind through a consultation with an objective, third-party network of leading specialists. The member is the primary point of contact between their original doctor and the 2nd.MD doctor. The member will receive a written document with the 2nd.MD consult summary that can be shared with their original doctor.    $0 Members are contacted directly by 2nd.MD when they are eligible to participate. A member may also be referred by a Priority Health care manager. If they choose, members may proactively reach out to 2nd.MD for a second medical opinion.
 Transportation
  • D-SNP
  • Individual
  • Medicare
  SafeRide® covers up to 30 one-way trips per calendar year to take members to and from health-related locations such as network providers and pharmacies. Each one-way trip is limited to 40 miles.  $0

Member account or customer service.

Members will need a referral code.

Travel coverage
  • Commercial
  • Individual
  • Medicare

Global emergency medical services for members powered by Assist America®. If someone becomes ill or injured while traveling more than 100 miles from home, Assist America provides support with medical referrals, monitoring, evacuation, repatriation and much more. $0

Member account or customer service.

Members will need a referral code.

Wellness, healthy habits and fitness-based benefits

Program Eligible plans Criteria About the program Cost to member How is the member informed?
Brain games
  • D-SNP
  • Medicare

  An online brain exercise tool called BrainHQ® that helps improve memory, attention, brain speed and more.
$0
Member information
Chronic condition management
 
  • D-SNP
  • Medicare

For D-SNP, all members are eligible, 

For Medicare, members are eligible if they have disorders of lipid metabolism, diabetes, hypertension, depression and 8 + chronic conditions. 

A digital tool called Wellth® that motivates medication adherence using reminders and rewards for chronic condition management. 
$0 (Members can earn up to $30/mo. in rewards)

The Wellth team reaches out to eligible members (list provided by Priority Health) to invite them to join the program and help guide them through set up.

Multi-channel approach: direct mail, email and phone outreach

Fitness center discounts
  • Commercial
  • Individual
  Through Active&Fit Direct®, members can choose from 11,000+ participating fitness centers nationwide for $25 a month (plus a $25 enrollment fee and taxes). Members can choose from 11,000+ participating fitness centers nationwide for $25 a month (plus a $25 enrollment fee and taxes). $25/mo. for gym membership if they opt-in Member account
Fitness center memberships
  • D-SNP
  • Medicare
  • Some commercial plans

Provides memberships to thousands of participating SilverSneakers® fitness locations, including local gyms. $0 Priority Health care manager or member information
Wellbeing Hub
  • Commercial
  • Individual
  • Medicare

Through this program, powered by Virgin Pulse®, members are rewarded for staying on track with preventive care and other milestones, like annual wellness visits, flu shots and diabetic retinal eye exams. There are also tracking tools to support our members, fun and engaging health goals and informative resources tailored to each individual’s specific health and wellbeing needs. . $0

Medicare member information

Non-Medicare member information

Member discounts

Program Eligible plans About the program Cost to member How is the member informed?

Perks and discounts: BenefitHub

  • Commercial
  • Individual
  • Medicaid
Members can enjoy discounts, rewards, and other perks on thousands of brands from apparel to entertainment.  $0

Member account

Members need a referral code.

TruHearing® discount program

 

  • D-SNP
  • Medicare
  • Commercial
  • Individual
Provides members and their extended family access to a $75 discounted hearing examination with a TruHearing hearing provider and discounts on hearing aids.

$75 out-of-pocket cost for hearing exam with TruHearing provider (not a medical benefit) plus cost of hearing aids after the discount is applied

No cost for D-SNP members.

Sell sheet (found in HighSpot), member information