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TIN:
SCHEDULE O
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is atwww.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Inspection
Name of the organization
Priority Health
Employer identification number
38-2715520
38-2715520
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH HMO | PRIORITY HEALTH IS AN INTEGRAL PART OF THE SPECTRUM HEALTH SYSTEM, AN INTEGRATED HEALTH SYSTEM SERVING COMMUNITIES THROUGHOUT MICHIGAN. PRIORITY HEALTH'S MISSION, LED BY ITS COMMUNITY BOARD, STRIVES TO RETURN VALUE TO THE COMMUNITIES SERVED BEYOND THE PROVISION OF HEALTHCARE TO ITS MEMBERS. PRIORITY HEALTH HAS BUILT A LONG HISTORY OF OFFERING MICHIGAN EMPLOYERS AND INDIVIDUALS PROGRESSIVE PRODUCTS AND INNOVATIVE PROGRAMS INTENDED TO KEEP COSTS DOWN AND MEMBERS HEALTHY. ITS BROAD PORTFOLIO OF PRODUCTS AND SERVICES INCLUDES TRADITIONAL MEDICAL PLANS AS WELL AS HSA'S, HRA'S AND OTHER CONSUMER-DRIVEN PRODUCTS. PRIORITY HEALTH CURRENTLY HAS AN "EXCELLENT" ACCREDITATION FOR ITS HMO PRODUCTS FROM THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA), AN INDEPENDENT MANAGED CARE ACCREDITING BODY. THIS IS THE HIGHEST RATING A HEALTH PLAN CAN EARN. PRIORITY HEALTH HAS EARNED AN "EXCELLENT" RATING EVERY YEAR SINCE 1998. SPECTRUM HEALTH IS A NOT-FOR-PROFIT HEALTH SYSTEM, BASED IN WEST MICHIGAN, OFFERING A FULL CONTINUUM OF CARE THROUGH THE SPECTRUM HEALTH HOSPITAL GROUP, WHICH IS COMPRISED OF 12 HOSPITALS; 180 AMBULATORY AND SERVICE SITES; 1,300 PHYSICIANS AND ADVANCED PRACTICE PROVIDERS, WHICH INCLUDE 1,100 MEMBERS OF THE SPECTRUM HEALTH MEDICAL GROUP; AND PRIORITY HEALTH, A HEALTH PLAN WITH MORE THAN 600,000 MEMBERS. SPECTRUM HEALTH IS WEST MICHIGAN'S LARGEST EMPLOYER, WITH 22,500 EMPLOYEES. THE ORGANIZATION PROVIDED $294.6 MILLION IN COMMUNITY BENEFIT DURING ITS 2014 FISCAL YEAR. SPECTRUM HEALTH IS THE ONLY HEALTH SYSTEM IN MICHIGAN TO BE NAMED ONE OF THE NATION'S 15 TOP HEALTH SYSTEMS BY TRUVEN HEALTH ANALYTICS FOR 2015. THIS IS THE FOURTH TIME THE ORGANIZATION HAS RECEIVED THIS RECOGNITION. THE AFFORDABLE CARE ACT (ACA) ADDED NEW REQUIREMENTS THAT HOSPITAL ORGANIZATIONS MUST SATISFY IN ORDER TO BE DESCRIBED IN SECTION 501(C)(3). ONE OF THE REQUIREMENTS UNDER THIS ACT IS TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND ADOPT AN IMPLEMENTATION STRATEGY AT LEAST ONCE EVERY THREE YEARS. SPECTRUM HEALTH COMPLETED SEVERAL IMPLEMENTATION PLANS IDENTIFYING THE COMMUNITY HEALTH NEEDS AND IMPLEMENTATION PLAN GOALS FOR EACH SPECTRUM HEALTH HOSPITAL. ONE NEED IDENTIFIED IN THE CHNA'S IS ACCESS TO HEALTHCARE, WHICH INCLUDES IMPROVING ACCESS TO AFFORDABLE HEALTHCARE FOR ALL COMMUNITY MEMBERS. IN ADDITION, ALL COMMUNITY MEMBERS SHOULD HAVE ACCESS TO PREVENTIVE CARE AND MEDICAL HOME CARE, INCLUDING THE UNINSURED AND LOW-INCOME WORKING INDIVIDUALS. SPECTRUM HEALTH WORKS CLOSELY WITH PRIORITY HEALTH TO ACHIEVE THE IDENTIFIED NEEDS AND GOALS. |
| Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH HMO (CONTINUED) | PRIORITY HEALTH PURSUES INITIATIVES THAT WILL IMPROVE PATIENT OUTCOMES WHILE HELPING TO REDUCE THE OVERALL COST TO THE MEMBER. IN 2014 PRIORITY HEALTH LOWERED HEALTH COSTS ACROSS ALL LINES OF BUSINESS BY ALMOST $16 MILLION THROUGH NEW MANAGED CARE INITIATIVES THAT INFLUENCE PHYSICIAN PRACTICES, PROMOTE APPROPRIATE HEALTHCARE UTILIZATION AND INCREASE QUALITY WHICH EXTENDS BEYOND PRIORITY HEALTH'S MEMBERS. IN ADDITION TO THE MANAGED CARE SAVINGS ABOVE, PRIORITY HEALTH PURSUES INITIATIVES TO PREVENT INDIVIDUALS FROM OBTAINING CHRONIC DISEASE, AS WELL AS INITIATIVES TO BETTER MANAGE INDIVIDUALS WITH CHRONIC DISEASE. IN 2014, PRIORITY HEALTH ESTIMATED A SAVINGS OF OVER $16 MILLION ASSOCIATED WITH THESE CHRONIC DISEASE MANAGEMENT PROGRAMS. PEER AND UTILIZATION REVIEW ASSURES THAT SERVICES ARE RENDERED IN A COST EFFICIENT AND PROFESSIONAL MANNER. EVIDENCE-BASED MEDICINE IMPROVES QUALITY AND LOWERS COST. PRIORITY HEALTH MEASURES EACH ACCOUNTABLE CARE NETWORK'S USE OF RATES FOR PREFERENCE SENSITIVE CONDITIONS AND DISTRIBUTES THIS BENCHMARK DATA UN-BLINDED TO HIGHLIGHT OUTLIERS IN STANDARDS OF CARE. WE CALL THIS VARIATION TO CHALLENGE TREATMENT APPROACH AND ENGAGEMENT OF PATIENTS IN ALTERNATIVE TREATMENTS. CONSUMER DECISION MAKING TOOLS HAVE ALSO BEEN DEVELOPED TO PROVIDE PATIENTS WITH ALTERNATIVES TO TREATMENT WITH RELATED EVIDENCE BASED OUTCOMES. PHARMACEUTICAL FORMULARY ASSESSMENTS GUIDE PHYSICIAN PRESCRIPTION ORDERING BEHAVIORS TOWARD THE LOWEST COST DRUGS THAT ARE PROVEN EFFECTIVE. QUALITY AND INCENTIVE PROGRAMS DESIGNED TO MONITOR AND REDUCE HIGH COST HEALTHCARE AREAS SUCH AS EMERGENCY ROOM VISITS, HIGH DIAGNOSTIC IMAGING, AND UNNECESSARY ADMISSIONS HAVE BEEN IMPLEMENTED ACROSS THE STATE OF MICHIGAN. OTHER EXAMPLES OF INITIATIVES INCLUDE IMPLEMENTATION OF ELECTRONIC MEDICAL RECORDS, WHICH BENEFIT NON-PRIORITY HEALTH PATIENTS. PRIORITY HEALTH DEVELOPS AND PUBLISHES PREVENTIVE HEALTHCARE GUIDELINES AVAILABLE TO THE GENERAL PUBLIC ON ITS WEBSITE. IN ADDITION, PRIORITY HEALTH USES COMMUNITY RATING WHICH MINIMIZES THE ECONOMIC IMPACT OF SEVERE ILLNESS ON A GIVEN INDIVIDUAL OR GROUP. PRIORITY HEALTH SERVES WHAT THE IRS HAS DEFINED AS THE "MOST IN NEED" POPULATION OF INDIVIDUALS, SMALL GROUPS AND ELDERLY, MAKING UP 50% OF THE MEMBERSHIP BASE. PRIORITY HEALTH PROVIDED COMMUNITY-RATED AFFORDABLE HEALTH INSURANCE TO OVER 85,000 MEMBERS WHO ARE INDIVIDUALS AND SMALL GROUPS IN 2014. PRIORITY HEALTH ALSO PROVIDES CAPITAL SUPPORT FOR ITS WHOLLY OWNED SUBSIDIARY, PRIORITY HEALTH CHOICE, INC., WHICH PROVIDES ACCESS TO EXCELLENT HEALTHCARE TO OVER 100,000 MEDICAID MEMBERS. |
| Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH HMO (CONTINUED) | IN 2013, THE MICHIGAN DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES (DIFS) ADOPTED OBAMA ADMINISTRATION'S EXTENSION OF THE TRANSITIONAL "AS IS" POLICY. THIS DECISION ALLOWS INSURERS TO DECIDE WHETHER THEY WOULD CONTINUE OFFERING POLICIES THAT ARE NOT COMPLIANT WITH THE ACA, WHICH BECAME PERMISSIBLE WHEN THE FEDERAL GOVERNMENT DELAYED THE REQUIRED SHIFT TO ACA-APPROVED INSURANCE COVERAGE. PRIORITY HEALTH CONTINUES TO OFFER AN EXTENSION OF ITS PRE-ACA INDIVIDUAL AND GROUP HEALTH PLANS TO SUBSCRIBERS THROUGH 2016, WHILE MAJOR COMPETITORS HAVE SHUT DOWN PLANS. THE DECISION TO EXTEND THE 2013 PRE-ACA PLANS FOR COVERAGE THROUGH 2016 IS CONSISTENT WITH PRIORITY HEALTH'S COMMITMENT TO PROVIDE INDIVIDUALS WITH FLEXIBILITY AND CHOICE. IN ADDITION, PRIORITY HEALTH REINSTATED POLICIES IT ALREADY HAD CANCELLED TO COMPLY WITH THE ACA REQUIREMENTS. THE REINSTATEMENT OF PREVIOUSLY CANCELLED POLICIES GAVE EMPLOYERS AND INDIVIDUALS PEACE OF MIND AND TIME TO ASSESS THEIR OPTIONS BEFORE BEING REQUIRED TO CHANGE PLANS UNDER THE ACA. PRIORITY ALSO BEGAN ENROLLING MEMBERS THROUGH THE FEDERALLY-FACILITATED HEALTH INSURANCE MARKETPLACE (HEALTHCARE.GOV) DURING THE 2013 OPEN ENROLLMENT PERIOD. |
| Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH HMO (CONTINUED) | THE STATE OF MICHIGAN NAMED THE PRIORITY HEALTH HMO THE BENCHMARK PLAN FOR ALL INDIVIDUAL AND GROUP HMO PLANS TO MODEL, RECOMMENDED BY GOVERNOR SNYDER AS THE BENCHMARK PLAN FOR MICHIGAN'S HEALTH INSURANCE OFFERINGS. THE GOVERNOR'S RECOMMENDATION UNDERSCORES PRIORITY HEALTH'S ABILITY TO DELIVER INCREDIBLE VALUE AND CREATE INNOVATIVE SOLUTIONS THAT IMPACT HEALTHCARE COSTS WHILE MAXIMIZING CUSTOMER EXPERIENCE. THIS PLAN IS THE LOWEST-COST BENCHMARK PLAN OPTION, WHICH WILL PROVIDE AN EXCELLENT FRAMEWORK FOR ALL INDIVIDUAL AND SMALL GROUP PLANS OFFERED IN MICHIGAN AFTER JANUARY 1, 2014. PRIORITY HEALTH PUBLISHED 2 EBOOKS, ONE FOR CONSUMERS AND ONE FOR EMPLOYERS, ON HEALTHCARE REFORM WHICH ARE FREE AND AVAILABLE TO THE PUBLIC ON PRIORITY HEALTH'S WEBSITE. THE GOAL OF THE CONSUMER'S GUIDE TO THE ACA IS TO CLARIFY HOW HEALTHCARE REFORM WILL AFFECT INDIVIDUALS IN MICHIGAN. THE GOAL OF THE GUIDE FOR EMPLOYERS IS TO PROVIDE SUMMARIES AND EXAMPLES AS AN EDUCATIONAL TOOL TO ASSIST EMPLOYERS' QUESTIONS REGARDING HEALTHCARE REFORM. PRIORITY HEALTH HAS A LONG HISTORY OF PROVIDING ITS MEMBERS WITH ACCESS TO CARE MANAGEMENT PROGRAMS FOCUSED ON IMPROVING OUTCOMES, LOWERING COST AND IMPROVING QUALITY OF LIFE. CHRONIC DISEASE, WITH INSIDIOUS PROGRESSION AND MORBID COMPLICATIONS, IS A MASSIVE CLINICAL AND FINANCIAL MANAGEMENT CHALLENGE. PRIORITY HEALTH PROVIDES A 1:1 APPROACH IN WORKING WITH MEMBERS WITH SEVERE AND CHRONIC CONDITIONS. THROUGH INDIVIDUALIZED CARE, SERVICES ARE COORDINATED AND OFFER EARLY INTERVENTION, IMPROVE ACCESS, REDUCE DUPLICATION, IMPROVE OUTCOMES AND REDUCE RESOURCE UTILIZATION. MEMBERS RECEIVE THE RIGHT CARE, AT THE RIGHT COST, IN THE RIGHT PLACE, FOR THE RIGHT LENGTH OF TIME. AS A PROACTIVE APPROACH, PRIORITY HEALTH OFFERS A FREE CHRONIC DISEASE AND HEALTHY LIFESTYLE MOBILE MANAGEMENT APPLICATION TO MEMBERS. CHRONIC DISEASES INCLUDING ASTHMA, DIABETES, COPD AND HEART FAILURE CAN BE MANAGED BY THIS APPLICATION. THE APPLICATION TRACKS MEDICATION ADMINISTRATION AND PROVIDES MEDICATION REMINDERS, AS WELL AS MEMBER CURRENT HEALTH STATUS, AND OTHER CLINICAL INDICATORS SUCH AS WEIGHT, BLOOD PRESSURE, EXERCISE AND DIET. USERS HAVE THE ABILITY TO TRACK/MANAGE A PLETHORA OF METRICS: FROM WEIGHT AND WATER INTAKE, TO MEDICATION ADMINISTRATION AND SLEEP HOURS, AND EVERYTHING IN BETWEEN. USERS ALSO HAVE THE OPTION TO SHARE THEIR ACCOUNT WITH FAMILY OR OTHER CARE GIVERS TO ENABLE TELEHEALTH FEATURES FOR REMOTE MANAGEMENT OF THEIR CHRONIC CONDITIONS. |
| Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH HMO (CONTINUED) | THE MICHIGAN ASSOCIATION OF HEALTH PLANS (MAHP), AN INDUSTRY VOICE FOR THE STATE'S HEALTHCARE PLANS, RECOGNIZES BEST PRACTICES IN HEALTH PLANS BY SPONSORING THE PINNACLE AWARDS. DURING 2014, 11 MICHIGAN HEALTH PLANS FROM ACROSS THE STATE SUBMITTED 37 GROUND-BREAKING PROGRAMS TO BE CONSIDERED FOR MAHP'S ANNUAL PINNACLE AWARDS, SHOWING ENTREPRENEURIAL SPIRIT AND AN INTEREST IN SERVING THEIR MEMBERS AS THEY SEEK TO INCREASE EFFICIENCY AND IMPROVE PATIENT HEALTHCARE TO LOWER COSTS AND INCREASE SERVICE TO MICHIGAN CITIZENS. PRIORITY HEALTH RECEIVED 3 OF 10 AWARDS, LEADING THE NUMBER OF PINNACLE AWARD WINNERS. PRIORITY HEALTH WAS A RECIPIENT TO A PINNACLE AWARD FOR 2014 IN THE CHRONIC DISEASE MANAGEMENT CATEGORY FOR INTEGRATED HEALTH COACHING FOR THE COMMERCIAL POPULATION. PRIORITY HEALTH IMPLEMENTED AN INTEGRATED HEALTH COACHING MODEL IN 2012, WITH COACHES MAXIMIZING SERVICES WITHIN THE ORGANIZATION INCLUDING MEDICAL, BEHAVIORAL HEALTH AND CASE MANAGEMENT SERVICES. OVER A TWO-YEAR PERIOD THE COACHING INCREASED PROGRAM ENGAGEMENT AND RETENTION WITH A MODEL THAT KEPT PARTICIPANTS ACCOUNTABLE WITH REGULAR ASSESSMENTS, GOALS AND REFERRALS. THROUGH INTEGRATED TEAM WORK, BEST PRACTICES AND OUTCOMES-BASED REPORTING, THE RETENTION RATE OF MEMBERS COMPLETING 3 MONTHS OF COACHING HAS INCREASED BY 40%, WHICH IN RETURN DECREASES MEMBER RISK LEVELS LEADING TO DIRECT AND INDIRECT COST AVOIDANCE. PRIORITY HEALTH ALSO RECEIVED A 2014 PINNACLE AWARD IN THE CLINICAL SERVICE IMPROVEMENT CATEGORY FOR IMPROVING HEALTH IN ADOLESCENTS AMONG THE COMMERCIAL POPULATION. PRIORITY HEALTH SET A GOAL TO BECOME A NATIONAL LEADER IN THE PROVISION OF ADOLESCENT IMMUNIZATIONS TO REDUCE THE RISK OF PREVENTABLE CONTAGIOUS DISEASES. BY INCENTING THE PROVIDER NETWORK, PROVIDING MONTHLY PERFORMANCE REPORTS, OFFERING IMMUNIZATION AT SPORTS PHYSICALS AND IMPLEMENTING AN OUTREACH PLAN, PRIORITY HEALTH GAINED THE STATUS OF 4TH IN THE NATION IN ADOLESCENT IMMUNIZATION RATES IN 2013. PRIORITY HEALTH PERFORMED AT 93%, WHICH IS 7% ABOVE THE NATIONAL 90TH PERCENTILE, BY PROVIDING SERVICES TO APPROXIMATELY 3,500 ADOLESCENTS. |
| Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH HMO (CONTINUED) | IN ADDITION, PRIORITY HEALTH RECEIVED A 2014 PINNACLE AWARD IN THE BUSINESS/OPERATIONAL PERFORMANCE CATEGORY FOR VIRTUAL VISITS AMONG THE COMMERCIAL POPULATION. THE DRIVE TO GIVE MEMBERS THE MOST BENEFICIAL AND COST-EFFECTIVE ACCESS TO HEALTHCARE RESULTED IN PRIORITY HEALTH'S DEVELOPMENT AND IMPLEMENTATION OF VIRTUAL VISITS. THE NEW TECHNOLOGY ENABLES MEMBERS WITH LESS SERIOUS CONDITIONS TO ACCESS TREATMENT 24/7/365 ONLINE OR ON THE PHONE WITH BOARD-CERTIFIED DOCTORS. A VIRTUAL OPTION MEANS MEMBERS CAN SKIP THE EMERGENCY ROOM FOR NON-EMERGENCIES, MAKING VIRTUAL VISITS MORE CONVENIENT AND COST-EFFECTIVE. FOR MORE THAN 20 YEARS, PRIORITY HEALTH HAS BEEN A LEADER IN PATIENT-CENTERED CARE AND HAS A PROVEN RECORD OF WORKING WITH PHYSICIANS TO IMPROVE HEALTH OUTCOMES. THROUGH ITS PARTNERS IN PERFORMANCE PROGRAM, PRIORITY HEALTH ENCOURAGES AND REWARDS THE QUALITY CARE OF PRIMARY CARE PHYSICIANS. THE PHYSICIANS AND PRACTICES SELECTED FOR THE PRIORITY HEALTH QUALITY AWARD HAVE ACHIEVED THE HIGHEST OVERALL SCORES FOR ENSURING PATIENTS RECEIVE PREVENTIVE CARE, CONTROL CHRONIC DISEASE AND HAVE A GOOD EXPERIENCE. EACH AWARD RECIPIENT IS SELECTED BY ANALYZING THE RESULTS OF THE PRIORITY HEALTH PRIMARY CARE PROVIDER INCENTIVE PROGRAM, A PROGRAM THAT TRACKS CLINICAL QUALITY MEASURES AGAINST NATIONAL STANDARDS AND EVIDENCE-BASED MEDICINE. SINCE 2003, WHEN THE QUALITY AWARD WAS ESTABLISHED, MORE THAN 200 HEALTHCARE PRACTICES HAVE BEEN DISTINGUISHED WITH THIS HONOR. PRIORITY HEALTH HAS AWARDED PRACTICES WITH $175 MILLION IN SUPPORT OF PRIMARY CARE, OVER AND ABOVE STANDARD PAYMENT FOR SERVICES. PRIORITY HEALTH PAID PHYSICIANS $21.5 MILLION IN 2015, BASED ON THEIR PERFORMANCE IN 2014. THE PROGRAM'S SUCCESS IS CLEARLY DEMONSTRATED BY THE NUMBER OF PRIORITY HEALTH MEMBERS WHO RECEIVE PREVENTIVE SCREENINGS. IN THE LAST YEAR, MORE THAN 74% OF PRIORITY HEALTH MEMBERS RECEIVED ROUTINE COLORECTAL CANCER SCREENING EXAMS COMPARED TO A NATIONAL AVERAGE OF 63%. ADDITIONALLY, 87% OF MEMBERS RECEIVED CHILDHOOD IMMUNIZATIONS COMPARED TO THE NATIONAL AVERAGE OF 76%. PRIORITY HEALTH SHARES RISK WITH PROVIDERS AND EMPLOYERS BY OFFERING OVER $25 MILLION OF INCENTIVES AND OTHER RISK SHARING ARRANGEMENTS. THIS PROMOTES LOWER OVERALL HEALTHCARE COSTS AND IMPROVED QUALITY TO THE COMMUNITY. |
| Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH HMO (CONTINUED) | PRIORITY HEALTH HAS BEEN A STRONG ADVOCATE FOR PATIENT-CENTERED CARE BY SUPPORTING THE NATIONAL MODEL FOR CHANGING REIMBURSEMENT WHICH INCLUDES PAYMENT FOR SERVICES, PAYMENT FOR PERFORMANCE BASED ON QUALITY AND EFFICIENCY, AND INFRASTRUCTURE SUPPORT THROUGH A FIXED PAYMENT PER PATIENT. IN 2013, PRIORITY HEALTH JOINED THE MICHIGAN PRIMARY CARE TRANSFORMATION (MIPCT) PROJECT. MIPCT IS A THREE-YEAR PROJECT AIMED AT IMPROVING HEALTH IN THE STATE, MAKING HEALTHCARE MORE AFFORDABLE AND ENHANCING THE PATIENT EXPERIENCE. IT IS THE LARGEST PATIENT-CENTERED MEDICAL HOMES PROJECT IN THE NATION WITH 38 PHYSICIAN/PHYSICIAN HOSPITAL ORGANIZATIONS REPRESENTING NEARLY 400 PRIMARY CARE PRACTICES AND 1,800 PRIMARY CARE PHYSICIANS. WITHIN THE INTEGRATED SPECTRUM HEALTH SYSTEM, INDIVIDUALS AND TEAMS ARE RECOGNIZED FOR QUALITY IN ACTION THROUGH THE ANNUAL AWARDS PROGRAM CALLED SYNERGY AWARDS. THE ONCOLOGY MEDICAL HOME TEAM WAS NOMINATED FOR THE 2013 GREATEST IMPROVEMENT SYNERGY AWARD AND WON THE AWARD FOR THIS CATEGORY. THE ONCOLOGY MEDICAL HOME INITIATIVE IS A JOINTLY DEVELOPED PROGRAM BETWEEN ONCOLOGY PRACTICES AND PRIORITY HEALTH THAT APPLIES THE PRINCIPLES OF THE PATIENT-CENTERED MEDICAL HOME TO ONCOLOGY. THE TEAMS WORKED TOGETHER TO DEVELOP A NOVEL AND READILY REPLICABLE MODEL TO FAIRLY COMPENSATE ONCOLOGISTS FOR COGNITIVE AND SUPPORT SERVICES WHILE REMOVING DEPENDENCE ON CHEMOTHERAPY DRUG MARGINS FOR FINANCIAL SOLVENCY. FURTHER, IT DEVELOPED TRANSFORMATIVE CARE PROCESSES TO SELECT SINGLE PREFERRED REGIMENS FOR TREATING COMMON CANCERS, IMPLEMENT EFFECTIVE ADVANCE CARE PLANNING, AND ENHANCE ACCESS AND CARE COORDINATION. TRUE NORTH METRICS IMPACTED INCLUDE SAFETY AND QUALITY, PATIENT EXPERIENCE, FINANCIAL STEWARDSHIP AND TALENT DEVELOPMENT. |
| Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH HMO (CONTINUED) | PRIORITY HEALTH IDENTIFIES ALL MEMBERS WITH NEWLY DIAGNOSED DIABETES AND CONTACTS THEM WITH INFORMATION ABOUT PRIORITY HEALTH PROGRAMS AND BENEFITS AVAILABLE TO THEM. ADDITIONALLY, AT LEAST ANNUALLY, ALL MEMBERS WITH DIABETES ARE NOTIFIED OF DIABETES SPECIFIC SERVICES THAT REQUIRE AND INFORM THEM TO FOLLOW UP WITH THEIR PRIMARY CARE PROVIDER TO OBTAIN THOSE SERVICES. IN JANUARY 2013, PRIORITY HEALTH PARTNERED WITH THE NATIONAL KIDNEY FOUNDATION OF MICHIGAN TO OFFER A FREE DIABETES PREVENTION PROGRAM ACROSS THE STATE OF MICHIGAN. THIS PROGRAM IS LED BY A CERTIFIED LIFESTYLE COACH WHO TEACHES PARTICIPANTS ABOUT NUTRITION AND STRESS REDUCTION. THE COACH WORKS ONE-ON-ONE WITH PARTICIPANTS TO OVERCOME OBSTACLES BY TRACKING FOOD INTAKE AND PHYSICAL ACTIVITY. FOR THOSE PREVIOUSLY DIAGNOSED WITH DIABETES, PRIORITY HEALTH OFFERS A DIABETES PROGRAM ASSISTING MEMBERS WITH MANAGING DIABETES BY PROVIDING INFORMATION AND TIPS FROM THE HEALTH MANAGEMENT TEAM. THROUGH THE INCENTIVE PROGRAM, PRIMARY CARE PHYSICIANS ARE GIVEN FINANCIAL REWARDS TO MEET NATIONAL 90TH PERCENTILE TARGETS FOR PROVIDING SERVICES AND ACHIEVING BEST OUTCOMES. PRIORITY HEALTH'S RATES FOR MULTIPLE DIABETES MEASURES ARE CONSISTENTLY AT, OR NEAR, THE NATIONAL TOP 10 PERCENTILE PERFORMANCE. ADDITIONALLY, THROUGH NATIONALLY RECOGNIZED MODELS, THE COST (AND PREVALENCE) OF COMMON DIABETES COMPLICATIONS FOR PRIORITY HEALTH MEMBERS WITH DIABETES IS SIGNIFICANTLY BELOW NATIONAL AND MICHIGAN RATES. THE DIABETES PREVENTION PROGRAM IS CREDITED WITH A 58-71% DECREASE IN THE RISK OF TYPE 2 DIABETES DEVELOPMENT RATES BY HELPING THOSE AT RISK ADOPT AND MAINTAINING LIFESTYLE CHANGES. PRIORITY HEALTH HAS ENROLLED 48 MEMBERS, WHILE 70 MEMBERS HAVE COMPLETED THE PROGRAM AND HAVE CHARTED A TOTAL OF 1,048 POUNDS LOST WITH AN AVERAGE OF 168 MINUTES OF WEEKLY ACTIVITY. PRIORITY HEALTH ENCOURAGES MEMBERS TO UNDERSTAND THE COST OF CARE WHEN MAKING HEALTHCARE DECISIONS. WITH THE LAUNCH OF HEALTHCARE BLUE BOOK IN AUGUST 2013, PRIORITY HEALTH BECAME THE FIRST MICHIGAN-BASED HEALTH PLAN TO PROVIDE ONLINE INFORMATION ABOUT CONTRACTED HEALTHCARE FEES ALONG WITH QUALITY INFORMATION TO ENGAGE MEMBERS THROUGH "COMPARISON SHOPPING." THE HEALTHCARE BLUE BOOK DISPLAYS PRIORITY HEALTH SPECIFIC FEES FOR MORE THAN 200 COMMON HEALTH SERVICES, INCLUDING SURGERIES, LAB WORK AND IMAGING TESTS. A KEY FEATURE OF THE HEALTHCARE BLUE BOOK IS THAT IT DISPLAYS THE "FAIR PRICE" FOR EACH PROCEDURE. MEMBERS CAN ALSO REVIEW QUALITY RANKINGS AND CONSUMER REVIEW OF HOSPITALS AND PHYSICIANS THROUGH HEALTHGRADES TO RECEIVE A COMPLETE PICTURE OF THE SERVICE THEY ARE BUYING. THE TOOL SUPPORTS PRIORITY HEALTH'S CONTINUED MARKET LEADERSHIP IN TRANSPARENCY AND WAS LAUNCHED THROUGH A MULTICHANNEL AWARENESS CAMPAIGN RESULTING IN NEARLY 3.1 MILLION GROSS IMPRESSIONS. THE HEALTHCARE BLUE BOOK WILL PROMOTE ENGAGEMENT BY PROVIDING MEMBERS WITH INFORMATION THAT EQUIPS THEM TO MAKE MORE INFORMED DECISIONS ABOUT THEIR HEALTHCARE WHICH ALLOWS THEM TO FIND THE BEST VALUE. THIS TRANSPARENCY TOOL LOWERS THE COST OF CARE TO THE COMMUNITY. THE PRIORITY HEALTH THIRD PARTY LIABILITY (TPL) TEAM HAS CONSISTENTLY IMPROVED OUTCOMES BY INCREASING SAVINGS THROUGH AUDIT, ANALYSIS, AND STANDARDIZATION OF WORK WHILE CONCURRENTLY IMPROVING BOTH MEMBER AND PROVIDER SATISFACTION. OVER THE PAST TWO YEARS THIS PROGRAM HAS IMPROVED ITS PER-MEMBER PER-MONTH (PMPM) SAVINGS BY 32 PERCENT. BY PURSUING THE NEEDS OF ITS CUSTOMERS AT ALL TIMES AND DRIVING CONTINUOUS IMPROVEMENT IN ALL AREAS OF THE DEPARTMENT, THE TPL TEAM HAS BEEN ABLE TO SUSTAIN IMPROVEMENT YEAR OVER YEAR. |
| Form 990, Part III, Line 4b PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH MEDICARE | PRIORITY HEALTH BEGAN OFFERING MEDICARE ADVANTAGE PLANS IN JULY 2005 AND MEDICARE ADVANTAGE PLANS WITH PRESCRIPTION DRUG COVERAGE IN JANUARY 2006. PRIORITY HEALTH'S MEDICARE PROGRAM HAS ONE OF THE LOWEST READMISSION RATES IN THE COUNTRY. ITS MEDICARE ADVANTAGE PLANS VARY IN PRICE BASED ON WHERE INDIVIDUALS LIVE AND WHAT BENEFITS THEY NEED. PRIORITY HEALTH STRIVES TO WORK WITH THE COMMUNITY AND MAKE MEDICARE SIMPLE TO UNDERSTAND. THAT IS WHY IT WROTE AND PUBLISHED "MEDICARE ADVANTAGE FOR DUMMIES." IT WAS WRITTEN BY A PRIORITY HEALTH EMPLOYEE, IN COOPERATION WITH WILEY PUBLISHING, OWNERS OF THE DUMMIES SERIES. THE BOOK HAS BEEN DISTRIBUTED FREE TO OVER 255,000 PEOPLE ACROSS MICHIGAN. AS A RESULT OF PRIORITY HEALTH'S WORK WITH THE COMMUNITY AND DEDICATION TO OFFERING PLANS THAT DELIVER HIGH QUALITY, ITS MEDICARE ADVANTAGE PLANS HAVE RECEIVED THE HIGHEST ACCREDITATION STATUS OF "EXCELLENT," WHILE FOUR OF ITS 2014 MEDICARE ADVANTAGE PLANS WITH PRESCRIPTION DRUG COVERAGE WERE AWARDED 4.5 OUT OF 5 STARS BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS). THE MEDICARE STAR RATINGS INDICATE HOW WELL A HEALTH PLAN PERFORMS OVERALL; THE BETTER THE STAR RATING, THE BETTER THE CARE IS DELIVERED. OF THE 43 QUALITY AND IMPROVEMENTS METRICS USED TO DETERMINE OUR OVERALL QUALITY RATING OF 4.5, APPROXIMATELY 58% OF THE METRICS WERE 5 STAR. PRIORITY HEALTH IS ABLE TO PROVIDE ITS MEMBERS HIGH QUALITY MEDICARE ADVANTAGE PLANS WHILE REMAINING AMONG THE LOWEST COST (RISK AND BENEFIT ADJUSTED) PLANS IN THE COUNTRY. |
| Form 990, Part III, Line 4b PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH MEDICARE (CONTINUED) | DURING THE 2014 MEDICARE ANNUAL ENROLLMENT PERIOD (AEP), PRIORITY HEALTH ENROLLED 51.2% OF THE INDIVIDUALS WHO PURCHASED A MAPD PLAN IN MICHIGAN FROM OCTOBER 15 - DECEMBER 7, 2013. PRIORITY HEALTH'S MEDICARE ADVANTAGE ENROLLMENT INCLUDES ABOUT 77,000 INDIVIDUAL ADVANTAGE MEMBERS, OR JUST OVER 27% OF THE TOTAL INDIVIDUAL MEDICARE ADVANTAGE MARKET, MAKING PRIORITY HEALTH THE LEADER IN MICHIGAN. AFTER ADDING 10 COUNTIES TO THE SERVICE AREA IN 2014, MEDICARE ADVANTAGE IS NOW OFFERED IN ALL 68 COUNTIES IN MICHIGAN'S LOWER PENINSULA. PRIORITY HEALTH'S NETWORK HAS MORE THAN 32,000 PROVIDERS AND A MEMBER RETENTION RATE OF 97%. IN 2012, PRIORITY HEALTH LAUNCHED HOME BASED PRIMARY CARE (HBPC) AS A PILOT WITH OUR AFFILIATE, SPECTRUM HEALTH MEDICAL GROUP (SHMG). HBPC BRINGS THE CARE TEAM INTO THE HOME OF PATIENTS THAT ARE AT THE FAR END OF THE POPULATION HEALTH CONTINUUM, THE ADVANCED CHRONICALLY ILL, WHOSE MULTIPLE MEDICAL CONDITIONS ARE COMPLICATED BY FUNCTIONAL AND/OR COGNITIVE LIMITATIONS THAT MAKE IT DIFFICULT FOR THEM TO ADEQUATELY ACCESS THE TRADITIONAL AMBULATORY PHYSICIAN OFFICE. IN ADDITION TO PRIORITY HEALTH CHANGING HOW THE PATIENT ACCESSES THEIR CARE, THERE IS NOW A TEAM BASED MODEL OF CARE TO MEET ALL THE NEEDS OF THE PATIENT. THE 2013 PILOT PROJECT RESULTED IN A 47% DECREASE IN EMERGENCY DEPARTMENT VISITS AND INPATIENT ADMISSIONS FOR 90 AT-RISK PATIENTS, WHILE ALSO RESULTING IN SIGNIFICANT IMPROVEMENTS IN THEIR HEALTH. MOST OF THE PATIENTS IN THE PROGRAM ARE MEMBERS OF PRIORITY HEALTH'S MEDICARE ADVANTAGE PROGRAM, ALTHOUGH SOME ARE COVERED BY MEDICAID OR PRIVATE INSURANCE. IN 2014, PRIORITY HEALTH BEGAN TO SCALE THIS PROGRAM TO REACH MORE PATIENTS AND HAS ENROLLED MORE THAN 400 PATIENTS WITH ADVANCED ILLNESS TO DATE. |
| Form 990, Part III, Line 4b PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH MEDICARE (CONTINUED) | PRIORITY HEALTH IMPLEMENTED A ROBUST MEDICATION THERAPY MANAGEMENT (MTM) PROGRAM IN PARTNERSHIP WITH A VENDOR SOLUTION. THE MTM PROGRAM OFFERS PRIORITY HEALTH MEDICARE MEMBERS THE OPPORTUNITY TO MEET ONE-ON-ONE WITH PHARMACISTS TO REVIEW ALL OF THEIR MEDICATIONS INCLUDING PRESCRIPTIONS, OVER-THE-COUNTER DRUGS, AND HERBAL AND VITAMIN SUPPLEMENTS. IN THE FIRST YEAR, 61% OF THE MORE THAN 16,000 MEMBERS WHO TOOK ADVANTAGE OF THE PROGRAM WERE ABLE TO IDENTIFY A COST SAVINGS. IN 2015, PRIORITY HEALTH EXPANDED THE PROGRAM TO COMMERCIAL AND MEDICAID MEMBERS. THIS HAS BEEN SUCCESSFUL TO RETURN POSITIVE DIRECT DRUG SAVINGS AS WELL AS INDIRECT COST AVOIDANCE. COMPLEX MEDICATION REGIMENS CREATE SIGNIFICANT CHALLENGES FOR PATIENTS LIVING WITH CHRONIC ILLNESS, THEIR CAREGIVERS, HEALTHCARE PROVIDERS, AND THE HEALTHCARE SYSTEM AS A WHOLE. THE IMPACT OF MEDICATION-RELATED PROBLEMS CAN BE MINIMIZED THROUGH A STRUCTURED MTM PROGRAM THAT USES PHARMACISTS WORKING COLLABORATIVELY WITH THE PATIENT AND THE PATIENT'S HEALTHCARE PROVIDERS. RETAIL AND OFFICE-BASED PHARMACIST WILL WORK WITH PATIENTS AND PROVIDERS TO ADDRESS DRUG RELATED PROBLEMS AND COMPLETE COMPREHENSIVE MEDICATION REVIEWS. IN 2014, PRIORITY HEALTH ENGAGED OVER 20,000 MEMBERS IN THE PROGRAM, RESULTING IN $1.46 SAVED IN DIRECT DRUG PRODUCT COST FOR EVERY $1 INVESTED IN MTM ($766,992 INVESTED; $1,122,707 SAVED). THE PROGRAM HAD 59% MEMBER ACCEPTANCE AND 87% PRESCRIBER ACCEPTANCE IN 2014. |
| Form 990, Part III, Line 4b PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH MEDICARE (CONTINUED) | PRIORITY HEALTH IMPLEMENTED A NEW CLINICAL QUALITY INITIATIVE BY PARTNERING WITH A COMPANY CALLED NAVIHEALTH TO ENHANCE THE QUALITY OF POST-ACUTE-CARE (PAC) SERVICES. THE RESEARCH AND DEVELOPMENT OF THIS POST ACUTE MODEL OF CARE BEGAN IN 2013, AND WAS IMPLEMENTED IN 2014. THIS INITIATIVE FOCUSES ON WHAT IS BEST FOR THE PATIENT, AND THE HOLISTIC MANAGEMENT OF PATIENT CARE THROUGH DISCHARGE PLANNERS, REHABILITATION THERAPISTS, SOCIAL WORKERS AND PRIORITY HEALTHCARE MANAGERS. DATA-DRIVEN INFORMATION WILL HELP PATIENTS AND THEIR FAMILIES UNDERSTAND WHAT TO EXPECT AT DISCHARGE AND THROUGHOUT THE REHABILITATION PERIOD. THE BENEFITS OF THIS INITIATIVE INCLUDE LOWER HOSPITAL ADMISSION RATES, OPTIMAL DISCHARGE SETTING EARLIER IN THE HOSPITAL STAY, EASIER MANAGEMENT OF PATIENT/FAMILY EXPECTATIONS, AND IDENTIFYING THE HIGHEST QUALITY PROVIDERS IN THE COMMUNITY. THIS DATA-DRIVEN APPROACH TO REHABILITATION HAS SUCCESSFULLY PROVEN TO IMPROVE EFFICIENCY AND QUALITY OF CARE FOR MEDICARE PATIENTS. PRIORITY HEALTH HAS SEEN HOSPITAL READMISSION RATES DECREASE, LENGTH OF HOSPITAL STAYS REDUCED BY 15% AND ACCESS TO POST-SURGICAL SERVICES IMPROVE BY 12%. PRIORITY HEALTH HAS A LARGE SKILLED NURSING FACILITY (SNF) NETWORK THAT CARE FOR ITS MEDICARE MEMBERS. THE AVERAGE LENGTH OF STAY FOR A PRIORITY HEALTH MEDICARE MEMBER IS APPROXIMATELY 22 DAYS, TWO DAYS LONGER THAN IS COVERED BY PRIORITY HEALTH AND 7 DAYS LONGER THAN THE BENCHMARK. THROUGH THE USE OF THIS VENDOR SOLUTION IN CONJUNCTION WITH SKILLED NURSES, WE ARE TARGETING A REDUCTION OF 4 DAYS IN THE AVERAGE LENGTH OF STAY AS WELL AS A REDUCTION IN RE-ADMISSIONS THROUGH BETTER DISCHARGE PLANNING. DURING 2014, PRIORITY HEALTH ESTIMATES A NET SAVINGS OF NEARLY $3 MILLION DUE TO POST ACUTE CARE INITIATIVES. |
| Form 990, Part III, Line 4c PROGRAM SERVICE DESCRIPTION - WELLNESS | FOR MORE THAN 20 YEARS, PREVENTION AND WELLNESS HAVE BEEN THE FOUNDATION OF PRIORITY HEALTH'S APPROACH TO HEALTHCARE. PRIORITY HEALTH HAS BECOME THE ONLY HEALTH PLAN IN MICHIGAN TO RECEIVE WELLNESS ACCREDITATION FROM THE NCQA AND IS ONE OF EIGHT HEALTH PLANS NATIONWIDE. THIS ACCREDITATION CERTIFIES PRIORITY HEALTH AS AN INDUSTRY LEADER IN KEEPING MEMBERS HEALTHY BY PREVENTING ILLNESS, MANAGING CHRONIC CONDITIONS AND ULTIMATELY REDUCING COSTS. PRIORITY HEALTH IS ONE OF FIVE NCQA WELLNESS AND HEALTH PROMOTION-ACCREDITED HEALTH PLANS IN THE U.S. ALSO ACCREDITED WITH PERFORMANCE REPORTING NATIONWIDE. PRIORITY HEALTH PROVIDES WELLNESS PROGRAMS WITHIN ITS STANDARD HEALTH PLANS, OFFERS STAND-ALONE WELLNESS PROGRAMS TO EMPLOYER GROUPS, PARTICIPATES IN, AND SPONSORS WELLNESS PROGRAMS FOR THE COMMUNITY AT LARGE TO IMPROVE THE HEALTH OF ALL PEOPLE, NOT JUST MEMBERS. IN 2014, OVER 260 HOURS OF WELLNESS CLASSES AND HEALTH FAIRS WERE PROVIDED TO THE COMMUNITY TO PROMOTE HEALTHY LIVING. |
| Form 990, Part III, Line 4c PROGRAM SERVICE DESCRIPTION - WELLNESS (CONTINUED) | SPECIFICALLY, PRIORITY HEALTH SPONSORS PROGRAMS WITHIN THE COMMUNITY. IN RECENT YEARS THIS HAS INCLUDED SPONSORING BIKE CLINICS AND CYCLING TEAMS WHICH ALSO PUT ON CLINICS IN SCHOOLS, AND PROVIDING FREE HELMETS TO CHILDREN, WALKS AND VARIOUS OTHER SCHOOL OR COMMUNITY EVENTS TO PROMOTE HEALTHIER LIVING. PRIORITY HEALTH ALSO SPONSORS OR PRODUCES COMMUNITY EDUCATION PROGRAMS, HEALTH FAIRS, WALKS/RUNS/TRIATHLONS, AND NEWSLETTERS. THIS INCLUDES THE GRAN FONDO, A CYCLING EVENT TO ACTIVELY ENGAGE THE COMMUNITY WHILE ACCELERATING SKIN CANCER AWARENESS, PREVENTION AND RESEARCH. THE SECOND ANNUAL RIDE ON SATURDAY, JUNE 28, 2014 DREW 1,400 CYCLISTS AND GENERATED NEARLY $120,000 IN SUPPORT OF THE MSU COLLEGE OF HUMAN MEDICINE MISSION, WITH 100% OF EVERY DOLLAR RAISED BENEFITING SKIN CANCER AWARENESS, PREVENTION AND RESEARCH. RIDERS PEDALED ANYWHERE FROM 12 MILES TO 80 MILES ACROSS THE ROLLING SCENIC TERRAIN OF WEST MICHIGAN. PRIORITY HEALTH HAD MORE THAN 200 EMPLOYEES PARTICIPATE IN THE EVENT, LOGGING MORE THAN 4,000 MILES AND RAISING MORE THAN $10,000 IN SUPPORT OF HEALTHY LIVING AND CANCER RESEARCH. IN ADDITION TO THE GRAN FONDO, PRIORITY HEALTH SPONSORED THE ARTS IN MOTION RUN/WALK BENEFITING MICHIGAN YOUTH ARTS AND NEW NON-PROFIT PARTNER ROCK CF, A NONPROFIT DEDICATED TO INCREASING THE QUALITY OF LIFE FOR PEOPLE WITH CYSTIC FIBROSIS. THIS RACE IS PART OF THE LONGSTANDING ARTS, BEATS & EATS FESTIVAL AND HIGHLIGHTS THE IMPORTANCE OF HEALTHY LIVING WITHIN THE COMMUNITY. THE 6TH ANNUAL PRIORITY HEALTH ARTS IN MOTION 5K/10K ATTRACTED 521 RUNNERS/WALKERS AND THE PRIORITY HEALTH ZUMBATHON CELEBRATION HAD 1,216 PEOPLE PARTICIPATE IN A HUGE ZUMBA CLASS-STYLE EVENT AT THE FESTIVAL. PRIORITY HEALTH ALSO SUPPORTED GIRLS ON THE RUN, A TRANSFORMATIONAL POSITIVE YOUTH DEVELOPMENT PROGRAM ROOTED IN PHYSICAL ACTIVITY FOR GIRLS IN 3RD-8TH GRADE. THE PROGRAM CULMINATES WITH THE GIRLS BEING PHYSICALLY AND EMOTIONALLY PREPARED TO COMPLETE A CELEBRATORY 5K RUNNING EVENT. THE GOAL OF THE PROGRAM IS TO UNLEASH CONFIDENCE THROUGH ACCOMPLISHMENT WHILE ESTABLISHING A LIFETIME APPRECIATION OF HEALTH AND FITNESS. IN 2014, PRIORITY HEALTH CONTRIBUTED $10,000 TO BENEFIT THE GIRLS ON THE RUN PROGRAM. |
| Form 990, Part III, Line 4c PROGRAM SERVICE DESCRIPTION - WELLNESS (CONTINUED) | PRIORITY HEALTH PARTICIPATES IN PARTNERSHIP WITH MARANDA, A WEST MICHIGAN NEWS CELEBRITY, DIRECTING MESSAGES TO CHILDREN ON HEALTH AND OTHER POSITIVE MESSAGING. MARANDA PRESENTS A TV SERIES CALLED "WHERE YOU LIVE" AND BRINGS IN EXPERTS TO TALK TO KIDS ABOUT HEALTHY LIVING. THIS PARTNERSHIP ALSO SPONSORS EVENTS THROUGHOUT WEST MICHIGAN REACHING OUT TO KIDS IN AT-RISK COMMUNITIES. IN 2014, OVER $50,000 WAS CONTRIBUTED TO BENEFIT MARANDA PARK PARTIES, WHICH PROVIDE FREE HEALTH AND FITNESS ACTIVITIES FOR CHILDREN AT INNER CITY PUBLIC PARKS. PRIORITY HEALTH PARTICIPATES IN PARTNERSHIP WITH THE WXYZ COMMUNITY ACTION TEAM, AN EAST MICHIGAN NEWS CHANNEL, TO SUPPORT THE COMMUNITY IN EAST MICHIGAN. THE PARTNERSHIP SUPPORTS THE WXYZ TREE LIGHTING CEREMONY AND VARIOUS NON-PROFIT PROJECTS INCLUDING HABITAT FOR HUMANITY. IT ALSO ENABLES PRIORITY HEALTH TO CREATE PUBLIC SERVICE ANNOUNCEMENTS THAT AIR THROUGHOUT THE YEAR. IN 2014, PRIORITY HEALTH DONATED $190,000 TO SUPPORT THE EFFORTS OF THE PARTNERSHIP WITH THE WXYZ COMMUNITY ACTION TEAM. |
| Form 990, Part III, Line 4c PROGRAM SERVICE DESCRIPTION - WELLNESS (CONTINUED) | PRIORITY HEALTH CONDUCTS FREE WELLNESS CLASSES THROUGHOUT THE STATE. THE BROADER COMMUNITY IS WELCOME TO ATTEND CLASSES THAT EDUCATE THE COMMUNITY IN TOPICS SUCH AS NUTRITION, FITNESS AND PREVENTION. PRIORITY HEALTH OFFERS A FREE HEALTHY LIFESTYLE PROGRAM FOR OVERWEIGHT CHILDREN AND THEIR FAMILIES THROUGH THE FIT KIDS 360 PROGRAM. FIT KIDS 360 IS FOR CHILDREN AGE 5 TO 16 WHO HAVE A BODY MASS INDEX (BMI) AT OR ABOVE THE 85%ILE (THE MEDICAL DEFINITION OF OVERWEIGHT). IT COMBINES EDUCATION ABOUT NUTRITION, BEHAVIORAL HEALTH AND PHYSICAL ACTIVITY WITH OPPORTUNITIES FOR EXERCISE AND OTHER ACTIVITIES. OVER THE PAST FOUR YEARS A TOTAL OF 33 FIT KIDS 360 CLASSES HAVE BEEN ADMINISTERED THROUGHOUT THE STATE OF MICHIGAN. A TOTAL OF 418 OVERWEIGHT OR OBESE PATIENTS AGED 5-16 YEARS OLD WERE ENROLLED IN ONE OF THE 33 FIT KIDS 360 CLASSES WHERE 258 PATIENTS COMPLETED THE PROGRAM AND FOLLOW-UP EVALUATION REPRESENTING A 62% RETENTION RATE. PRIORITY HEALTH SUPPORTS HEALTH AND SOCIAL WELFARE ACTIVITIES VIA WELL THOUGHT OUT CONTRIBUTIONS OF OVER $230,000 ANNUALLY TO ORGANIZATIONS IN ORDER TO IMPROVE HEALTH SERVICES AND CONDITIONS IN NEIGHBORHOODS, WORKPLACES AND SCHOOLS THROUGHOUT THE COMMUNITIES IT SERVES. THINK HEALTH, A NEW DIGITAL MAGAZINE, WAS RELEASED BY PRIORITY HEALTH IN 2014 TO SUPPORT CONSUMERS AND BUSINESS OWNERS AS THEY MAKE HEALTHCARE DECISIONS. THINK HEALTH FEATURES PRIORITY HEALTH EXPERTS AS WELL AS OTHER THOUGHT LEADERS AND THIRD PARTY ORGANIZATIONS ACROSS THE HEALTH INSURANCE, HEALTHCARE TECHNOLOGY AND FITNESS INDUSTRIES. THE SITE ALSO HIGHLIGHTS PERSONAL STORIES FROM INDIVIDUALS LOOKING TO IMPROVE THEIR HEALTH AND INSPIRE OTHERS, AS WELL AS INSIDER TIPS ON HOW TO GET INVOLVED IN ACTIVITY-RELATED EVENTS ACROSS MICHIGAN. |
| Form 990, Part IV, Line 14a Audited Financial Statements | The organization's financial statements are audited annually by an independent accounting firm. The "No" response to these questions relates to the fact that the GAAP basis financial statements were prepared on a consolidated basis and not on a stand alone basis. The organization is audited annually on a stand alone basis and issued financial statements on a stand alone basis which are prepared in accordance with SAP (Statutory Accounting Principles), as required by regulatory authorities. The figures in this Form 990 reconcile to the financial statements prepared under statutory accounting principles as submitted to the State of Michigan. |
| Form 990, Part V, Line 2a NUMBER OF EMPLOYEES REPORTED ON FORM W-3 | ALL EMPLOYEES OF PRIORITY HEALTH WERE EMPLOYED DURING THE YEAR BY SPECTRUM HEALTH SYSTEM (38-3382353) AND LEASED BACK TO PRIORITY HEALTH. SALARIES AND WAGES, EMPLOYEE BENEFITS AND PAYROLL TAXES ARE ALLOCATED TO PRIORITY HEALTH VIA A MANAGEMENT FEE. THE SALARIES AND WAGES REPORTED IN PART IX STATEMENT OF FUNCTIONAL EXPENSES REFLECTS THE PORTION OF SALARIES AND WAGES ALLOCATED TO PRIORITY HEALTH. SPECTRUM HEALTH SYSTEM FILED ALL APPLICABLE IRS TAX FILINGS INCLUDING FORMS W-2 AND W-3 ON BEHALF OF PRIORITY HEALTH. |
| Form 990, Part VI, Line 12c CONFLICT OF INTEREST POLICY (CONTINUED) | MANAGEMENT 1. Upon acceptance of an employment offer, each member of management completes a conflict of interest disclosure questionnaire. A copy of the member of management's disclosure questionnaire is sent to the organization's legal department. A copy of the member of management's disclosure is reviewed by the organization's COI coordinator and escalated to the COI Committee if necessary. 2. Annually, each member of management completes an annual conflict of interest disclosure questionnaire electronically. The disclosure questionnaire is reviewed by the legal, organizational integrity, internal audit, and human resources departments. 3. There is an ongoing requirement that members of management complete another disclosure questionnaire at any point during his/her employment when a new potential conflict of interest arises. If a member of management completes a disclosure questionnaire as a result of a new potential conflict of interest, that disclosure questionnaire is submitted to the legal, organizational integrity, internal audit, and human resources departments. 4. The legal, organizational integrity, internal audit, and human resources departments, in consultation with executive management, determine how any reported conflicts should be managed. Management of a conflict may take a variety of different forms from implementation of a management plan to requiring that the member of management cease the activity creating the conflict or, in extreme cases, leave the organization's employment. Management is determined on an individual basis based upon the facts and circumstances surrounding the disclosure. The purpose of conflict management is to provide transparency within the organization and to ensure that the organization's employees are always acting in the best interest of the organization. |
| Form 990, Part VI, Line 7b DECISIONS REQUIRING APPROVAL BY MEMBERS OR STOCKHOLDERS (CONTINUED) | 2.2.8 All borrowings or guarantees of indebtedness by the corporation (or any entity controlled by the corporation), including any operating lease in an amount greater than one million dollars ($1,000,000.00) during the initial lease term, not including renewals and/or extensions; 2.2.9 All lending by the corporation (or any entity controlled by the corporation) to persons other than Spectrum Health or an entity controlled by Spectrum Health in excess of the Authority Matrix Amount; 2.2.10 The corporation's investments of cash and/or reserves, whether on an individual basis or as part of a pooled investment strategy; 2.2.11 Any merger or consolidation of the corporation (or any entity controlled by the corporation), or any other change in ownership percentages, control, or capital structure of the corporation (or any entity controlled by the corporation); 2.2.12 The purchase of all, or a majority of, another corporation, limited liability company, partnership or other legal entity's stock, membership interest, partnership interest, other ownership interest, or assets; 2.2.13 The creation of any entity controlled, directly or indirectly, by the corporation; 2.2.14 The sale or transfer of more than ten percent (10%) of the assets of the corporation (or any entity controlled by the corporation) to any person or entity not controlled by Spectrum Health; 2.2.15 Dissolution of the corporation; 2.2.16 The selection, retention, and oversight of the outside auditors for the corporation (or any entity controlled by the corporation) and 2.2.17 In other cases when required by law or as otherwise provided in these Bylaws. The Class A Shareholder, prior to exercising any of the reserved powers set forth above, shall notify the Class B Shareholder (provided such action is not taken at a duly called meeting of the shareholders, Board of Directors or any designated committee). 2.3 Class B Shareholders' Reserved Powers. The Class B Shareholders shall have the reserved powers set forth in this Section 2.3. The corporation's Board of Directors may recommend action to the Class B Shareholders with respect to the reserved powers set forth in this Section 2.3. The Class B Shareholders may, notwithstanding any other provision of these Bylaws or the Articles, act jointly, within their sole and exclusive powers and discretion, elect and/or remove the Class B Shareholder-appointed members of the corporation's Board of Directors pursuant to Article VI of these Bylaws. 2.4 Compliance with Spectrum Health Policies. Notwithstanding anything contained in these Bylaws to the contrary, the corporation and its subsidiaries shall at all times comply with and implement Spectrum Health policies and procedures approved by the Chief Executive Officer of Spectrum Health, or his/her designee as being specifically applicable to the corporation, except to the extent that such compliance and/or implementation would (a) materially and negatively impact the rights, powers, or preferences of the Class B Shareholders; or (b) be noncompliant with applicable laws and/or regulations. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | Committees - The Chair of the Board of Directors may establish such standing or special committees from time to time as he or she will deem appropriate to conduct the activities of the corporation, and will define the powers and responsibilities of such committees. Persons who are not members of the Board of Directors will be eligible to serve on committees other than the Executive Committee. The members and chair of all committees will be appointed by the Chair of the Board of Directors for a one (1) year term or until their successors are duly elected, but will be subject to removal at any time by the Chair of the Board of Directors. A committee will have the specific powers and responsibilities as determined by the Board of Directors excluding those powers and responsibilities retained by the shareholders or Board of Directors pursuant to the Articles of Incorporation or Bylaws of the corporation. Executive Committee - The Chair of the Board of Directors may appoint an Executive Committee consisting of the Chair of the Board of Directors, the Vice Chair, and such additional directors as the Chair of the Board of Directors may determine from time to time. The Executive Committee may exercise all powers and authority of the Board of Directors in managing the corporation between meetings of the Board of Directors (within the limits prescribed by the Articles of Incorporation or Bylaws of the corporation or by law) or may have such specific powers and responsibilities as determined by the Chair of the Board of Directors. |
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | MEMBERS OF THE BOARD OF DIRECTORS AND OFFICERS OF THE ORGANIZATION ALSO SERVE ON THE BOARD OF DIRECTORS AND/OR AS OFFICERS OF RELATED TAXABLE ENTITIES - Business relationship |
| Form 990, Part VI, Line 6 Classes of members or stockholders | The Organization has three shareholders as follows: Spectrum Health System (EIN 38-3382353), Class A Shareholder - 93.9% Munson Healthcare (EIN 38-1362830), Class B Shareholder - 5.5% Northern Michigan Regional Health System (EIN 38-2146751), Class B Shareholder - 0.6% All Shareholders are tax-exempt Internal Revenue Code Section 501(c)(3) organizations. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | Election of Members and Their Rights From Priority Health bylaws: 6.2 Number and Class of Directors. The Board of Directors will be composed of not less than fifteen (15) and not more than twenty-one (21) members, which will be divided into the following classes: 6.2.1 One-third (1/3) of the directors will be adult enrollees as specified under MCL Section 500.3511(1) and elected pursuant to Section 6.3 below. At least one (1) of such adult enrollee directors will be from the corporation's Northern service area that is also served by Munson Healthcare or Healthshare, Inc. (together, "Northern Shareholders"). 6.2.2 Two (2) of the directors will be appointed jointly by the Northern Shareholders. Of such directors, one (1) will be a physician. 6.2.3 The remainder of the directors (not less than eight (8)) will be appointed by Spectrum Health. 6.3 Election of Adult Enrollee Members. The Governance Committee or similarly delegated committee of the Board of Directors will solicit names of potential candidates from the members, shareholders, directors and community. The Committee will submit to the Board of Directors a list of nominees for election to the Board of Directors as adult enrollee representatives. At least one (1) member will be nominated for each directorship to be filled at such annual meeting. In addition, any group of adult enrollees in the corporation's health maintenance plan, upon filing a petition with more than one hundred (100) legitimate signatures of current members with the Secretary of the Board of Directors at least ninety (90) days prior to the election date for the Board of Directors, may nominate a candidate for election to the Board of Directors. Eligible members will be given the opportunity to vote on the candidates for election to the Board of Directors. No more than two (2) persons employed by or affiliated with any one (1) employer or other group may be nominated. 6.4 Term. The adult enrollee members will be divided into three (3) classes, which will be as evenly divided as possible. The terms of office of the classes will expire in three (3) successive years, with one (1) class expiring each year. Each elected director will be elected for a term of three (3) years (except for the directors elected immediately after adoption of this Section 6.4 who will serve the terms designated by the Board of Directors). The directors appointed by the Northern Shareholders and Spectrum Health will serve one (1) year terms or until such time as their successor is appointed. 6.5 Vacancies. Any vacancy in a Board of Director position designated by the Northern Shareholders or Spectrum Health will be filled by the Northern Shareholders or Spectrum Health, respectively. Any vacancy in a position for an adult enrollee will be filled by the remaining adult enrollees on the Board of Directors. Each person appointed to fill a vacancy will complete the unexpired portion of the original term of the director being replaced. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | Decisions Subject to Approval of shareholders (Not Members) Certain decisions are subject to approval of shareholders. From Priority Health bylaws: 2.2 Class A Shareholder's Reserved Powers. The Class A Shareholder shall have the reserved powers set forth in this Section 2.2. The corporation's Board of Directors may recommend action to the Class A Shareholder with respect to the reserved powers set forth in this Section 2.2. The actions listed below may, notwithstanding any other provision of these Bylaws or the Articles, be unilaterally caused and/or taken by the Class A Shareholder, within its sole and exclusive power and discretion, and shall not be deemed authorized unless and until approved by the Class A Shareholder: 2.2.1 Amendment of the Articles of Incorporation or Bylaws of the corporation as provided in Section 13.1 of these Bylaws; 2.2.2 Election and/or removal of the Class A Shareholder-appointed members of the corporation's Board of Directors pursuant to Article VI of these Bylaws; 2.2.3 Election and/or removal of the corporation's Chairperson of the Board of Directors; 2.2.4 Hiring, discharge, and evaluation of the corporation's President following consultation with the corporation's Board of Directors pursuant to Section 7.3; 2.2.5 Adoption of the corporation's strategic plan(s); 2.2.6 Adoption of the corporation's annual operating and capital budgets, and any amendments to such budgets; 2.2.7 All capital expenditures by the corporation in excess of that amount (the "Authority Matrix Amount") set forth in the Authority Matrix for Capital Expenditures and Loans to Non-Spectrum Health Entities (the "Expenditure Authority Matrix"), a current copy of which is attached hereto as Exhibit A and which may be amended from time to time by Spectrum Health System ("Spectrum Health"); |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The review process for this Form 990 is as follows: 1. Preparation of the return is supervised and reviewed by the organization's Corporate Tax Manager. 2. A second review is performed by an external CPA firm with expertise in tax-exempt return preparation. 3. The return is reviewed by the organization's finance and legal departments and presented to the Finance and Audit Committee who is responsible for approving the return for filing and distribution to the Board of Directors. 4. The return is sent to the members of the Board of Directors. 5. The organization's Chief Financial Officer reviews comments or questions received by members of the Board of Directors, if any, to address or to incorporate, as appropriate, into the return prior to filing. |
| Form 990, Part VI, Line 12c Conflict of interest policy | BOARD OF DIRECTORS 1. Conflicts of interest must be disclosed, BOTH VIA AN ANNUAL ELECTRONIC DISCLOSURE PROCESS as well as verbally at a board meeting prior to discussion of any agenda item with regard to which a board member has a conflict. 2. A person having a financial interest in a proposed transaction or arrangement may make a presentation at a meeting of the Board of Directors or committee considering that transaction or arrangement, but after that presentation he or she shall leave the meeting during discussion and voting on that proposed transaction or arrangement. The person having the financial interest shall not be counted in determining whether a quorum is present. 3. The chairperson of the Board of Directors or committee shall, if appropriate, appoint a disinterested person or committee (including outside advisors) to investigate alternatives to the proposed transaction or arrangement, and to advise whether the proposed transaction or arrangement is in the organization's best interest. 4. The Board of Directors or committee shall exercise due diligence to determine whether the organization can, with reasonable efforts, obtain a more advantageous transaction or arrangement that would not give rise to a conflict of interest. 5. If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the Board of Directors or committee shall determine by a majority vote of the disinterested directors and members whether the proposed transaction or arrangement is in the organization's best interest and for its own benefit and whether the transaction is fair and reasonable to the organization, and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. 6. The minutes of the meetings of the Board of Directors and all of the organization's committees shall set forth: a)The names of the persons who disclosed a financial interest in a proposed transaction or arrangement involving the organization or any of its subsidiaries and the nature of the financial interest; and b)The names of the persons who were present for discussions and votes relating to such transaction or arrangement, including any discussion of alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection with that matter. The votes of individual members need not be recorded unless otherwise directed by the Board of Directors or committee. 7. There is an ongoing requirement that members of the board of directors complete another disclosure questionnaire at any point during his/her tenure on the board of directors when a new potential conflict of interest arises. If a member of the board of directors completes a disclosure questionnaire as a result of a new potential conflict of interest, that disclosure questionnaire is submitted to the legal, organizational integrity, internal audit, and human resources departments for review. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | The Spectrum Health System Board of Directors (through its Executive Committee) uses the following process for determining compensation of the top management official, other officers, and key employees at Priority Health. Labor market data reflecting comparable organizations and jobs (prepared by independent firms) are relied upon. Competitive assessment reports are provided to the Executive Committee in advance of meetings. The competitive assessment report is prepared by a nationally known independent executive compensation firm and, for calendar 2014 (1/1/14-12/31/14), was based on the following independent surveys of healthcare executives at comparable health systems, health plans, and medical groups: * American Medical Group Association: 2013 Medical Group Compensation & Financial Survey * Chief Executive of Multi-site organizations: 2013 Leading Age-CEMO Leadership Compensation Survey * Integrated Healthcare Strategies: 2013 Children's Hospitals Executive Compensation Survey * Integrated Healthcare Strategies: 2013 Healthcare Executive Compensation Survey * Mercer Human Resources Consulting: 2013 Benchmark Database Executive Survey * Mercer Human Resources Consulting: 2013 Integrated Health Networks Compensation Survey * Medical Group Management Association: 2013 Management Compensation Survey * Sullivan, Cotter and Associates: 2013 Survey of Manager and Executive Compensation in Hospitals and Health Systems * Sullivan, Cotter and Associates: 2013 Survey of Manager and Executive Compensation in Children's Hospitals * Sullivan, Cotter and Associates: 2013 Physician Compensation and Productivity Survey Report * Towers Watson: 2013 HealthCare Executive and Management Compensation Survey Report * Towers Watson: 2013 General Industry Top Management Compensation Survey Report * Warren: Fall 2013 The HMO Salary Survey Compensation adjustments are approved by Executive Committee members, consistent with the Spectrum Health compensation philosophy described below. Minutes of Committee discussions and decisions are prepared to memorialize Executive Committee decisions based upon the above data. Cash compensation data relied upon by the Executive Committee is national and reflects the compensation paid to executives in comparable jobs in comparably-sized healthcare and / or health insurance organizations. Spectrum Health recruits nationally for its executives. Benefits data reflect national healthcare / health insurance market practices. Geographic pay differential and cost of living data indicates consistency with national data. This process is intended to assist Spectrum Health in qualifying for the rebuttable presumption of reasonableness (Intermediate Sanctions Regulations) and complying with the potential Spectrum Health Excess Benefit Transaction Policy for those individuals in the group who are disqualified persons. The opinion submitted from the third party independent consulting firm is in accordance with the provisions of Treasury Regulations Section 53.4958-6(c)(2) and is also intended to satisfy the professional advice requirement of Treasury Regulations Section 53.4958-1(d)(4)(iii). |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | See explanation provided for Form 990, Part VI, Line 15a. |
| Form 990, Part VI, Line 19 Required documents available to the public | The organization's Articles of Incorporation and Statutory Financial Statements are on file with the State of Michigan and available to the public on the State's website. The organization's bylaws and internal policies are generally not made available to the public. The overall system consolidated financial statements are provided at www.spectrumhealth.org in the section titled "about us." Financial performance is discussed at an annual public meeting held and posted to www.spectrumhealth.org annually (under the section titled "about us"). |
| Form 990, Part VII, Section A, Line 2 Individuals Compensated more than $100,000 | There are no individuals reported due to the integration with Spectrum Health System. Refer to the disclosure for Form 990, Part V, Line 2a for further detail. |
| Form 990, Part VII, Section A COMPENSATION OF DIRECTORS | BASED ON EXTERNAL OPINION BY SULLIVAN COTTER AND ASSOCIATES, INC., OBTAINED A FEW YEARS AGO, PRIORITY HEALTH COMPENSATES BOARD MEMBERS IN A MANNER THAT IS REASONABLE IN RELATION TO MARKET DATA. BOARD OF DIRECTORS COMPENSATION IS REVIEWED ANNUALLY BY INTERNAL STAFF TO CONFIRM COMPENSATION FALLS WITHIN REASONABLE LIMITS. ANY COMPENSATION AMOUNT IS TREATED AS TAXABLE TO THE BOARD MEMBER AND IS REPORTED AND PROVIDED TO THEM ON FORM 1099, AS REQUIRED ACCORDING TO THE REPORTING THRESHOLDS. CERTAIN BOARD MEMBERS ARE EMPLOYED BY A RELATED ORGANIZATION. COMPENSATION REPORTED IN PART VII, SECTION A, COLUMN E IS FOR SERVICES PERFORMED FOR THE RELATED ORGANIZATION, NOT THE FILING ORGANIZATION. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Change in Nonadmitted Assets - -30067173; Net unrealized gain (loss) on subsidiaries - 14246562; |
| Form 990, Part XII, Line 2b Audited Financial Statements | The organization's financial statements are audited annually by an independent accounting firm. The organization issued GAAP basis financial statements which are prepared on a consolidated basis and not on a stand alone basis. The organization is audited annually on a stand alone basis and issued financial statements on a stand alone basis which are prepared in accordance with SAP (Statutory Accounting Principles), as required by regulatory authorities. The figures in this Form 990 reconcile to the financial statements prepared under statutory accounting principles as submitted to the State of Michigan. |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014
Additional Data
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |