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.
Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
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 NOT-FOR-PROFIT 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 HEALTH CARE 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 HAS CONSISTENTLY MAINTAINED "COMMENDABLE" ACCREDITATION FOR ITS HMO PRODUCTS FROM THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA), AN INDEPENDENT MANAGED CARE ACCREDITING BODY. PRIORITY HEALTH HAS EARNED EITHER A "COMMENDABLE" OR "EXCELLENT" RATING EVERY YEAR SINCE 1998 (2020 RATINGS WERE NOT RELEASED DUE TO COVID-19 PANDEMIC). PRIORITY HEALTH HAS ALSO MAINTAINED AN "A" (EXCELLENT) FINANCIAL STRENGTH RATING FOR FIVE CONSECUTIVE YEARS FROM A.M. BEST, A HEALTH INSURANCE RATINGS AGENCY, RECOGNIZING THE FINANCIAL STRENGTH OF THE ORGANIZATION AND FOCUS ON MANAGING THE COST OF HEALTH CARE FOR ITS COMMUNITY. IN EARLY 2020, PRIORITY HEALTH COMPLETED A MERGER WITH TOTAL HEALTH CARE, INC., A HEALTH PLAN BASED IN SOUTHWEST MICHIGAN. BOTH COMPANIES WILL CONTINUE TO OPERATE INDEPENDENTLY AND MAINTAIN SEPARATE BRANDS. PRIORITY HEALTH WILL CONTINUE TO SERVE MEMBERS STATEWIDE AND TOTAL HEALTH CARE WILL CONTINUE TO CONCENTRATE ON THE CITY OF DETROIT AND THE SURROUNDING COMMUNITIES. AS PART OF THIS MERGER, A FOUNDATION WAS ESTABLISHED TO WHICH PRIORITY HEALTH COMMITTED $25 MILLION TO FOCUS ON IMPROVING HEALTH IN DETROIT AREA COMMUNITIES. THE FOUNDATION WILL SUPPORT AND INVEST IN HEALTH CARE INITIATIVES THAT INCREASE ACCESS, IMPROVE OUTCOMES, AND HAVING A MEANINGFUL IMPACT ON THE LIVES OF THE PEOPLE IN AND AROUND THE CITY OF DETROIT. PRIORITY HEALTH'S MAJORITY SHAREHOLDER, 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 14 HOSPITALS; 150 AMBULATORY AND SERVICE SITES; 4,700 PHYSICIANS AND ADVANCED PRACTICE PROVIDERS; AND PRIORITY HEALTH, A HEALTH PLAN WITH MORE THAN 920,000 MEMBERS. SPECTRUM HEALTH IS WEST MICHIGAN'S LARGEST EMPLOYER, WITH OVER 31,000 EMPLOYEES. THE ORGANIZATION PROVIDED $542 MILLION IN COMMUNITY BENEFIT DURING CALENDAR YEAR 2020. SPECTRUM HEALTH REMAINS ONE OF THE TOP HEALTH SYSTEMS IN THE COUNTRY IN THE COUNTRY AND EXPANDED ITS FOOTPRINT WITH THE 2018 INTEGRATION OF LAKELAND REGIONAL HEALTH SYSTEM IN SOUTHWEST MICHIGAN. THE AFFORDABLE CARE ACT (ACA) ADDED NEW REQUIREMENTS THAT HOSPITAL ORGANIZATIONS MUST SATISFY IN ORDER TO MAINTAIN TAX EXEMPT STATUS UNDER IRC 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 HEALTH CARE, WHICH INCLUDES IMPROVING ACCESS TO AFFORDABLE HEALTH CARE 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. PRIORITY HEALTH PURSUES INITIATIVES THAT WILL IMPROVE PATIENT OUTCOMES WHILE HELPING TO REDUCE THE OVERALL COST TO THE MEMBER. IN 2020, PRIORITY HEALTH LOWERED HEALTH COSTS ACROSS ALL LINES OF BUSINESS BY $11.9 MILLION IN INCREMENTAL SAVINGS THROUGH NEW OR EXPANDED MANAGED CARE INITIATIVES AND CHRONIC DISEASE MANAGEMENT PROGRAMS. THESE PROGRAMS INFLUENCE PHYSICIAN PRACTICES, PROMOTE APPROPRIATE HEALTH CARE 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 DEVELOPING CHRONIC DISEASES, AS WELL AS INITIATIVES TO BETTER MANAGE INDIVIDUALS WHO ALREADY HAVE CHRONIC DISEASES. IN 2020, PRIORITY HEALTH ENROLLED OVER 74,000 MEMBERS IN MANAGED CARE AND CHRONIC DISEASE MANAGEMENT PROGRAMS. 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. 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 HEALTH CARE AREAS SUCH AS EMERGENCY ROOM (ER) 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; DEVELOPING AND PUBLISHING PREVENTIVE HEALTH CARE GUIDELINES AVAILABLE TO THE GENERAL PUBLIC ON ITS WEBSITE; AND USING 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 WITH INDIVIDUALS, SMALL GROUPS AND ELDERLY MAKING UP NEARLY 67% OF THE MEMBERSHIP BASE. PRIORITY HEALTH PROVIDED COMMUNITY-RATED AFFORDABLE HEALTH INSURANCE TO OVER 534,000 MEMBERS WHO ARE INDIVIDUALS, SMALL GROUPS AND ELDERLY IN 2020. PRIORITY HEALTH ALSO SUPPORTS ITS WHOLLY OWNED SUBSIDIARY, PRIORITY HEALTH CHOICE, INC., WHICH PROVIDES ACCESS TO EXCELLENT HEALTH CARE TO OVER 154,000 MEDICAID MEMBERS OF THE 534,000 MEMBERS MENTIONED PREVIOUSLY. |
| Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH HMO (CONTINUED) | IN 2016, PRIORITY HEALTH WAS SELECTED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) TO PARTICIPATE IN A FEDERAL COMPREHENSIVE PRIMARY CARE PLUS (CPC+) INITIATIVE, A NATIONAL ADVANCED PRIMARY CARE MEDICAL HOME MODEL THAT AIMS TO STRENGTHEN PRIMARY CARE THROUGH REGIONALLY BASED MULTI-PAYER PAYMENT REFORM AND CARE DELIVERY TRANSFORMATION. THE GOALS OF CPC+ ARE TO IMPROVE THE QUALITY-OF-CARE PATIENTS RECEIVE, IMPROVE PATIENTS' HEALTH, AND SPEND HEALTH CARE DOLLARS WISELY. CPC+ WILL BRING TOGETHER CMS, COMMERCIAL INSURANCE PLANS, PRIORITY HEALTH CHOICE, AND PRIORITY HEALTH MEDICARE TO PROVIDE THE FINANCIAL SUPPORT NECESSARY FOR PRACTICES TO MAKE FUNDAMENTAL CHANGES IN THEIR CARE DELIVERY. THE CPC+ PILOT BEGAN IN JANUARY 2017 AND TESTS A 5-YEAR MODEL. 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 AWARDS 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. PRIORITY HEALTH PAID PRIMARY CARE PROVIDERS MORE THAN $39 MILLION IN 2021 BASED ON THEIR PERFORMANCE IN 2020. 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 65% AND 78% OF MEMBERS RECEIVED RECOMMENDED BREAST CANCER SCREENING COMPARED TO THE NATIONAL AVERAGE OF 73%. ADDITIONALLY, 80% OF MEMBERS RECEIVED CHILDHOOD IMMUNIZATIONS COMPARED TO THE NATIONAL AVERAGE OF 73%. PRIORITY HEALTH SHARES RISK WITH PROVIDERS AND EMPLOYERS BY OFFERING THESE INCENTIVES AND OTHER RISK SHARING ARRANGEMENTS. THIS PROMOTES LOWER OVERALL HEALTH CARE COSTS AND IMPROVED QUALITY TO THE COMMUNITY. IN 2015, PRIORITY HEALTH LAUNCHED A COST ESTIMATOR TOOL TO HELP MEMBERS CALCULATE THEIR OUT-OF-POCKET COSTS TO FIND THE MOST AFFORDABLE SERVICES. THE ONLINE COST ESTIMATOR TOOL DISPLAYS PRIORITY HEALTH SPECIFIC FEES FOR 300 COMMON HEALTH CARE PROCEDURES. THE COST ESTIMATOR RECOMMENDS LOWER-COST DOCTOR/FACILITY OPTIONS TO HELP ENSURE MEMBERS GET THE HIGHEST-QUALITY CARE AT THE BEST PRICE. THIS INNOVATIVE TOOL SUPPORTS PRIORITY HEALTH'S CONTINUED MARKET LEADERSHIP IN TRANSPARENCY AND LOWERS THE COST OF CARE TO THE COMMUNITY. SINCE LAUNCHING IN 2015, THE COST ESTIMATOR HAS RESULTED IN CUMULATIVE SHARED SAVINGS OF MORE THAN $14 MILLION. THE PRIORITY HEALTH THIRD PARTY LIABILITY (TPL) TEAM HAS CONSISTENTLY IMPROVED OUTCOMES BY INCREASING SAVINGS THROUGH AUDIT, ANALYSIS, AND THOROUGH ACCOUNT EVALUATION. WITH EMPHASIS ON IMPROVING BOTH MEMBER AND PROVIDER SATISFACTION, PROGRAM IMPROVEMENTS WERE MADE AT THE END OF 2019 TO EXPEDITE LIABILITY DETERMINATIONS BY FOCUSING ON COST CONTAINMENT EFFORTS AND DRIVING CONTINUOUS IMPROVEMENT IN ALL AREAS OF THE DEPARTMENT, THE TPL TEAM HAS BEEN ABLE TO CREATE EFFICIENCIES WHILE REALIZING PROGRAM SAVINGS OF OVER $25 MILLION. THE MICHIGAN DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES (DIFS) ADOPTED THE 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. WHILE MAJOR COMPETITORS HAVE SHUT DOWN PLANS, PRIORITY HEALTH CONTINUES TO OFFER AN EXTENSION OF ITS PRE-ACA INDIVIDUAL AND GROUP HEALTH PLANS TO SUBSCRIBERS AS LONG AS PERMITTED BY REGULATORY GUIDANCE. THE DECISION TO EXTEND PLANS IS CONSISTENT WITH PRIORITY HEALTH'S COMMITMENT TO PROVIDE INDIVIDUALS WITH FLEXIBILITY AND CHOICE. AT A TIME WHEN NATIONAL CARRIERS ARE EXITING THE INDIVIDUAL ACA MARKET, PRIORITY HEALTH REMAINS COMMITTED TO SERVING THIS POPULATION. |
| Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH HMO (CONTINUED) | AS A REQUIREMENT OF THE ACA, EACH STATE SELECTS AN ESSENTIAL HEALTH BENEFITS "BENCHMARK PLAN" THAT SERVES AS A REFERENCE FOR ALL OTHER HEALTH PLANS TO FOLLOW (INDIVIDUAL AND SMALL BUSINESS), WHEN DESIGNING THE SCOPE AND LIMITATIONS SURROUNDING COVERED SERVICES. A BENCHMARK PLAN IS CHOSEN BY EACH STATE EVERY FIVE YEARS. PRIORITY HEALTH WAS SELECTED AS THE STATE'S BENCHMARK PLAN IN 2012 AND IS THE ONLY HEALTH PLAN IN MICHIGAN TO EVER EARN THIS DESIGNATION. STARTING IN 2017 (CONTINUING IN 2018 AND FORWARD), THE MICHIGAN DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES (DIFS) HAS RECOMMENDED THE PRIORITY HEALTH HMO PLAN TO CONTINUE TO SERVE AS THE ESSENTIAL HEALTH BENEFITS BENCHMARK FOR THE STATE. THE RECOMMENDATION UNDERSCORES PRIORITY HEALTH'S ABILITY TO DELIVER INCREDIBLE VALUE AND CREATE INNOVATIVE SOLUTIONS THAT IMPACT HEALTH CARE COSTS WHILE MAXIMIZING CUSTOMER EXPERIENCE. PRIORITY HEALTH'S HMO PLAN WAS SELECTED BECAUSE DIFS BELIEVES IT ACHIEVES THE BEST BALANCE BETWEEN COMPREHENSIVENESS AND COST-EFFECTIVENESS FOR MICHIGAN CONSUMERS. THE MICHIGAN ASSOCIATION OF HEALTH PLANS (MAHP), AN INDUSTRY VOICE FOR THE STATE'S HEALTH CARE PLANS, RECOGNIZES BEST PRACTICES IN HEALTH PLANS BY SPONSORING THE PINNACLE AWARDS. HEALTH PLANS ARE RECOGNIZED FOR ACHIEVEMENTS IN ADDRESSING THE CHALLENGES OF A SHIFTING HEALTHCARE ENVIRONMENT THROUGH IMPROVEMENTS IN OPERATIONS, CLINICAL SERVICES, DISEASE MANAGEMENT AND COMMUNITY OUTREACH. THE PINNACLE AWARD CONTINUES TO SERVE AS AN EMBLEM OF EXCELLENCE TO THE MEMBER PLANS THAT ARE RECOGNIZED. THE 2020 PINNACLE AWARDS WERE POSTPONED DUE TO THE COVID-19 PANDEMIC. THE PINNACLE AWARDS WILL BE HELD AGAIN IN 2021 AND PRIORITY HEALTH HOPES TO CONTINUE IT'S HISTORY OF BEING RECOGNIZED FOR ITS FOCUS ON IMPROVING HEALTH WHILE LOWERING COST. PRIORITY HEALTH CONTINUES TO BE RECOGNIZED FOR THEIR DEVELOPMENT OF PROGRAMS THAT HAVE LED TO INCREASED EFFICIENCY AND PATIENT CARE, HELPING LOWER COSTS, AND INCREASE SERVICE TO IT'S MICHIGAN PATIENTS BY THE MICHIGAN ASSOCIATION OF HEALTH PLANS. DURING 2019, 9 MICHIGAN HEALTH PLANS FROM ACROSS THE STATE SUBMITTED 28 PROGRAMS DEMONSTRATING CREATIVE APPROACHES TO SOLVING PROBLEMS AND IMPROVING SERVICES IN THE COMMERCIAL, MEDICARE, AND MEDICAID SECTORS. THESE 28 GROUND-BREAKING PROGRAMS CONSIDERED FOR MAHP'S ANNUAL PINNACLE AWARDS, SHOW AN ENTREPRENEURIAL SPIRIT AND AN INTEREST IN SERVING MEMBERS AS WELL AS TO INCREASE EFFICIENCY AND IMPROVE PATIENT HEALTH CARE WHILE LOWERING COSTS AND INCREASING SERVICE TO MICHIGAN CITIZENS. PRIORITY HEALTH RECEIVED 1 PINNACLE AWARD IN 2019. PRIORITY HEALTH WON A 2019 PINNACLE AWARD FOR COMMUNITY OUTREACH BY A SINGLE PLAN. PRIORITY HEALTH, WHILE WORKING CLOSELY WITH MAHP'S CHILDREN'S SPECIAL HEALTH CARE SERVICES ("CSHCS") AND THEIR FAMILIES, WAS QUICK TO IDENTIFY NEEDS AND GAPS IN KNOWLEDGE RELATED TO CARE COORDINATION BETWEEN THESE FAMILIES AND THE COMMUNITY PROVIDERS THEY RELY ON TO SERVE THEM. IN RESPONSE TO THESE FINDINGS, PRIORITY HEALTH LAUNCHED THE MEDICALLY COMPLEX CHILDREN'S INFORMATION SHARING EVENTS. THESE EVENTS ARE HELD QUARTERLY TO PROVIDE A VENUE FOR HEALTH CARE PROVIDERS AND COMMUNITY PARTNERS WHO WORK WITH THE CSHCS POPULATION TO NETWORK, SHARE INFORMATION, ESTABLISH A MORE ROBUST REFERRAL PROCESS AND TO COLLABORATE MORE. THE RESULT IS GREATER CARE COORDINATION AND AVAILABILITY OF RESOURCES, WHICH ARE AVAILABLE BUT OFTEN UNDERUTILIZED IN THESE COMMUNITIES. IN 2018, PRIORITY HEALTH RECEIVED A PINNACLE AWARE FOR ITS COMMUNICATION AND PUBLIC RELATIONS CAMPAIGN , "KNOW YOUR HEALTH CARE COSTS". PRIORITY HEALTH'S PUBLIC RELATIONS TEAM EXECUTED AN INTEGRATED COMMUNICATIONS PLAN TO SUPPORT THE WORK DONE TOWARDS HEALTH CARE PRICE TRANSPARENCY. THE GOAL WAS POSITIONING PRIORITY HEALTH AS A HEALTH CARE TRANSPARENCY AND INNOVATION LEADER, WHILE EDUCATING AND ENGAGING CUSTOMERS ABOUT THE IMPORTANCE OF UNDERSTANDING THEIR HEALTH CARE COSTS. CONSUMERS AREN'T ACCUSTOMED TO SHOPPING FOR HEALTH CARE PROCEDURES, SO FOCUSING ON EDUCATION AND PRICE TRANSPARENCY WAS CRUCIAL. THE OVERALL OBJECTIVES OF THE CAMPAIGN WERE TO INCREASE AWARENESS OF PRICE TRANSPARENCY THROUGH THE PRIORITY HEALTH SHOPPING TOOL, COST ESTIMATOR. THE FOCUS WAS ON PROVISION OF EDUCATION BY INFORMING CONSUMERS ABOUT THE IMPORTANCE OF UNDERSTANDING HEALTH CARE COSTS. THIS INCLUDED ADDING 80 NEW SERVICES AND SHARING UPDATES ON TOTAL HEALTH CARE COSTS SAVED WITH THIS TOOL. ALSO, THE ADDITION OF SHOPPING PHARMACY COSTS WITH THE TOOL WAS HIGHLIGHTED FOR CONSUMERS. |
| Form 990, Part III, Line 4c PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH WELLNESS | PREVENTION AND WELLNESS HAVE BEEN THE FOUNDATION OF PRIORITY HEALTH'S APPROACH TO HEALTH CARE. PRIORITY HEALTH PROVIDES WELLNESS TOOLS AND RESOURCES VIA AN ONLINE WELLBEING PLATFORM WITHIN ITS COMMERCIAL STANDARD HEALTH PLANS, WHILE ALSO OFFERING CUSTOMIZED, STAND-ALONE WELLNESS PROGRAMS TO EMPLOYER GROUPS TO EMPOWER THEIR EMPLOYEES TO PURSUE HEALTHIER LIFESTYLES. IN ADDITION TO HEALTH PLAN OFFERINGS, PRIORITY HEALTH PARTICIPATES IN, AND SPONSORS, WELLNESS PROGRAMS FOR THE COMMUNITY AT LARGE TO IMPROVE THE HEALTH OF ALL PEOPLE, NOT JUST MEMBERS. IN 2020, PRIORITY HEALTH INVESTED OVER $37,000 TO PROACTIVELY REACH OUT TO THE COMMUNITY THROUGH AN E-NEWSLETTER AND SENIOR WELLNESS PROGRAM WITH MESSAGES OF HEALTH AND WELLNESS TO PROMOTE HEALTHY LIVING. IN ADDITION, APPROXIMATELY 40 STAFF HOURS OF SOCIAL MEDIA, TELEVISION, PODCASTS AND CONFERENCE PRESENTATIONS WERE PROVIDED TO THE COMMUNITY TO PROMOTE HEALTHY LIVING. PRIORITY HEALTH'S WELLNESS PROGRAMS ADDRESS THE OVERALL WELLBEING OF ITS MEMBERS. EMPLOYERS ARE ABLE TO SUPPORT THE OVERALL WELLBEING OF THEIR EMPLOYEES AND IMPROVE ENGAGEMENT, SATISFACTION AND PRODUCTIVITY, ULTIMATELY RESULTING IN IMPROVED TALENT RETENTION AND A HEALTHIER WORKFORCE. PRIORITY HEALTH PARTNERS WITH EMPLOYERS TO HELP THEM DELIVER TARGETED, SMART PROGRAMS THAT EFFECTIVELY IMPROVE EMPLOYEE PHYSICAL AND EMOTIONAL HEALTH WHILE ALSO IMPROVING WORKPLACE MORALE AND REDUCING OVERALL HEALTH COSTS WITH A PERSONALIZED WELLBEING APPROACH. PRIORITY HEALTH OFFERS A WELLBEING HUB, WHICH OFFERS A PERSONALIZED ONLINE WELLNESS EXPERIENCE TAILORED TO EACH EMPLOYEE'S INDIVIDUAL NEEDS. THE WELLBEING HUB, AVAILABLE TO ALL PRIORITY HEALTH MEMBERS, OFFERS MEMBERS ACCESS TO CONTENT AND TOOLS CENTERED ON SUPPORTING STRESS MANAGEMENT, NUTRITION, WEIGHT LOSS, QUITTING TOBACCO, CHRONIC CONDITION MANAGEMENT, FINANCIAL SUPPORT, SLEEP HEALTH AND MORE. IN RECENT YEARS PRIORITY HEALTH HAS SPONSORED MANY COMMUNITY EDUCATION PROGRAMS, HEALTH FAIRS, WALKS/RUNS/TRIATHLONS AND NEWSLETTERS. DURING 2020, PRIORITY HEALTH CONTRIBUTED OVER $60,762 BY OFFERING DISCOUNT CODES TO PROMOTE WELLNESS AND SPONSOR WALKS/RUNS ACROSS THE STATE. ONE OF THE MORE SIGNIFICANT CONTRIBUTIONS WAS TO THE MSU GRAN FONDO, A CYCLING EVENT TO ACTIVELY ENGAGE THE COMMUNITY WHILE ACCELERATING SKIN CANCER AWARENESS, PREVENTION AND RESEARCH. ALTHOUGH THE EVENT WAS POSTPONED DURING 2020 DUE TO COVID-19, THE CONTRIBUTIONS RECEIVED WERE ROLLED OVER TO THE 2021 EVENT, WHICH HAS RAISED OVER $1.1 MILLION WITH 100% OF EVERY DOLLAR RAISED BENEFITING SKIN CANCER AWARENESS, PREVENTION AND RESEARCH. IN ADDITION TO THE GRAN FONDO, PRIORITY HEALTH HAS BEEN A SUPPORTER OF THE ARTS, BEATS & EATS, OAKLAND COUNTY'S FAVORITE SUMMER FESTIVAL CELEBRATING ART, MUSIC, CUISINE AND COMMUNITY FOR NEARLY A DECADE CONTRIBUTING OVER $23,000 IN 2020. DUE TO COVID-19, THE FESTIVAL WAS ESSENTIALLY POSTPONED IN ITS NORMAL FORMAT, WITH LIMITED PROGRAMMING BEING OFFERED INCLUDING OUTDOOR YOGA AND ZUMBA, ALL DONE WITH LIMITED CAPACITY AND IN A SAFELY DISTANCED OUTDOOR SPACE. PRIORITY HEALTH'S ZUMBATHON HAD MORE THAN 100 PARTICIPANTS. PRIORITY HEALTH PARTICIPATES IN PARTNERSHIP WITH MARANDA, A WEST MICHIGAN NEWS PERSONALITY, 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. PRIORITY HEALTH IS ONE OF THE LONGEST RUNNING SUPPORTERS OF THE MARANDA PARK PARTIES, WHICH PROVIDE FREE FOOD, HEALTH AND FITNESS ACTIVITIES FOR CHILDREN AT INNER CITY PUBLIC PARKS THROUGHOUT WEST MICHIGAN. THE PARK PARTIES HAVE BEEN RECOGNIZED BY THE USDA AS ONE OF THE NATION'S LARGEST SUMMER FEEDING PROGRAMS AND WHILE COVID-19 DIDN'T ALLOW MARANDA TO HOST PARTIES, SHE PARTNERED WITH DOZENS OF SCHOOLS IN WEST MICHIGAN TO SUPPORT THE USDA EFFORTS TO FEED FAMILIES IN CRISIS DURING THE COVID-19 PANDEMIC. PRIORITY HEALTH DISTRIBUTED THOUSANDS OF BACKPACKS, PEDOMETERS AND SUNSCREEN PACKETS TO PEOPLE IN NEED THROUGHOUT THE SUMMER CONTRIBUTED OVER $80,000 IN SUPPORT DURING 2020 TO THIS CAUSE. ADDITIONALLY, IN 2020 NEARLY 140 MIDDLE SCHOOL STUDENTS FROM FIVE DISTRICTS IN KENT COUNTY CONVERGE EVERY YEAR FOR A DAY OF EMPOWERMENT, EDUCATION, AND ENCOURAGEMENT. MARANDA'S BEAUTIFUL U TEACHES GIRLS TO BE BEAUTIFUL IN MIND, BODY, AND SOUL. THE STUDENTS STRETCHED AND HEARD MOTIVATING WORDS FROM A PRIORITY HEALTH HEALTH COACH DURING THE PROGRAM. PRIORITY HEALTH PARTNERS TO SUPPORT FREE ACCESS TO WELLNESS OPPORTUNITIES 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 PARTNERED WITH AM YOGA TO PROVIDE MONTHLY COMMUNITY YOGA AT THE GRAND RAPIDS ART MUSEUM (GRAM). PRIORITY HEALTH SPONSORS THIS PROGRAM AND CONTRIBUTED $5,000 IN 2020. THIS SPONSORSHIP PROVIDES ACCESS TO HEALTH AND WELLNESS THAT PEOPLE MAY NOT NORMALLY BE ABLE TO AFFORD. THE DONATIONS FROM EACH CLASS ARE THEN TURNED AROUND TO PROVIDE YOGA TO OTHER AREAS AND COMMUNITIES THAT MAY NOT HAVE ACCESS AND REACHES OVER 1,200 YOGIS PER YEAR. IN 2020, PRIORITY HEALTH CONTRIBUTED $13,000 TO THE AMERICAN HEART ASSOCIATION (AHA). A PORTION WENT TO THE PROGRAM CALLED GO RED FOR WOMEN DESIGNED TO CREATE AWARENESS OF THE ISSUE OF WOMEN AND HEART DISEASE. FINANCIAL SUPPORT HELPS FUND THE AHA PROGRAMS AND INITIATIVES THAT ADVANCE THE MISSION TO BUILD HEALTHIER LIVES, FREE OF CARDIOVASCULAR DISEASES AND STROKE. PRIORITY HEALTH SUPPORTS THE AHA'S GOAL OF SEEKING WAYS TO INCREASE COMMUNICATION WITH THE PUBLIC AND TO CREATE TOOLS AND RESOURCES TO HELP THEM MANAGE AND PREVENT HEART DISEASE . THE REMAINDER WENT TO THE AHA HEART WALK, WHICH IS THEIR PREMIER EVENT RAISING FUNDS TO SAVE LIVES FROM THE COUNTRY'S NUMBER 1 AND NUMBER 5 KILLERS - HEART DISEASE AND STROKE, THE GRAND RAPIDS HEART BALL, DETROIT HEART BALL, AND THE HEART WELLNESS SYMPOSIUM. |
| Form 990, Part III, Line 4c PROGRAM SERVICE DESCRIPTION - PRIORITY HEALTH WELLNESS (CONTINUED) | IN 2020, PRIORITY HEALTH CONTINUED ITS PARTNERSHIP WITH THE DETROIT LIONS. THIS SPONSORSHIP HELPS SUPPORT THE TEAM'S EFFORTS TO SERVE AS COMMUNITY ADVOCATES BY BRINGING AWARENESS TO HEALTH PLAN OPTIONS DURING COVID-19 THROUGH MARKETING EFFORTS. IN 2020, PRIORITY HEALTH PARTNERED WITH THE DETROIT PISTONS TO SUPPORT VARIOUS YOUTH ACTIVITIES THAT SUPPORTED LEADERSHIP, EMPOWERMENT, MAKING SMART CHOICES FOR THE FUTURE, THE GIRLS DREAM BIG SUMMIT, DIVERSITY EFFORTS INCLUDING MARTIN LUTHER KING JR. DAY AND BLACK HISTORY MONTH. THROUGH THIS PARTNERSHIP, PRIORITY HEALTH AWARDED A $20,000 CHECK TO A DETROIT AREA STUDENT TO PURSUE HIGHER EDUCATION. PRIORITY HEALTH ALSO PROVIDED $10,000 TO FORGOTTEN HARVEST TO PURCHASE AND PROVIDE MORE THAN 80,000 MEALS DURING COVID-19 IN WAYNE, MACOMB, AND OAKLAND COUNTIES. IN ADDITION, PRIORITY HEALTH SPONSORS THE UNITED SPORTS PROFESSIONAL BASEBALL LEAGUE DANCE TEAM IN SOUTHEAST MICHIGAN. THIS PROGRAM GIVES AN INCLUSIVE HEALTHY ACTIVITY FOR NEARLY 100 KIDS AND ADULTS AGES 6-23 DURING THE BASEBALL SEASON. IN 2020, PRIORITY HEALTH BECAME THE OFFICIAL STATE SPONSOR ALONGSIDE THE NATIONAL FITNESS CAMPAIGN, LAUNCHING A PARTNERSHIP TO GRANT $300,000 TO ORGANIZATIONS THROUGHOUT LOWER MICHIGAN TO LOCAL MUNICIPALITIES TO CONSTRUCT 15 OUTDOOR FITNESS COURTS. THIS PARTNERSHIP CREATES PROGRAMMING AND FREE ACCESS TO NEIGHBORS AND CREATES PARTNERSHIPS TO DRIVE BETTER HEALTHY EQUITY AND HEALTH OUTCOMES. RECOGNIZING THE CONNECTION BETWEEN PHYSICAL, MENTAL AND ENVIRONMENTAL HEALTH, PRIORITY HEALTH LAUNCHED AN ANNUAL PARTNERSHIP WITH RELEAF MICHIGAN - A TREE PLANTING AND EDUCATION NON-PROFIT. PRIORITY HEALTH EMPLOYEES WILL ASSIST WITH PLANTING 200-400 TREES OVER THE LIFE OF THE PARTNERSHIP AND ALSO PROMOTE HEALTHY LIVING AND ENVIRONMENT THROUGH FREE WEBINARS AVAILABLE TO ANYONE IN THE STATE. GRAND VALLEY STATE UNIVERSITY WAS THE RECIPIENT OF A $20,000 SCHOLARSHIP CONTRIBUTION TO PROVIDE ACCESS TO EDUCATION FOR STUDENTS WHO MIGHT NOT OTHERWISE QUALIFY FOR FINANCIAL AID. THIS SCHOLARSHIP PROMOTES ACCESS TO HEALTH CARE CAREERS. PRIORITY HEALTH HAS DEVELOPED AN INNOVATIVE DIGITAL MEMBER OUTREACH PROGRAM THAT RELIES ON THOUSANDS OF DATASETS AND PREDICTIVE ANALYTICS TO HELP EDUCATE AND INFORM OUR MEMBERS. USING THIS DATA-DRIVEN APPROACH, PRIORITY HEALTH IS ABLE TO GAIN INSIGHTS INTO CHALLENGES OUR MEMBERS MAY FACE AND IDENTIFY ACTIONS THEY CAN TAKE TO IMPROVE OR PROTECT THEIR HEALTH. BASED ON THIS INFORMATION, PRIORITY HEALTH DELIVERS PERSONALIZED MESSAGING ON A VARIETY OF PLATFORMS TO HELP MEMBERS GET THE MOST FROM THEIR PLAN. DURING THE COVID-19 PANDEMIC, PRIORITY HEALTH USED THE TECHNOLOGY TO PROTECT MEMBERS AT HIGHER RISK BY OFFERING TIPS ON SPECIAL PRECAUTIONS THEY COULD TAKE BASED ON THEIR CONDITION TO STAY SAFE. IN TOTAL, PRIORITY HEALTH SUPPORTED HEALTH AND COMMUNITY BENEFIT ACTIVITIES VIA CONTRIBUTIONS OF NEARLY $1,300,000 IN 2020 IN AN EFFORT TO IMPROVE HEALTH SERVICES AND CONDITIONS IN NEIGHBORHOODS, WORKPLACES, AND SCHOOLS THROUGHOUT THE COMMUNITIES IT SERVES WITH MORE THAN $110,000 SUPPORTING COVID-19 RELIEF EFFORTS. Throughout the COVID-19 pandemic, Priority Health supported members, employers, providers and the community in numerous ways including via financial support, support in mitigating the spread of COVID-19, and Community/Mental Health Support. Financial Support: * Waiving all copays, deductibles, and coinsurance for the treatment of COVID-19 through September 30, 2021. * Offering premium credits and waiving cost sharing for the most heavily impacted populations. * Expanding $0 virtual care to most members for routine care in 2020. * Accelerating value-based payments and quality bonuses to offer physician and provider partners financial stability. * Waiving cost sharing for all Medicare Advantage members for in-person and telehealth primary care visits in 2020. * Creating a unique, affordable new option to help those who have lost their employer-based health benefits due to COVID-19. By combining a short-term plan, to bridge any coverage gap, with a special enrollment in an individual ACA plan, Priority Health members could safely move from their employer-sponsored coverage to a new plan without the risk of going uninsured during the ongoing outbreak. * Priority Health was the only health coverage carrier in Michigan who offered this unique combination that provides gap-free, same day coverage. * Creating an Employer Decision Guide for employer groups that outlined options for helping employees maintain health coverage during a time of widespread temporary layoffs. Mitigating the Spread of COVID-19 * Fully covering the cost of physician-ordered COVID-19 testing for all members. * Using predictive analytics to connect with high-risk members to engage them in personalized interventions which helped them stay safe during the pandemic. * Covering the COVID-19 vaccine at $0 cost share for all our members, meaning that none of Priority Health's more than one million members would ever receive a bill related to the COVID-19 vaccine. * Priority Health has also leveraged numerous different strategies to help drive vaccinations within its membership and throughout Michigan, including a multi-touch marketing campaign, transportation support, educational materials and more. * Expanding access to home medication deliveries for all members with the largest pharmacies in the state (CVS, Meijer, Walgreens). Community/Mental Health Support * Donating more than 226,000 diapers to families in need in Southwest Michigan. * Donating more than 5,000 antibacterial wipes and hand sanitizers to organizations throughout Michigan. * Mailing "Stay Well Kits" to 170,000 Priority Health Medicare members to help protect the most vulnerable population during the ongoing pandemic and flu season. * The kits include Priority Health masks, reusable strip thermometers, a bandage dispenser and a deck of playing cards at no cost to the member. * Providing free access for all members to COVID-19 content from myStrength, an online mental wellness tool. * Providing members with free access to Brook, a personal mobile health companion that provides support in the areas of nutrition, sleep management, general health and COVID-19 information. * Launching a #MaskUpMichigan campaign that resulted in a $5,000 donation to the National Alliance on Mental Illness of Michigan (NAMI), which provides statewide support for people living with serious mental illness and their families. * Hosting a PPE collection site at the Priority Health campus which collected thousands of donations from employees and community members. |
| Form 990, Part III, Line 4b PRIORITY HEALTH SENIOR MARKETS | PRIORITY HEALTH BEGAN OFFERING MEDICARE ADVANTAGE PLANS IN JULY 2005 AND MEDICARE ADVANTAGE PLANS WITH PRESCRIPTION DRUG COVERAGE IN JANUARY 2006. ITS MEDICARE ADVANTAGE PLANS VARY IN PRICE BASED ON WHERE MEMBERS LIVE AND WHAT BENEFITS THEY NEED. MORE THAN 154,000 MICHIGANDERS HAVE A PRIORITY HEALTH MEDICARE ADVANTAGE PLAN, AND MORE THAN 16,000 CHOSE A PRIORITY HEALTH MEDICARE SUPPLEMENT PLAN, ALSO KNOWN AS MEDIGAP. 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 IN COOPERATION WITH WILEY PUBLISHING, OWNERS OF THE DUMMIES SERIES. THE BOOK HAS BEEN DISTRIBUTED FREE TO OVER 255,000 PEOPLE ACROSS MICHIGAN AND DOWNLOADED COUNTLESS TIMES AS IT IS NOW AVAILABLE ELECTRONICALLY AS AN E-BOOK. AS A RESULT OF PRIORITY HEALTH'S WORK WITH THE COMMUNITY AND DEDICATION TO OFFERING PLANS THAT DELIVER HIGH QUALITY, ITS MEDICARE HMO-POS AND PPO ADVANTAGE PLANS WERE ACCREDITED WITH THE NATIONAL CENTER FOR QUALITY ASSURANCE (NCQA), WITH OUR HMO-POS PLANS EARNING A 4.5 RATING OUT OF 5. PRIORITY HEALTH'S 2020 MEDICARE ADVANTAGE PLANS WITH PRESCRIPTION DRUG COVERAGE WERE ALSO AWARDED 4.0 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 HIGHER QUALITY CARE AND EXPERIENCE IS DELIVERED. OF THE 43 QUALITY AND IMPROVEMENTS METRICS USED TO DETERMINE OUR OVERALL QUALITY RATING OF 4.0, APPROXIMATELY 75% OF THE METRICS WERE EITHER 4 OR 5 STARS. PRIORITY HEALTH IS ABLE TO PROVIDE ITS MEMBERS HIGH QUALITY MEDICARE ADVANTAGE PLANS WHILE REMAINING AMONG THE LOWEST COST PLANS IN THE COUNTRY. MEDICARE ADVANTAGE MEMBERS CAN ENROLL EITHER INDIVIDUALLY, OR THROUGH AN EMPLOYER GROUP. DURING THE 2020 MEDICARE ANNUAL ENROLLMENT PERIOD (AEP), PRIORITY HEALTH ENROLLED 30% OF THE INDIVIDUALS WHO PURCHASED A MAPD PLAN IN MICHIGAN FROM OCTOBER 15 - DECEMBER 7, 2020. PRIORITY HEALTH'S MEDICARE ADVANTAGE ENROLLMENT INCLUDES ABOUT 147,000 INDIVIDUAL ADVANTAGE MEMBERS, OR 31% OF THE TOTAL INDIVIDUAL MEDICARE ADVANTAGE MARKET, MAKING PRIORITY HEALTH THE LEADER IN MICHIGAN. INDIVIDUAL MEDICARE ADVANTAGE IS OFFERED IN ALL 68 COUNTIES IN MICHIGAN'S LOWER PENINSULA, WITH 98% OF PROVIDERS, INCLUDING ALL MAJOR HOSPITAL SYSTEMS, IN OUR NETWORK. PRIORITY HEALTH'S NETWORK HAS MORE THAN 50,000 PROVIDERS. 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. IN 2020 PRIORITY HEALTH CONTINUED ITS ENGAGEMENT WITH PATIENTS HAVING ADVANCED ILLNESS IN PARTNERSHIP WITH SPECTRUM HEALTH MEDICAL GROUP AND TWO OTHER CONTRACTED PROVIDERS WHICH RESULTED IN $12.2 MILLION IN SAVINGS BY REACHING MEMBERS ENROLLED IN HBPC PROGRAMS. CHRONIC CONDITIONS ARE LEADING CONTRIBUTORS TO RISING HEALTH CARE COSTS NATIONWIDE. TO ADDRESS THIS, PRIORITY HEALTH LAUNCHED THE MEDICATION THERAPY MANAGEMENT (MTM) PILOT PROGRAM WITH ITS MEDICARE MEMBERS. THE MTM PILOT PROGRAM OFFERED 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. COMPLEX MEDICATION REGIMENS CREATE SIGNIFICANT CHALLENGES FOR PATIENTS LIVING WITH CHRONIC ILLNESS, THEIR CAREGIVERS, HEALTH CARE PROVIDERS AND THE HEALTH CARE 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 HEALTH CARE PROVIDERS. RETAIL AND OFFICE-BASED PHARMACISTS WILL WORK WITH PATIENTS AND PROVIDERS TO ADDRESS DRUG-RELATED PROBLEMS AND COMPLETE COMPREHENSIVE MEDICATION REVIEWS. IN 2015, PRIORITY HEALTH EXPANDED ITS MTM PROGRAM TO COMMERCIAL AND MEDICAID MEMBERS. WITH THIS MOVE, PRIORITY HEALTH BECAME THE FIRST HEALTH PLAN IN THE STATE TO EXPAND THE PROGRAM TO BOTH ITS MEDICARE AND EMPLOYER-SPONSORED HEALTH PLANS. IN 2020, PRIORITY HEALTH ENGAGED OVER 60,000 MEDICARE MEMBERS IN THE MTM PROGRAM AND REDUCED THEIR OVERALL COST OF CARE. IN 2017, PRIORITY HEALTH RECEIVED A PINNACLE AWARD FOR ITS MEDICARE CARE MANAGEMENT HYBRID PROGRAM. THE CARE MANAGEMENT TEAM UNDERSTANDS AND ACKNOWLEDGES THAT SOCIAL DETERMINANTS OF HEALTH IMPACT DISEASE MANAGEMENT. WHILE DATA SCIENCE CONTINUES TO EVOLVE AND IMPROVE IN ITS ABILITY TO IDENTIFY THESE NON-CLAIMS DRIVEN INDICATORS OF RISK, IT IS DIFFICULT FOR THE USUAL METHODS OF CARE MANAGEMENT TO IDENTIFY AND ADDRESS THEM. |
| Form 990, Part III, Line 4b PRIORITY HEALTH SENIOR MARKETS (CONTINUED) | PRIORITY HEALTH LANCED ITS HYBRID PROGRAM AS AN AT-HOME CARE MANAGEMENT PROGRAM TO ADDRESS THE FULL BURDEN OF ILLNESS AND SOCIO-DEMOGRAPHIC RISK FACTORS FOR MEDICARE MEMBERS. AS A RESULT, PRIORITY HEALTH HAS OBSERVED LOWER ADMISSION RATES THAN STATE AND NATIONAL AVERAGES THANKS IN PART TO INTERDISCIPLINARY TEAMS THAT PROVIDE A QUICK RESPONSE TO CONDITION DESTABILIZATION. IN 2018, PRIORITY HEALTH ADDED ADDITIONAL FUNCTIONALITY TO ITS COST ESTIMATOR TOOL ENABLING MEDICARE ADVANTAGE MEMBERS TO ACCESS REAL-TIME COST INFORMATION ON PRESCRIPTION DRUGS, HELPING MEMBERS PAY LESS BY SWITCHING TO A LOWER PRICED ALTERNATIVE, USING A PREFERRED PHARMACY, OR OPTING FOR MAIL ORDER. MORE THAN 6,000 PRESCRIPTIONS ARE AVAILABLE VIA THE COST ESTIMATOR TOOL INCLUDING PILLS, CHEWABLES, AND CAPSULE DRUGS. WHEN A MEDICATION IS PRICED THROUGH THE TOOL, MEMBERS HAVE THE OPTION TO VIEW MORE AFFORDABLE ALTERNATIVES AND SEE EXACT COSTS AT THEIR PREFERRED PHARMACIES, WHICH FOR COULD PROVIDE SIGNIFICANT SAVINGS TO THOSE MEMBERS WHO REQUIRE SOME OF THE MOST EXPENSIVE DRUGS IN THE MARKET. |
| Form 990, Part IV, Line 12a 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 and the National Association of Insurance Commissioners (NAIC). |
| 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 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 | CERTAIN 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 38-2640544), Class B Shareholder - 5.5% McLaren Northern Michigan (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 the Class B Shareholders (the Northern Shareholders). 6.2.2 Two (2) of the directors will be appointed jointly by the Class B 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 the Class A Shareholder. 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. 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 Class A and Class B Shareholders 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 Class A and Class B Shareholders will be filled by the Class A and Class B Shareholders, 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 or such term as designated by the shareholder, following non-binding consultation with the Chairperson of the corporation's Board; or (ii) allow the seat to remain vacant until an individual is appointed by the shareholder pursuant to Section 6.4 of these Bylaws. |
| 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 in excess of the Authority Matrix Amount; 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"); 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 President and 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 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 (Including the SVP, Finance; SVP, General Counsel; VP, Controller) and shared with the members of the finance committee and board of directors. 4. The organization's SVP, Finance reviews comments or questions received from 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. 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 Organizational Integrity 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 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. For Calendar Year 2020 (1/1/20-12/31/20), three health care executive compensation surveys, two medical group surveys, one pediatric hospital survey and one health plan survey prepared by independent firms were the primary sources referenced to obtain market data for the review: * Sullivan, Cotter and Associates: 2018 Survey of Manager and Executive Compensation in Hospitals and Health Systems * Integrated Healthcare Strategies: 2018 HealthCare Executive Compensation Survey * Mercer: 2018 Integrated Health Networks Compensation Survey, also provides data for health plans * Medical Group Management Association: 2018 Management Compensation Survey * Sullivan, Cotter and Associates: 2018 Physician Compensation and Productivity Survey Report * Sullivan, Cotter and Associates: 2018 Custom Survey of Manager and Executive Compensation in Children's Hospitals * Warren: Fall 2018 HMO Salary Survey In addition, four general industry surveys were referenced: * Mercer: 2018 Executive Compensation Survey * Mercer: 2018 Information Technology Survey * Mercer: 2018 Human Resources Survey * Towers Watson: 2018 Top Management Compensation Report In addition to the above data sources, the Executive Committee approved the creation of a custom peer group of high performing integrated health systems to ensure robust data and a relevant comparator universe. The peer group organizations are approved by the Executive Committee and consist of double A bond rated and / or Truven top quintile organizations. Data for the peer group organizations is compiled by the independent executive compensation firm. 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 health care and / or health insurance organizations. Spectrum Health recruits nationally for its executives. Benefits data reflect national health care / 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/about-us in the section titled "value and transparency." Financial performance is discussed at an annual public meeting held and posted to www.spectrumhealth.org/about-us annually (under the section titled "value and transparency"). |
| Form 990, Part VII, Section A, Line 2 Individuals Compensated more than $100,000 | THERE ARE NO INDIVIDUALS REPORTED AS ALL ARE EMPLOYED BY THE PARENT ORGANIZATION 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., 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 - 91184609; Net Unrealized Gain(Loss) on Subsidiaries - 33671443; |
| 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 and the National Association of Insurance Commissioners (NAIC). |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2020
Additional Data
| Software ID: | 20011424 |
| Software Version: | 2020v4.0 |