Priority Health in Grand Rapids Introduces Tiered Network Plan in Metro Detroit


Grand Rapids-based Priority Health Tuesday announced a tiered network plan available to southeast Michigan employers called Southeast MI Partners. The plan is targeted at companies that have most of their employees residing within the six-county footprint of Wayne, Oakland, Macomb, Livingston, Washtenaw, and St. Clair counties.

“Tiered network plans offer an innovative solution to addressing cost concerns without sacrificing quality of care,” says Diane Wolfenden, vice president eastern region for Priority Health. “We’re thrilled to partner with some of the best health care providers in the region to expand our tiered network solutions to Southeast Michigan employers.”

The plan offers up to 11 percent savings in monthly premium costs compared to non-tiered offerings, and members will pay lower out-of-pocket costs when they receive care with Tier 1 physicians and hospitals. Members can see providers in Tier 2, which includes the entire Priority HMO network of providers, but they will pay a higher cost share for care.

Priority Health has partnered with the Together Health Network to offer lower-cost Tier 1 coverage. The network includes Ascension Michigan, Saint Joseph Mercy Health System, Lake Huron Medical Center, and Michigan Medicine. It also includes in-network pharmacies, emergency services, and statewide ancillary facilities including labs, physical therapy, radiology, and home health.

“Together Health Network is patient-centered and physician-led,” says Scott Eathorne, president and CEO of Together Health Network. “Working with Priority Health to offer a tiered network solution allows us to further our mission of expanding access to affordable, high-quality care at our leading network of affiliated physicians and health systems.”

Tier 2 coverage includes 97 percent of providers in Michigan and more than 1 million providers nationwide for travelers and out-of-state employees.

Southeast MI Partners members will also have access to tools like Cost Estimator, which allows members to know the cost of hundreds of procedures and prescriptions before receiving care, so they can shop for the best price. Members will also be eligible for virtual care for as little as $0 per visit and have access to Wellbeing Hub, a free digital wellness experience. Small groups enrolled in any Priority Health plan receive prescription savings with $5 preferred generic copays.

Priority Health is the second-largest health plan in Michigan and has close to 800,000 members across the state.

In related news, Priority Health today announced a partnership with Omada Health in California to offer a new digital prevention tool to help members manage diabetes. Priority Health is the first plan in Michigan to add the Center for Disease Control and Prevention fully recognized digital program as a preventive benefit.

The program is evidence-based and works to empower people to make sustainable behavioral changes to lower their risk of chronic disease. The company offers an adaptable intervention for employees or members as risk for obesity-related conditions such as type 2 diabetes and heart disease. The program leverages social connectivity, professional health coaches, curriculum, connected tools, and small group support.

Members can access the program on a computer, smartphone or tablet. It is offered as an additional option to Priority Health’s work with the National Diabetes Prevention Program.

“Diabetes continues to be one of the fastest-growing chronic diseases in the nation, and Michiganders suffer more than in most states,” says John Fox, associate vice president of medical affairs at Priority Health. “As we pursue new tools to fight diabetes and its consequences, Omada provides our members a convenient, engaging, and proven method to manage diabetes.”

More than 1.8 million people in Michigan have diabetes, according to the American Diabetes Association. Another 2.7 million have prediabetes.

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