| Program | Eligible plans | Criteria | About the program | Cost to member | How is the member informed? |
| Behavioral health self care | - Commercial
- D-SNP
- Individual
- Medicaid
- Medicare
| | An online mental health tool powered by Teladoc Health that offers coping tools, inspirational resources, community support and one-on-one coaching for depression, anxiety, substance abuse, stress and chronic pain. | $0 | Members sign upon their own or their care manager may refer them |
| Care after inpatient admission |
- Commercial
- D-SNP
- Individual
- Medicaid
- Medicare
| Members with a risk of 8-10%+ of having a 30-day unplanned readmission | A 30-day program aimed at preventing readmission by connecting members to PCPs for follow-up and providing education on condition and medication. | $0 | Outreach by Priority Health care manager |
| Care management | - Commercial
- D-SNP
- Individual
- Medicaid
- Medicare
| Members are proactively targeted using Johns Hopkins ACG model. All D-SNP members have a care manager. Children with special needs who need extra support | Care managers educate patients with complex medical needs on disease self-management, assist with coordination of care and navigating the health care system, and connect patients with social, medical and behavioral health care to reduce avoidable hospital admissions, readmissions and emergency department visits. | $0 | Priority Health care manager |
| Community Care Management | - Commercial
- D-SNP
- Individual
- Medicare
| Members who are at risk of rehospitalization and/or have experienced psychosocial barriers accessing outpatient therapy. | Community Care Management is a program that offers individuals and families time-sensitive treatment and support to help avert a crisis or allow for a successful transition back home after a mental health hospitalization. | Based on members’ outpatient mental health benefit. | Priority Health care manager |
| Companion care | | | Papa connects college students (Papa Pals®) to Medicare members with chronic conditions who need assistance with transportation, house chores, technology, companionship and other services. | $0 | Priority Health care manager |
| Diabetes management program | - Commercial
- Individual
- Medicare
| Members 18 or older with type 2 diabetes who are not pregnant | A digital diabetes management program called Livongo®, now owned by Teladoc Health, that provides a personalized experience for our members to better manage their type 2 diabetes. It includes telephonic health coaching, an app with 24/7 monitoring and support, a blood glucose meter that offers real-time feedback and unlimited test strips, a Bluetooth-connected weight scale and a blood pressure cuff. | $0 | Referral email, Priority Health care manager |
Diabetes prevention program
| - Commercial
- Individual
- Medicare
- Medicaid
| Members diagnosed with pre-diabetes. Learn more. | A one-year virtual program that helps patients with healthy lifestyle changes like eating healthy, exercising and managing stress. The program provides a coach, lessons and access to a peer support group. Virtual DDP programs are available to commercial and individual members, which also provide a scale. | $0 | Program outreach email, Priority Health care manager |
| In-home chronic disease care | - Commercial
- D-SNP
- Individual
- Medicaid
- Medicare
| Members in advanced stages of chronic disease | In-home care management and care coordination through Tandem365® to help patients in advanced stages of chronic disease remain in their home for as long as safely possible. | $0 | Priority Health care manager or Tandem365 care team
|
In-home health assessments
| - Individual
- Medicaid
- Medicare
| | A health care provider visits the member in their home and reviews medical history, medications and answers questions. All results from the visit are shared with their primary care provider. | $0 | Member informationor outreach from Signify Health to schedule a visit
|
Over-the-counter allowance
| - D-SNP
- Some Medicare members (not all Medicare plans offer OTC benefits)
| | D-SNP membersget $222 per quarter to spend on over-the-counter items. D-SNP Advantage members get $106 per month to spend on over-the-counter items. SomeMedicare membersget $40-100 per quarter or $26-35 per month, depending on their plan. | $0
|
|
| Advanced illness care | - Commercial
- D-SNP
- Individual
- Medicaid
- Medicare
| Members in advanced stages of chronic disease | A variety of Advanced Illness Care programs provide in-home care, services and supports are available to members in advanced stages of chronic disease. | $0 | Priority Health care manager or Advanced Illness Program care team member |
Pathways Community Connections
| |
| Community health workers connect high risk patients to medical, social and behavioral health services to reduce risk factors.
| $0
| Priority Health care manager
|
Personal emergency response for falls
| - D-SNP
- Commercial
- Individual
- Medicare
| Members with high risk for falls or a history of falling.
| Members who are at high risk of falling receive a device that detects if they fall, and alerts an emergency contact of their choice, or 911. This benefit package includes in-home or mobile GPS equipment, installation support, onboarding welcome call, 24/7 monitoring, and member services that include social care. | $0
| Priority Health care manager
|
Postnatal support
| - Commercial
- Individual
- Medicaid
| All memberswith a child under six months old
| PriorityBABY™ isa program designed to support children and their caregivers during a child’s first two years. It is a continuation of the successful PriorityMOM™ program (see below) and includes health care information, gifts and incentives.
| $0
| |
Pregnancy support
| - Commercial
- Individual
- Medicaid
| Pregnant members
| PriorityMOM™ supports expectant mothers in their pregnancy journey. The goal is to reduce OB costs, preterm births, postpartum readmissions and improve health outcomes for mom and baby.
| $0
| |
| Prescription discount program | | | Price Assure®and PriceMyMeds® ensure our commercial members get the lowest available price for their prescriptions, without any hassle. Learn how Price Assure works. | | |
| Priority Health Connect | - Commercial
- D-SNP
- Individual
- Medicare
|
| With attention to social determinants of health, this program connects members with free and reduced-cost programs and social services. Members can search for resources like housing support, legal assistance, access to health foods and childcare, within their zip code. This online platform is powered by Aunt Bertha®
| $0
| Priority Health care manager
|
| Remote health condition monitoring | - Commercial
- D-SNP
- Individual
- Medicare
| Members who meet clinical criteria for telemonitoring (i.e. congestive heart failure, COPD, diabetes) | Members who need close clinical monitoring are provided devices specific to their illness, like a blood pressure cuff, scale or pulse oximeter. | $0 | Priority Health care manager |
| Second medical opinions | | Available for select procedures, depending on the member's plan. | 2nd.MD® provides members a second medical opinion for certain procedures or surgeries. Members get peace of mind through a consultation with an objective, third-party network of leading specialists. The member is the primary point of contact between their original doctor and the 2nd.MD doctor. The member will receive a written document with the 2nd.MD consult summary that can be shared with their original doctor. | $0 | Members are contacted directly by 2nd.MD when they are eligible to participate. A member may also be referred by a Priority Health care manager. If they choose, members may proactively reach out to 2nd.MD for a second medical opinion. |
| Transportation | - D-SNP
- Individual
- Medicare
| | SafeRide® covers up to 30 one-way trips per calendar year to take members to and from health-related locations such as network providers and pharmacies. Each one-way trip is limited to 40 miles. | $0 | Member account or customer service. Members will need a referral code. |
| Travel coverage | - Commercial
- Individual
- Medicare
|
| Global emergency medical services for members powered by Assist America®. If someone becomes ill or injured while traveling more than 100 miles from home, Assist America provides support with medical referrals, monitoring, evacuation, repatriation and much more. | $0 | Member account or customer service. Members will need a referral code. |
