We provide support for:

New market entrants

We offer a turnkey solution for health plans, health systems and ACOs seeking answers on how to enter the Medicare Advantage market. Through our end-to-end partnership model, we provide the support of an industry leader experienced in running all functions needed for high performance; including product development, risk adjustment, network setup, and more.

Existing plans

If you have a Medicare Advantage plan that’s struggling, or are looking to improve performance in one or more key areas, we can help you unlock the full potential of a high-performing plan with our Centers of Excellence.

  • Product design and pricing

    Success in Medicare Advantage takes more than just building a competitive plan. It comes from understanding your differentiators, your markets, and your consumers; from building unique products that drive healthy outcomes; and it comes from strategic pricing to balance short-term financial goals with long-term sustainability. Our deep analytic approach ensures alignment of these important factors.

  • Revenue management and risk adjustment

    High performing Medicare Advantage plans maximize reimbursement through accurate risk adjustment and coding that looks both prospectively and retrospectively at population and individual health to create a full and accurate risk profile. We use predictive analytics, coupled with expert insights, to drive member engagement. Our partnerships with providers allows for a collaborative team to effectively identify risk, and deliver healthier member outcomes.

    Risk Adjustment
  • Health care management

    How a Medicare Advantage plan takes care of its members is a hallmark of high performance. Having systems in place to both respond to member health concerns, as well as to reach out to high-risk, and likely costly, members can minimize gaps in care, and improve utilization management and appropriateness of care. Doing these well results in improved health outcomes, member satisfaction, and reduces cost.

    Health Care Management Priority Health
  • Operations

    Managing enrollment, claims and billing are critical to meeting compliance requirements, retaining membership, and billing and paying providers. While these services are offered by a number of sources, there is tremendous value in choosing a partner that understands Medicare Advantage end-to-end. We provide a full-suite of infrastructure and process options, drawing on the insight of an experienced partner to help you quickly achieve high performance.

  • Customer service

    In Medicare Advantage, the better a plan can perform, the higher the revenue and bonuses the plan can achieve. CMS has more than 100 quality measures, each of which requires focus, process, and reporting to achieve. Knowing the opportunities can make the difference between average and high performance. No plan in Michigan has had as a quality rating, nor kept is as long, as Priority Health. Priority Advantage quality teams leverage that expertise.

  • Compliance

    Compliance with CMS rules and regulations can be challenging and has a direct impact on a plan’s overall performance. Operating efficiencies in claims processing, customer service, grievance and appeals, and compliance have led Priority Health to be a high-performing plan with 4.5 Stars. Priority Advantage compliance professionals will work to help you achieve plan compliance from the start and reduce the risks of CMS fines and penalties.

    Priority Health Compliance

Download Whitepaper #1

We’re a lot like you. We are a health plan—and we are part of an integrated health system. We understand business and what it takes to deliver a comprehensive program. Download a whitepaper that details the opportunities that Priority Advantagepresents to organizations like yours.

Why Priority Advantage?

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We’d welcome the opportunity for an initial exploratory discussion to better understand your market and how Priority Advantage could be the right partner for you.