‘We don’t shy away from things that are hard’

Priority Health and Total Health Care in late November won approval from Michigan regulators to merge. Total Health Care—the state’s oldest health plan, founded in 1973— will become a wholly owned subsidiary of Grand Rapids-based Priority, which is part of Spectrum Health. Priority is Michigan’s second-largest health insurer after Blue Cross and Blue Shield of Michigan with more than $4 billion in 2018 revenue and 830,000 covered lives. As part of the merger, Priority Health agreed to contribute $25 million to create a Joan Budden, foundation to address health disparities in Detroit. who has been Priority Health’s CEO since January 2016, is eager to share best practices between the two organizations. She recently talked with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.

MH: Why did you think that now was the time to expand your footprint and merge with Total Health Care?

Budden: We serve all of the other markets in Southeast Michigan except the most vulnerable, which is the Medicaid market.

When an opportunity presented itself to work with the longest-serving health plan dedicated to the Detroit market, we thought it was just an incredible opportunity.

Priority Health is ranked the highest in terms of quality for Medicaid in the state of Michigan year after year, so it allows us to have a great learning opportunity for them; how we can best serve that population delivering high-quality care so that people can be their healthiest.

MH: How did the opportunity first present itself?

Budden: Priority Health and Total Health Care leadership teams serve on many of the same committees in Michigan for Medicaid. We were obviously familiar with each other and part of this was their decision that they needed to have a broader footprint in order to have a bigger impact on the state. We began to have a conversation about what could that look like in order to maintain their unique identity, but also be part of a broader organization.

MH: How do you see the two maintaining their identities?

Budden: I expect that Total Health Care as the unique brand … would continue to have its focus on the tricounty area in Michigan, which is Wayne, Oakland and Macomb, where they’ve been the most successful. They’ll still focus on the most vulnerable population. We will work with them. We’ll be walking through the different aspects of Medicaid and talking about what’s their best practices and what’s ours and what is the best for all of our members across the state. How do we learn from each other?

About half their membership is in smallgroup and individual Affordable Care Act membership. We think that we can work well with them in terms of having affordable products for the city alongside a whole spectrum of services that might go across the whole state of Michigan. Economies of scale are always really important.

So the digital technology transparency tools that we have, the infrastructure to do forecasting to share risks, those kinds of things will be valuable.

MH: Are there things that you’ve seen from them with their Medicaid portfolio that, off the bat you would say, Priority could pick that up?

Budden: I’m really excited to share some of the social determinants of health work they do. We do some today at Priority Health, but I believe that Total Health Care might even take it a step further with having their social workers out in the field with people.

MH: One of the other areas you’re looking at for 2020 is a new offering for the dualeligible market. What are you hoping to achieve there?

Budden: We have about 8,000 members who were eligible already for Medicare and Medicaid but enrolled separately. We believe that by bringing those benefits together into a single plan we will be able to more seamlessly help them address chronic diseases and fragile

lifestyles; try and get care management that will more fully address the social needs that they have that are impacting their health and their lives.

It’s a vulnerable population; the kind of population that Priority Health stays committed to. We don’t shy away from things that are hard. And while this can be a challenging population, our long-standing care-management program will be very well-served to help them have their best health, get the right care at the right place at the right time. Our home-based primary-care services, which are targeted toward the frail elderly or people with multiple chronic conditions, are really aimed for this kind of population.

MH: Are there things that you’ve been doing on the social determinant front across your membership that you think will apply to dual-eligibles?

Budden: We worked on social determinants before it had its own acronym. Our care-management programs always have been that far-sweeping approach to helping a member. We had an app that helped members get connected with social services, community services partners, before that was the thing to do.

One of the things that we work with our provider partners on is how do we make it a mutually beneficial situation. No one pays providers to address the social determinants of health. So how do we incent that? How do we work with them to have the infrastructure to support the underlying foundational things that are causing some people to be less healthy or that we could address to make them healthier?

So lifestyle medicine and cooking classes—those are the kinds of things that we’ve been doing for our Medicaid population for a long time, but this is taking it to a new level.

“We worked on social determinants before it had its own acronym. Our care-management programs always have been that far-sweeping approach to helping a member.”

MH: Do you build any of that into your provider contracts?

Budden: It’s a little bit of everything. It’s pilot projects and starting with small things, seeing if they work. We’ve been working on virtual mental health to get greater access to care across all of Michigan. A lot of our state is rural populations with very little access to that kind of care. We want to make that more available to people, especially to a Medicaid population where reimbursement levels aren’t the same as commercial. ●