Priority Health Choice Inc

What it reported doing in 2024

Priority health offers medicaid, including michild, healthy Michigan plan and children's special health care services (cshcs) plans for individuals and their families in Michigan. Priority health choice, inc. Provides more than 211,000 lower income and/or disabled residents in 37 Michigan counties with access to quality and affordable health care services. It promotes and incentivizes open access to providers.our medicaid plans offer excellent health coverage and are rated as top-quality plans by the Michigan department of health and human services. Our service area includes west Michigan, northern Michigan and the metro detroit area.priority health choice, inc. Received a rating of 3.0 out of 5 from the national committee for quality assurance (ncqa). The rating was based on clinical quality, member satisfaction and ncqa accreditation survey results which were conducted on more than 1,000 health insurance plans. In addition to this recognition from ncqa, the 2024 medicaid health plan consumer guide from the Michigan department of health & human services has awarded priority health choice, inc. With the highest overall rating. The overall rating includes all 5 categories in addition to how the members feel about their plan and the help the members receive from their plan.as a result of the recent medicaid rebid, priority health choice, inc. Has undergone significant changes that will impact providers in northern and southwest Michigan. Effective october 1, 2024, priority health choice, inc. Will maintain access to regions 4 (west Michigan) and 10 (detroit metro), gain access to regions 2 and 3 (northern Michigan), and lose access to region 8 (southwest Michigan). This rebid, conducted by the Michigan department of health and human services (mdhhs), determines where health plans can offer their medicaid products across Michigan's 10 prosperity regions. Providers in the newly acquired regions are encouraged to join priority health's network and assist medicaid members during this transition. Members will receive letters from mdhhs with instructions on selecting new plans if their current plan exits their region. Providers will guide their patients through this process and utilize available resources to ensure a smooth transition.children's special health care services (cshcs) is a specialty program offered by the state of Michigan to provide care for children and some adults with chronic health conditions. In addition, the cshcs program offers support to the families and caregivers of the member. Cshcs program eligibility is based on more than 2,700 medical diagnoses. The majority of the cshcs population is enrolled in a medicaid health plan. Priority health choice, inc. Has a specialty care management program for this unique population. A dedicated care management team ensures cshcs members are established with a primary care medical home while also providing care coordination between their primary care / specialty care providers and any ancillary providers. This team includes care managers, community health workers, field service representatives, and other key partners, including county health departments, early on, early head start, the intermediate school districts, specialty providers, and medical suppliers. The care management team also facilitates access for families to the family center for children and youth with special health care needs, and the children's special needs funds in lansing. As of december 31, 2024, priority health choice, inc. Had 5,443 members enrolled in the cshcs program an increase of 9% from the prior year.the healthy Michigan plan encourages healthy behaviors and personal responsibility, helps low-income Michigan residents access affordable health coverage, and reduces uncompensated care that shifts costs onto businesses and taxpayers. As of december 31, 2024, priority health choice, inc. Had 61,051 members enrolled in the healthy Michigan plan.priority health choice, inc. Makes outreach calls to e

Financial Efficiency

• Mission deployment rate: 91.9%; rating input score 92
• Program expense ratio: 96.8%; rating input score 97
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 92.9%; rating input score 93; 17th percentile among comparable filings
• Pay-setting controls: 0 of 6 controls in place; rating input score 0
  • Compensation committee: Missing
  • Independent consultant: Missing
  • Other Form 990s reviewed: Missing
  • Written employment contract: Missing
  • Compensation survey or study: Missing
  • Board or committee approval: Missing
• Foreign activity oversight: Limited
• Grant itemization coverage: Limited
• Major donor itemization: Limited
• Related-party transparency: Limited

Accountability

• Independent voting board: 14.3%; rating input score 14; 9th percentile among comparable filings
• Governance controls: 7 of 9 controls in place; rating input score 78
  • Conflict-of-interest policy: Pass
  • Whistleblower policy: Pass
  • Document-retention policy: Pass
  • CEO compensation review process: Fail
  • Other executive compensation review process: Fail
  • Form 990 shared with the board: Pass
  • Board meeting minutes documented: Pass
  • Audit committee oversight: Pass
  • Independent financial-statement audit: Pass

Sustainability

• Operating margin: 3.4%; rating input score 50; 50th percentile among comparable filings
• Total-asset coverage ratio: 0.34; rating input score 11; 11th percentile among comparable filings
• Liabilities to assets ratio: 0.43; rating input score 42; 42nd percentile among comparable filings
• Officer compensation ratio: 0.1%; rating input score 92; 92nd percentile among comparable filings

Growth

• Program expense growth: 14.1% per year; rating input score 100; 86th percentile among comparable filings
• Revenue growth: 14.3% per year; rating input score 100; 88th percentile among comparable filings
• Asset growth: 16.5% per year; rating input score 100; 89th percentile among comparable filings