Grand Rapids-based Priority Health is leading the chorus of health care organizations calling for smart health care and better outcomes. A new Web-based tool allows members to evaluate care options prior to choosing surgery.

“Priority Health is changing how health care is delivered by producing better outcomes and creating better experiences for members all while eliminating avoidable medical costs,” said Kimberly K. Horn, president and CEO.

According to the Centers for Medicaid and Medicare Services and other organizations, up to 50 percent of the cost in the total health care system is avoidable. These costs could be eliminated without impacting the quality or the outcome of care.

One case study demonstrating this fact involves Priority Health’s award-winning back pain management program. Spine surgery rates across Michigan vary. In fact, some Michigan communities have double the incidence of back surgery as the national average. In contrast, research shows that patients are more likely to choose a less invasive approach when given all of their treatment options.

Priority Health worked with its provider network to educate members with back pain. Prior to seeing a spine surgeon, members experiencing back pain see a physiatrist, a physician specializing in musculoskeletal and neurological conditions, who may recommend alternatives to surgery. The members also review a video designed to help them make an informed decision. Following that consultation, members can proceed with recommendations of the physiatrist or choose to consult with a surgeon.

The program resulted in a 26 percent reduction in spine surgeries and yielded high patient satisfaction with 74 percent reporting they were satisfied or very satisfied.

“Our members’ health is our top concern,” said Horn. “Through this program and others, we’ve been successful at delivering smart health care by focusing on treatments that garner the best results for our members. As the number of people enrolled in consumer-engaged health plans increases, we hope to capitalize on this opportunity to create an age of consumerism within healthcare. We each have a responsibility to ask questions of our care givers to ensure the care we receive is the best option available.”

To help members become informed, Priority Health offers a surgery decision support tool on its Web site. Members can use this interactive video tutorial to learn if the surgery they are considering is the right option for their situation. To date, thousands of members have researched their treatment options for conditions like knee pain and back pain. Most members are eligible to receive free wellness materials or fitness equipment after completing the tutorial.

Priority Health offers a broad portfolio of products for employer groups, individuals and Medicare and Medicaid. As a nonprofit company, Priority Health serves more than 600,000 people and continues to be ranked among the America’s best health plans by the National Committee for Quality Assurance.


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