Clinical resources

Manage your patients' health

Clinical practice guidelines list

Here's a list of all Priority Health-recommended Clinical Practice Guideline documents by topic.

Disease management services

Our disease management programs, which include our Centers of Excellence, are designed to support our physicians' practice of moving patients to optimum health.

How to enroll members

There are seven focus areas in our disease management programs, which are all free of cost to our members:

  • Asthma
  • Depression
  • Diabetes
  • Cardiovascular (hypertension, hypercholesterolemia/hyperlipidemia, CHF)
  • Tobacco cessation
  • Extreme obesity with co-morbidities
  • Pregnancy/high-risk pregnancy

Priority Health plan members are automatically enrolled in disease management programs based on claims data, but you may also refer a newly diagnosed patient for enrollment or specific services by calling 800.998.1037. You'll need the patient's:

  • Name
  • Contract number
  • Phone number
  • Specific care needs

Or you can:

  • Use the online Patient Profile tool to identify patients who need clinical services.
  • Schedule a care manager office visit if you would like more information.

How and when we contact your patients

Priority Health has a schedule of initial and follow-up mailings and phone calls from our registered nurses. Disease management programs provide patients with:

  • Information about their conditions
  • Assessment of their immediate needs
  • On-the-spot health information including education on risk factors, healthy lifestyles and adherence to evidence-based treatment
  • Follow-up, education on or compliance with treatments you have ordered
  • Notification of needed tests, abnormal lab values or significant changes
  • Reminders for missed services
  • Direction to online patient education and interactive modules that support patient decisions and management

How we communicate with you

To help you manage your patients, we:

  • Identify patients for you that require clinical support
  • Communicate with you on the care and education we offered the patient
  • Notify you of any needed tests, abnormal lab values or significant changes
  • Work directly with your practice to maintain a high quality of care

Care management services

Our care managers help coordinate health care for Priority Health members.

How to enroll members

Members of Priority Health plans can be enrolled in care management services in three ways.

  • Automatically: All members who meet the above criteria are screened for care management services and automatically enrolled in our program.
  • Inpatient admission reviews: Our utilization management nurses review inpatient admissions and identify members likely to need care management services based on clinical review for clinical appropriateness and transitional needs.
  • Provider referrals: You may refer a patient you feel needs care management services to the care manager assigned to the patient. You can:
    • Send your referral using your secure Mailbox: Send us the patient's name, contract number, DOB and clinical information using your secure Mailbox. Simply choose "Care management referrals" from the list of "To" addresses.
    • If you're not logged in, call the Provider Helpline at 800.942.4765, option 1.

How Priority Health care management works for you

To help you manage your patients' care, we:

  • Identify patients for you that require clinical support
  • Provide tools and resources about specific conditions
  • Communicate with you on the care and education we offered the patient
  • Notify you of any needed tests, abnormal lab values or significant changes
  • Work directly with your practice to maintain a high quality of care