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Mike Koziara, chief operating officer at Priority Health Mike Koziara, chief operating officer at Priority Health COURTESY PHOTO

Priority deal with McLaren opens Lansing market for GR-based insurance provider

BY Sunday, January 29, 2017 08:00pm

A deal with McLaren Health Care fills the final gap in the map for Priority Health’s care network across the Lower Peninsula.

Under an agreement reached last week, McLaren Health Care will accept Priority Health commercial and Medicare Advantage coverage for members seeking care from its hospitals and nearly 1,000 physicians in Lansing, Flint, Bay City and Lapeer.

The participating agreement finally gives the Grand Rapids-based health plan in-network coverage at one of the two health systems based in Lansing through its PPO, HMO, point-of-service and Medicare Advantage plans.

Securing the agreement with McLaren Health rounds out Priority Health care network, which now spans the entire Lower Peninsula. The deal enables Priority Health to pursue business not only in the Lansing area but with employers based elsewhere in Michigan who may have an office in the market.

“When pursuing employers for statewide coverage, we’ll be able to provide them coverage without an exception,” said Mike Koziara, chief operating officer at Priority Health. “We’re looking forward to really growing from this.”

Priority Health already contracted with McLaren for coverage at its hospitals elsewhere in Michigan.

McLaren has 12 hospitals across the state, plus outpatient surgery and imaging centers and a primary-care physician network. The Flint-based McLaren also owns commercial and Medicaid HMOs that have more than 240,000 members.

“The expansion of our existing relationship represents a natural evolution of this strategic partnership,” said McLaren President and CEO Phil Incarnati. “Providing Priority Health’s customers with greater access to McLaren’s statewide network of hospitals and physicians is truly a win-win combination for our respective organizations.”

Priority Health lacks a participating agreement for its commercial health plans with Lansing-based Sparrow Health, although the two do have a contract for the insurer’s Medicare coverage.

Priority Health, which is majority-owned by Spectrum Health in Grand Rapids, remains interested in an agreement with Sparrow Health for its commercial health plans, although the two are not actively in discussions, Koziara said.

“We think Sparrow Health System is a fine organization. It has great services and great doctors and we would like nothing more than to enter into a contractual relationship with that organization,” he said. “We think that would be good for the market and good for the state and we would value that greatly.”

Sparrow Health has two campuses in Lansing, plus Sparrow Clinton Memorial Hospital in St. Johns, Sparrow Ionia Hospital in Ionia and an affiliation with Carson City Hospital. It also operates a number of ambulatory care centers. Additionally, Sparrow owns a Physicians Health Plan, a 36,000-member commercial HMO, and Sparrow PHP, a Medicaid HMO with more than 21,000 members.

While the deal with McLaren Health gives Priority an entry in the Lansing-area market, the opportunity remains limited without having Sparrow Health in its care network for its commercial business.

“We’ll certainly grow our market share, but it won’t always meet every employer’s needs that say, ‘I need Sparrow access as well,’” Koziara said. “We still may not be as strong in the market, but we’ll certainly be able to serve the vast majority of employers around Lansing.”

Read 2773 times Last modified on Friday, 27 January 2017 13:23