Priority Health sells muscle and joint care as riders, so the decision is whether your claims justify paying for them.
Priority Health lists virtual physical therapy, a surgical Centers of Excellence rider, a virtual pain clinic and a supplemental product that rewards use of top-rated providers.
What the program is and what members do.
Sword Health virtual PT
Priority Health says Sword Health provides members whose employer groups purchased the rider with digital physical therapy from home. Priority Health launched Sword Health and the MSK Centers of Excellence together to meet rising need for musculoskeletal care. It is a rider, not a standard plan feature.
MSK Centers of Excellence
Priority Health describes an optional rider covering a coordinated approach to total hip and knee replacement, lumbar fusion, lumbar laminectomy, cervical fusion and cervical laminectomy. Benefits include reduced member cost share and travel cost coverage. Members can still see their preferred surgeon, with care covered according to their plan.
Flowly and Garner Health
Flowly is a virtual clinic delivering pain science for members who have struggled to find relief, listed for all commercial and Medicare members. The Garner app identifies top-performing in-network providers and covers out-of-pocket costs for participating members who choose them, but only where the employer bought the Garner supplemental product.
Eligibility, funding and plan design.
Who qualifies
Priority Health lists the virtual PT and MSK COE offerings for commercial members whose employer purchased the rider. Garner is for commercial members whose employer purchased the supplemental product. Flowly is listed more broadly, for all commercial members, group and individual.
How it is sold
Three of the four items are purchased add-ons. That means a price, a contract term and an employer decision. The pages we reviewed do not publish rider prices, so ask for them in writing. Ask whether each rider has a minimum term, and what happens to cost if the group adds or drops one mid-year.
Plan design fit
Musculoskeletal conditions are a common claims driver, but whether they are a driver for your group is a data question. Riders make most sense where claims show frequent back, joint or surgical spending. The rider also changes member cost sharing, which employees will notice.
What to settle before relying on it.
Do our claims show a musculoskeletal problem worth a rider?
Before buying, we would look at your claims for joint replacement, spine procedures and physical therapy. If volume is low, a rider may cost more than it saves. If it is high, ask Priority Health to model the expected effect for a group your size.
Is travel coverage and reduced cost share clearly documented?
The MSK COE rider includes reduced member cost share and travel cost coverage. Ask for the exact amounts, any limits, and how they appear in the plan documents. Employees considering surgery will need specifics, not a general description. Ask whether the travel benefit covers a companion, and whether it applies to every listed procedure.
Does anything here create a wellness incentive?
Programs that reward members for choosing certain providers or completing activities should be checked against HIPAA and ACA wellness rules. Garner covers out-of-pocket costs for choosing top-rated providers, which is a design feature worth running past employment counsel. Employment counsel can tell you whether the design needs notices or an alternative standard.
Common questions about this program.
Can members still see their own surgeon?
Priority Health says members with the MSK COE rider are free to see their preferred orthopedic surgeon, even if the provider is not in the MSK COE. Care is covered according to their plan.
Is virtual physical therapy included in every plan?
No. Priority Health lists Sword Health for commercial members whose employer groups have purchased the virtual PT rider.
What does Garner Health do?
Priority Health says the Garner app identifies top-performing providers in its network and covers out-of-pocket costs for participating members who choose them. It applies to groups that bought the Garner supplemental product.
Programs and vendors named on this page
Official pages for the services mentioned above. Availability, cost and eligibility vary by plan and employer group, so confirm what applies to your group with the carrier.
Where these details come from.
This page summarizes what Priority Health publishes. Programs change, so confirm current details with the carrier before relying on them.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
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