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Healthy Behaviors Program

Prestige Health Choice (Prestige) offers Healthy Behaviors Programs whereby members are eligible to earn rewards for completing certain health milestones in 8 areas that focus on helping members change unhealthy behaviors.

For the three programs listed below, members who are interested will be required to see their primary care provider (PCP) and must agree to participate in Prestige's Care Management Program before joining and committing to the program.

  • Weight loss.
  • Smoking cessation.
  • Alcohol and substance use.

Members expressing interest in joining will bring a Commitment Form (PDF) with them to their appointment. Members may participate in more than one program.

PCPs should indicate the program their patient/member is interested in completing, and then sign the member's Commitment Form. PCPs can fax the Commitment Form to the Prestige Rapid Response and Outreach Team at 1-855-236-9281, or return the form to the member to mail in the prepaid envelope provided to:

Prestige Health Choice
P.O. Box 7181
London, KY 40742

Once the member submits his or her completed form to Prestige, a care manager will call the PCP office to confirm the member kept his or her appointments and was referred appropriately.

Prestige will reward members for milestone completion. Rewards start at the $10 level. Depending on how many health milestones are achieved, members can receive an end-of-program reward valued up to $50. For more information on milestones and rewards, please refer to the Healthy Behaviors Goal Completion Grid (PDF).

For the following programs, members will be identified through claims data, or they may choose to self-enroll. Participants in these programs will receive a Completion Form (PDF).

  • Dental.
  • Maternity.
  • Postpartum.
  • Well child (31 days to 15 months of age).
  • Well child (3 to 6 years of age).
  • Adolescent well care.
  • Lead screening.
  • Diabetes testing.
  • Diabetes eye exam.
  • Behavioral health.
  • Breast cancer screening.
  • Cervical cancer screening.

After the member has completed the required number of visits for one or more programs, you can fax the Completion Form to the Rapid Response and Outreach Team at 1-855-236-9281, or the member may mail the signed form in the prepaid envelope provided to:

Prestige Health Choice
P.O. Box 7181
London, KY 40742

Once the form is returned to Prestige, the member will receive a gift card in the mail after services have been verified. If claims for services cannot be verified, the member will be responsible for providing proof of service.  Members can receive a reward of up to $50 value per program.

Weight loss management

The Commit to Be Fit Program provides members with weight loss resources and support, as well as rewards for dietary and nutritional counseling, behavioral therapy, and physical activity.

This weight loss program is for members who have a documented body mass index (BMI) of 35 or above. The member will be engaged with their PCP and have initial and follow-up BMI assessments (initial, at five to seven weeks and at three months) to maintain a medically supervised weight loss program.

BMI screenings will be conducted by the PCP at each visit to document improvement. Members can be referred to a dietitian or nutritionist and will earn a gift card for attending this appointment as well.

The Prestige Care Management team will follow the member's progress through communication with the member’s PCP. The overall goal is for members to reduce their BMI and decrease risk of comorbidities.

Smoking cessation

This program will provide members with resources for smoking cessation. Once members have joined the program, a Prestige care manager will instruct them on how to become eligible for free nicotine replacement therapy through Tobacco Free Florida. Care managers will also help members sign up for the Tools to Quit and Quit Smoking Now programs. A provider may also prescribe smoking cessation medication.

Members are coached by their care managers on following through with health goals and are taught how to earn rewards for completing certain activities, such as attending a smoking cessation seminar and submitting a certificate of completion to Prestige.

Please refer to the tobacco quick reference guide (PDF) for more information on smoking cessation.

Alcohol and substance use

This program will provide members with resources for alcohol and substance use recovery services. Members will be referred to Beacon Health Options Encompass Program, a program offered by our behavioral health vendor.

Treatment options include attending community support groups, such as Narcotics Anonymous and Alcoholics Anonymous. Physicians will monitor each member's medication management, therapy, and psychosocial rehabilitation.

In collaboration with Beacon Health Options, Prestige Care Management will follow each member's progress through communication with the member’s PCP. The Beacon Health Options care manager will also educate the member about rewards for completing health milestones, such as maintaining sobriety for 30, 90, and 180 days.

The goals of this program are to successfully engage the member in substance use treatment from the PCP and help the member achieve sobriety and become healthier.

Prestige asks that all PCPs screen members for signs of alcohol or substance use as part of prevention evaluation at the following times:

  • Initial contact with new member.
  • Routine physical exams.
  • Initial prenatal contact.
  • When the member evidences serious overutilization of medical, surgical, trauma, or emergency services.
  • When documentation of emergency room visits suggests the need.

Dental

This program is for members 2 to 20 years old who complete at least one dental visit on or between January 1, 2017, and December 31, 2017.

Maternity

This program is for pregnant members, regardless of the member’s pregnancy risk. Each member will receive a gift card for attending at least 10 of 13 prenatal visits and a postpartum visit. The postpartum visit must have occurred within 21 and 42 days after giving birth.

The member must have delivered a child on or between November 6, 2016, and November 5, 2017. 

See how you can help members stay on track with our Bright Start® pregnancy program.

Postpartum

This program is for members who complete a postpartum visit within 21 and 42 days of giving birth. The member must have delivered a child on or between November 6, 2016, and November 5, 2017.

Members who complete the Maternity Reward Program will not be eligible for the Postpartum Reward Program as well.

Well child (for members who have turned 15 months of age during 2017)

This program is for members who complete six or more well-child visits from 31 days to 15 months of age. The member must turn 15 months old during the measurement year from January 1, 2017, through December 31, 2017.

Well child (for members who are 3 to 6 years of age during 2017)

This program is for members who complete one or more well-child visits with a doctor. Member must be 3 to 6 years of age on or between January 1, 2017, and December 31, 2017.

Adolescent well care

This program is for members who complete at least one well-care visit with a PCP or an OB/GYN practitioner. Member must be 12 to 21 years of age on or between January 1, 2017, and December 31, 2017.

Lead screening

This program is for members who complete one or more capillary or venous lead blood test for lead poisoning. The member must be at least two years of age on or between January 1, 2017, and December 31, 2017.

Breast cancer screening

Member must complete one mammogram screening for breast cancer. Member must be 50 to 74 years of age on or between January 1, 2017, and December 31, 2017.

Cervical cancer screening

Member must complete one cervical cytology screening for cervical cancer. Member must be 21 to 64 years of age on or between January 1, 2017, and December 31, 2017.

Diabetes testing

This program is for members 18 to 75 years old with diabetes who have the following diabetes tests:

  • Hemoglobin (HbA1C) blood test.
  • Microalbumin/urine screen/monitor (kidney disease screening).

Member must be 18 to 75 years of age on or between January 1, 2017, and December 31, 2017.

Diabetes eye exam

This program is for members 18 to 75 years old with diabetes who have the following diabetes tests:

  • Retinal or dilated annual eye exam.

Member must be 18 to 75 years of age on or between January 1, 2017, and December 31, 2017.

Behavioral health follow up

This program is for members 6 years old and older who were hospitalized for treatment of selected mental illness diagnoses and had a follow-up visit with their provider within seven days of discharge from an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner. The member must be at least six years of age on or between January 1, 2017, and December 31, 2017.

You may also contact your provider account executive or call Provider Services for more information at 1-800-617-5727.