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Provider Educational Seminar. Lines of Business. 10/4/2014. Lines of Business: Priority Partners Managed Care Organizatio n. One of seven MCOs authorized by the State to serve Medicaid, Maryland Children’s Health Insurance Program and Primary Adult Care program recipients
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Provider Educational Seminar Lines of Business 10/4/2014
Lines of Business:Priority Partners Managed Care Organization • One of seven MCOs authorized by the State to serve Medicaid, Maryland Children’s Health Insurance Program and Primary Adult Care program recipients • Owned by Johns Hopkins HealthCare and the Maryland Community Health System (eight Federally Qualified Health Centers) • Currently over 185,000 members Presented by: Johns Hopkins HealthCare 10/4/2014
Priority Partners Managed Care Organization:HealthChoice Program Children, families, and pregnant women • Visits with a primary care provider, outpatient/inpatient services, maternity care • X-rays, screenings, and lab tests • Dental and vision care (check website for limitations) • Substance abuse treatment • Access to care management programs and outreach services • Visits to urgent care centers • Low cost over-the-counter and prescription medications (check the formulary for details) Presented by: Johns Hopkins HealthCare 10/4/2014
Priority Partners Managed Care Organization:Primary Adult Care (PAC) Program Adults 19 years of age and older • Visits with a primary care provider, outpatient services • X-rays, screenings, and lab tests • Dental care (check website for limitations) • Substance abuse treatment • Access to care management programs • Vision and podiatry care for diabetics • Low cost over-the-counter and prescription medications (check the formulary for details) • Emergency department facility services Presented by: Johns Hopkins HealthCare 10/4/2014
Lines of Business:Johns Hopkins Employer Health Programs (EHP) • Self-funded health plan • Over 50,000 plan members in Maryland, Southern Pennsylvania, and Northern Virginia • Employers are Johns Hopkins entities and other regional employers • All packages governed by the Department of Labor ERISA regulations Presented by: Johns Hopkins HealthCare 10/4/2014
Johns Hopkins Employer Health Programs (EHP) • Doctor’s visits, outpatient services, inpatient services, maternity care • Local:14,000 health care providers, 30 hospitals • National (MultiPlan): 695,000 providers, 3,500 hospitals • Dental coverage through United Concordia Company, Inc.* • Pharmacy coverage through Caremark* • Behavioral health services • Care Management programs for members with chronic conditions* • Health Coach service* *client option Presented by: Johns Hopkins HealthCare 10/4/2014
Lines of Business:Johns Hopkins US Family Health Plan (USFHP) • Department of Defense designated provider of TRICARE Prime benefits to eligible military beneficiaries in and around Maryland • 30,000+ members • Main primary care group is Johns Hopkins Community Physicians (JHCP) • 17 private health centers throughout Maryland • Recently expanded into Southern Pennsylvania through Wellspan contract Presented by: Johns Hopkins HealthCare 10/4/2014
Johns Hopkins US Family Health Plan (USFHP)Military Health System Presented by: Johns Hopkins HealthCare 10/4/2014
Johns Hopkins US Family Health Plan (USFHP) • Doctor’s visits, outpatient/inpatient services, maternity care (JHCP and others) • Lab tests, screenings, and lab tests • Dental care through United Concordia Companies, Inc. • Vision care through Wilmer Eye Institute or Block Vision • Prescription drug coverage through Rite Aid pharmacy • Behavioral health services • Care management programs for members with chronic conditions • Health coach service Presented by: Johns Hopkins HealthCare 10/4/2014
