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8/9/2015 Provider Educational Seminar Lines of Business 8/9/2015.

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Presentation on theme: "8/9/2015 Provider Educational Seminar Lines of Business 8/9/2015."— Presentation transcript:

1 8/9/2015 Provider Educational Seminar Lines of Business 8/9/2015

2 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 8/9/2015 Presented by: Johns Hopkins HealthCare

3 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) 8/9/2015 Presented by: Johns Hopkins HealthCare Priority Partners Managed Care Organization: HealthChoice Program

4 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 8/9/2015 Presented by: Johns Hopkins HealthCare Priority Partners Managed Care Organization: Primary Adult Care (PAC) Program

5 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 8/9/2015 Presented by: Johns Hopkins HealthCare Lines of Business: Johns Hopkins Employer Health Programs (EHP)

6 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 8/9/2015 Presented by: Johns Hopkins HealthCare Johns Hopkins Employer Health Programs (EHP)

7 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 8/9/2015 Presented by: Johns Hopkins HealthCare Lines of Business: Johns Hopkins US Family Health Plan (USFHP)

8 8/9/2015 Presented by: Johns Hopkins HealthCare Johns Hopkins US Family Health Plan (USFHP) Military Health System TRICARE TRICARE Standard (FSS ) TRICARE Extra (Preferred Provider) TRICARE Prime (Managed Care ) US Family Health Plan Military Treatment Facilities and MCSC TRICARE For Life (65+ Medicare Supplemental )

9 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 8/9/2015 Presented by: Johns Hopkins HealthCare Johns Hopkins US Family Health Plan (USFHP)


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