Transcript Provider Educational Seminar

Provider Educational
Seminar
Lines of Business
4/10/2015
4/10/2015
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
4/10/2015
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
4/10/2015
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
4/10/2015
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
4/10/2015
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
4/10/2015
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
4/10/2015
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
Presented by: Johns Hopkins HealthCare
4/10/2015
TRICARE For
Life (65+
Medicare
Supplemental)
Military
Treatment
Facilities and
MCSC
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
4/10/2015