04/21/23

Provider Educational Seminar

Lines of Business

04/21/23

Lines of Business:Lines of Business:Priority Partners Managed Care Priority Partners Managed Care OrganizatioOrganizationn• 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

04/21/23Presented by: Johns Hopkins HealthCare

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)

04/21/23Presented by: Johns Hopkins HealthCare

Priority Partners Managed Care Priority Partners Managed Care Organization:Organization:HealthChoice ProgramHealthChoice 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

04/21/23Presented by: Johns Hopkins HealthCare

Priority Partners Managed Care Priority Partners Managed Care Organization:Organization:Primary Adult Care (PAC) ProgramPrimary Adult Care (PAC) Program

• 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

04/21/23Presented by: Johns Hopkins HealthCare

Lines of Business:Lines of Business:Johns Hopkins Employer Health Programs Johns Hopkins Employer Health Programs (EHP)(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

04/21/23Presented by: Johns Hopkins HealthCare

Johns Hopkins Employer Health Johns Hopkins Employer Health Programs (EHP)Programs (EHP)

• 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

04/21/23Presented by: Johns Hopkins HealthCare

Lines of Business:Lines of Business:Johns Hopkins US Family Health Plan Johns Hopkins US Family Health Plan (USFHP)(USFHP)

04/21/23Presented by: Johns Hopkins HealthCare

Johns Hopkins US Family Health Plan Johns Hopkins US Family Health Plan (USFHP)(USFHP)Military Health SystemMilitary Health System

• 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

04/21/23Presented by: Johns Hopkins HealthCare

Johns Hopkins US Family Health Plan Johns Hopkins US Family Health Plan (USFHP)(USFHP)