Priority Partners, one of seven Managed Care Organizations authorized by the State of Maryland to provide health care services for Medicaid and Maryland Children's Health Insurance Program recipients, is owned by Johns Hopkins and five federally qualified health centers throughout the State. Priority Partners has established a statewide network of doctors, health centers, and hospitals offering doctors visits, vision care, prescription coverage, immunizations, hospital coverage, dental care, and no-cost over-the-counter medications, as well as substance abuse services. To manage complicated healthcare issues, Priority Partners has several Care Management initiatives which provide one-on-one nurse case managers to assist individuals in understanding their illness, adapting to their treatment plan, and coordinating medical appointments. The Maryland Childrens Health Program (MCHP) was established in 1998 using federal and state funds to provide no cost health care coverage to children up to age 19. The program also offers pregnant woman of any age full pre-natal, delivery, and post-partum health care. Eligibility for MCHP, determined by family size and income, is based on a sliding scale. For example, a family of four with income at or below $46,800 would qualify to have its children enrolled in MCHP at no cost. In determining eligibility for pregnant women, the program counts the unborn child as a member of the family and increases the income eligibility levels significantly (i.e. a family of four including a pregnant women would qualify with a household income as high as $58,500). In cases where family income is somewhat higher, many families are eligible for MCHP Premium, a low-cost health insurance program. A family of four with income at or below $58,500 could participate for a monthly fee of $44. If the family included a pregnant woman, the eligibility income level would rise to $70,200 for the household.
Established in 1987, D.C. Chartered Health Plan, Inc., (Chartered) is a private sector, minority-owned and operated managed care organization, currently participating in the District of Columbia Medicaid Managed Care Program. Chartered's 20 year mission has been to enhance access to high quality health care services in underserved areas throughout its diverse communities. In 1990, a sister company, Rapid Trans, was incorporated to schedule, manage and transport Chartered's Medicaid members to and from their medical appointments. In 1992, Chartered established its first staff model primary care provider site. On March 25, 1995, Chartered opened a 15,000 square foot, state of the art, and comprehensive health care center. The Chartered Family Health Center provides pediatric, internal medicine, family practice, OB/GYN, podiatry, allergy, WIC, radiology, laboratory and pharmacy services. On May 17, 2000, Chartered was purchased by DC Health Systems, Inc., a DC-based healthcare services company, owned by Jeffrey Thompson, the financier who successfully secured the start-up capital to launch Chartered in 1987. Chartered has maintained strong financial viability and has enhanced its financial position significantly from 1998 to present. With its fiscal strength and the corporate commitment of its owner, Chartered is in a dominant financial position to continue to develop its infrastructure and health care delivery systems that will result in better service delivery to its current and future members. Through the collaboration of its employees, providers and community based organizations; Chartered delivers care in a culturally sensitive and caring manner. Chartered is committed to the philosophy of quality improvement and its primary goals have been customer service and health outcomes improvement as well as systems and operations integration improvement. As a result, Chartered became accredited by the National Committee of Quality Assurance (NCQA) in April 2007. Currently, Chartered enrolls over 38,000 TANF, SCHIP and 50-64 beneficiaries and over 21,000 Alliance/uninsured recipients. Tamara A. Smith, President and CEO of Chartered Health Plan is committed to providing high quality health care services and efficient health plan operations with the vision to expand services in new markets in 2007 and beyond.
The Monroe Plan For Medical Care is a not-for-profit health care organization that provides Blue Choice Option, Child Health Plus, and Family Health Plus insurance in the Monroe and surrounding counties. The Monroe Plan provides health care for approximately 90,000 members and represents over 4,500 medical professionals in the counties that we serve.
The GHG Speakers Bureau offers the Medicare managed care industry's most highly regarded consultants to provide expert insight and commentary for your program. The Bureau was founded by John Gorman, President and CEO, and recipient of the Best Speaker Award for the 2000 National Managed Health Care Congress, the nation's largest annual convention of the managed care industry. Mr. Gorman delivers over 50 speeches annually to health plans, industry trade organizations, pharmaceutical audiences, and others on a variety of topics critical to the success of these entities in the Medicare space. Other speakers include GHG Senior Consultants Tom Anderson, Jeffery Fox, Jean LeMasurier, and Bette Weisberg. Speaking topics include: Industry Trends Marketing and Sales Special Needs Programs, Provider Network Contracting and Relations Pharmacy Benefits Strategy, Employer Group Strategy and many others For more information on the Bureau, or to request a speaker, please send us an email.
Network Health is a comprehensive health plan that provides access to high-quality health care for Massachusetts residents who could not otherwise afford it. Today we serve more than 150,000 members in more than 300 cities and towns. We provide health insurance coverage for eligible individuals under the Commonwealth Care Insurance Program through our Network Health Forward plan. Nationally recognized for our innovative programs, we are also one of four nonprofit organizations contracted by the Commonwealth of Massachusetts to provide coverage for a portion of the state's Medicaid population through MassHealth, a state and federally funded Medicaid program designed to provide access to high-quality care to low- and medium-income residents who meet certain eligibility guidelines. MassHealth members may select our Network Health Together plan for high-quality care, plus other benefits and discounts. Members get access to a friendly, professional, multilingual staff. Contact us by phone at 888-257-1985 Monday through Friday, from 8:30 a.m. to 5 p.m. For urgent and emergency care, clinicians and medical services are available 24 hours a day, seven days a week. Network Health provides an interdisciplinary approach to care by performing all clinical functions in-house, including medical management, behavioral health, social care management and pharmacy. Network Health also partners with a growing network of almost 15,000 primary care providers, specialists, hospitals, and community organizations that work together to coordinate care.
CalOptima is an integrated health care system that administers health insurance programs for Orange County children, low income families, and persons with disabilities. The public agency's programs include coverage for people in Medi-Cal, a Medicare Special Needs Plan called OneCare, and coverage for children in the Healthy Families and Healthy Kids programs through CalOptima Kids. CalOptima's network of doctors and hospitals includes more than 5,000 primary care doctors and specialists and 20 hospitals serving nearly 330,000 members.
HMA, INC. is privately held and one of The i/mx Companies (www.imxinc.com)family of integrated managed healthcare and insurance companies. The i/mx Companies provide managed healthcare services to over one million covered lives, 75,000 healthcare providers and 50,000 pharmacies. The i/mx Companies offer a variety of health plans including Health Maintenance Organizations ("HMO"), Heath Insurance and Reinsurance, Preferred Provider Organizations ("PPO"), Point of Service plans ("POS"), Administrative Service Only plans ("ASO") and Prescription Benefit Management plans ("PBM"). The i/mx Companies offer these plans to employers, health and welfare trust funds, government entities and individuals. HMA, INC. ("HMA"), founded in 1983, is a diversified healthcare management and information services organization and one of the fastest growing and largest Third Party Administrators in the United States. Sharply focused on managed healthcare and employee benefits, HMA has successfully redefined the role of outsourcing the administration of employee benefit health plans. Utilizing its proprietary information management technology, and through its wholly owned subsidiary companies and service centers in Nevada, Arizona, Hawaii and Iowa/Illinois, The HMA Companies offer their clients the following services: The HMA Companiesâ€¦.Defining The Power Of Product Integration! , Third Party Administration and Claims Management for employee benefit health plans , Medical Management, Disease Management and complex Case Management services , Provider Network Development and Management of PPOs, EPOs, IPAs, PHOs, MCOs and HMOs , Prescription Benefit Management services and a national Pharmacy Network , Consulting and Advisory services for self-funded employee benefit health plans , Native American Program initiatives including development and management services , Medicaid Managed Care and KidsCare Programs including development and management services , HMO and MCO Programs including development and management services , Consulting and Advisory services for Physicians and Group Practices Health Management Network, Inc. ("HMN") . . . founded in 1992, is a national Preferred Provider Organization ("PPO") with over 75,000 providers and a presence in every state and a state-wide/region-wide presence in the west, southwest, Midwest and Hawaii. Medical Management Services, Inc. ("MMS") . . . a regional Medical Management Organization which provides utilization review, quality assessment, performance improvement and large case management to both self-funded and fully insured health plans. MMS also provides practice management and physician advisory services to physician group practices, including single specialty and multi-specialty groups.
Centene Corporation is a multi-line healthcare enterprise operating primarily in two segments: Medicaid Managed Care and Specialty Services. The Companyâ€™s Medicaid Managed Care segment provides Medicaid and Medicaid-related health plan coverage to individuals through government subsidized programs, including Medicaid, the State Childrenâ€™s Health Insurance Program (SCHIP) and Supplemental Security Income Program (SSI). As of December 31, 2007, Medicaid accounted for 74% of the Companyâ€™s membership, while SCHIP and SSI accounted for 20% and 6%, respectively. Centene Corporationâ€™s Specialty Services segment provides specialty services, including behavioral health, life and health management, long-term care programs, managed vision, nurse triage, pharmacy benefits management and treatment compliance, to state programs, healthcare organizations and other commercial organizations, as well as to its own subsidiaries on market-based terms. (Source: 10-K)
AMERIGROUP Corporation is a multi-state managed healthcare company focused on serving people, who receive healthcare benefits through publicly sponsored programs, including Medicaid, State Childrenâ€™s Health Insurance Program (SCHIP), FamilyCare and Medicare Advantage. The Company designs its programs to address the particular needs of its members, for whom AMERIGROUP Corporation facilitates access to healthcare benefits pursuant to agreements with the applicable regulatory authority. The Company combines medical, social and behavioral health services to help its members obtain healthcare in an efficient manner. As of December 31, 2007, AMERIGROUP Corporation provided an array of products to approximately 1,711,000 members in the District of Columbia, Florida, Georgia, Maryland, New Jersey, New York, Ohio, South Carolina, Tennessee, Texas and Virginia. (Source: 10-K)
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