Commitment to Above and Beyond Health Care

At Johns Hopkins USFHP, we believe taking charge of your health is one of the most important things you can do for yourself. Your health is our number one priority, and we encourage all of our members to live healthy, fulfilling lives. Enjoy all of the health and wellness benefits we have to offer at no cost to you.

Care Management

Care managers/member advocates

Care managers collaborate with members and all their health care providers to achieve the best possible health for members. Care managers help members to improve their health and quality of life by:

  • Assessing psychosocial, spiritual, and financial needs
  • Educating on ways to manage health
  • Assisting with referrals to specialty providers
  • Coordinating care with our outreach and health education department, home health, and other health and community agencies
  • Providing ongoing communication to check progress and review for continuing services

Care Management Population Health Initiative

Our care management department is devoted to helping you better understand and manage your health through our Population Health Initiative. Assistance through this initiative is offered on two levels depending on your need.

Complex care management – high intensity

Complex care management is provided for adults and children with diabetes and asthma, as well as all adults with chronic obstructive pulmonary disease (COPD) and cardiovascular disease. Once a member is identified with complex medical conditions or a special need, our highly-qualified staff determines the specific services the member needs. The nurses and social workers on our staff are trained to help these members with a wide range of services.

Care management is also available for the following:

  • High-risk pregnancy
  • Cancer
  • Children with sickle-cell conditions, genetic conditions, complications from prematurity, obesity, neurological problems, and other conditions
  • End-stage renal disease (ESRD) and members on dialysis
  • Members with rehabilitation needs for spinal cord injury, traumatic brain injury, severe burns, trauma from motor vehicle accidents, and stroke

Monitored care management – moderate intensity

Members with less complicated conditions may benefit from ongoing monitoring and improvement of self-management skills. Once a member is identified with having asthma and/or diabetes, and may have risk factors for developing other conditions or complications, our skilled staff of personal care managers monitor the member’s health status and ongoing needs over time. These personal care managers encourage progress toward health goals. They provide guidance and tools aimed to improve overall self-management of asthma and diabetes.

Other population health-based services

  • Periodic mailings of educational materials focused on increasing self-management skills and preventing complications
  • Review of medications and discussion with our clinical pharmacy services if needed
  • Assistance with obtaining behavioral health services
  • Treatment coaching (This service can be reached by calling 888-309-4573.)
  • Assistance moving members from a hospital to a lower level of care and then home: staff works with providers, members, and families on discharge planning, care coordination, and member and family education.

Health Education

USFHP health educators offer a variety of programs to help our members identify risks that could be harmful to their health and learn ways to achieve and maintain healthy lifestyles—like losing weight or learning how to manage a specific health condition. Classes are interactive and fun, and often include gifts and prizes. The programs are offered year-round and are conveniently located within or near Johns Hopkins Community Physician sites throughout Maryland.

Health Coaching

If you want to adopt lifestyle changes that will help you lead a fulfilling and healthful life, we encourage you to sign up for our Health Coaching Program. The Health Coach Program gives you the opportunity to work one-on-one with a personal health coach and create an individualized action plan.  Whether you want to manage stress, lose weight, improve fitness and nutrition or quit smoking, a USFHP health coach will provide you with the information and encouragement you are looking for. The coaching sessions are flexible for your busy schedule and are conducted over the telephone. If you are interested in creating a dynamic partnership with someone who can help you reach your short and long term wellness goals, this program is for you.

If you would like to speak with a US Family Health Plan health coach, please call: 1-800-957-9760, or email:

Health Information Library

Access our comprehensive health and wellness library of information provided through Johns Hopkins. You can find definitions of various health topics; browse conditions, treatments, and health centers; get information on drugs, herbs, and supplements; see tips for healthy living and general wellness; and understand the personal care each family member needs. Our library boasts quizzes, articles, videos, and other interactive tools to give you all the resources you need to improve your health and wellness.

Visit our health information library.

24/7 Nurse Chat Line

Have a health question or need medical advice? Consult with a registered nurse online or over the phone whenever it’s convenient for you—24 hours a day, seven days a week.

Call 1-844-344-4218, then enter PIN 382, or connect to the online nurse chat website.