DIRECTORY OF UR PROVIDERS AND CASE MANGERS ( H )

H
HCX Inc.
600 New Hampshire Ave. N.W.,
Suite 600, Washington, D.C. 20037-2409; 202-625-3200; fax: 202-298-6188
Utilization Review/Case Management
1996 revenues
Total gross revenue*$13,000,000
UR/case mgmt. direct to employers30%
Svcs. to managed care/insurance providers20%
Other services50%
Staff
Total UR/case management employees47
UR/case mgmt. employees on retainer72
Clients
Total50
Corporate/institutional employer clients23
Covered lives/reviewed admissions
Employee benefit plan lives served437,397
Workers compensation lives served1,500,000
Acute care inpatient admissions reviewed3,000,000
Diverted for outpatient treatment10%
UR/case mgmt. services since: 1982.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, patient education, second surgical opinion, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, manipulation review and early identification.
Occasional services: Onsite case management, review of lab work, retrospective review, written reports.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, physical medicine, physical therapy, diagnostic testing, IMEs.
Branch offices: Phoenix; Naperville, Ill.; Charleston, W.Va.
Compensation: Per employee per month; per case; per hour; flat rate.
Officers: Don Hernley, president; Sharon O'Shea, COO; Dr. Henry Feffer, director-medical research; Kirt Kemp, vp-operations/MIS; Karen McCray, vp-western operations.
Contact: David Henderson, marketing manager.
**Estimate.
HHS Inc.
5363 44th St. S.E., Grand Rapids, Mich. 49512; 616-956-9440; fax: 616-956-6843
Utilization Review/Case Management
1996 revenues
Total gross revenue$2,316,440
UR revenue$2,154,290
Case mgmt. revenue$162,150
UR/case mgmt. direct to employers94%
Svcs. to managed care/insurance providers6%
Staff
Total UR/case management employees18
Professionals18
Clients
Total443
Corporate/institutional employer clients408
Covered lives/reviewed admissions
Employee benefit plan lives served221,040
Acute care inpatient admissions reviewed12,120
Diverted for outpatient treatment5.4%
UR/case mgmt. services since: 1985.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, patient education, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Occasional services: Review of lab work, free prescreening, retrospective review, second surgical opinion, hospital bill audits.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, prescription.
Compensation: $0.45 to $1.90 per employee per month; $375 to $410 per case; $70 to $165 per hour.
Officers: Denise Zoeterman, president; Moni Evans-Smith, director-health management; Bill Jones, director-finance; Richard Hodsdon, director-customer relations; Harriett Keast, director-care management.
Health Care Evaluation Inc.
6702 N. Inglewood Ave., Suite G, Stockton, Calif. 95207; 209-951-6711; fax: 209-951-2731
Utilization Review/Case Management
1996 revenues
Total gross revenue$2,868,628
UR revenue$2,113,693
Case mgmt. revenue$698,532
UR/case mgmt. direct to employers88%
Svcs. to managed care/insurance providers11%
Other services1%
Staff
Total UR/case management employees25
Professionals25
UR/case mgmt. employees on retainer230
Clients
Total55
Corporate/institutional employer clients53
Covered lives/reviewed admissions
Employee benefit plan lives served421,746
Workers compensation lives served22,437
Acute care inpatient admissions reviewed22,194
Diverted for outpatient treatment14%
UR/case mgmt. services since: 1968.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, review of lab work, patient education, free prescreening, retrospective review, second surgical opinion, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports, high risk pregnancy screening, claims review.
Occasional services: Onsite case management.
Medical services reviewed/managed: Group health, dental, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, skilled nursing facility.
Branch offices: Sacramento and San Francisco, Calif.
Compensation: $1.00 to $2.50 per employee per month; $45 to $100 per case; $60 to $100 per hour.
Officers: Bernice Wahler, president; Dr. George Williams, vp; Dr. John Kellar, secretary/medical director; Paul Wandel, CFO; Jeff Roby, executive director.
Contact: Jackie Grove, director-client services.
Health Design Plus
1891 Georgetown Road, Suite B, Hudson, Ohio 44236; 216-656-1072;
fax: 216-656-9387
Utilization Review/Case Management
1996 revenues
Total gross revenue$1,500,000
UR revenue$1,010,000
Case mgmt. revenue$105,000
UR/case mgmt. direct to employers74%
Other services26%
Staff
Total UR/case management employees23
Professionals11
UR/case mgmt. employees on retainer1
Clients
Total32
Corporate/institutional employer clients32
Covered lives/reviewed admissions
Employee benefit plan lives served25,000
Acute care inpatient admissions reviewed2,818
Diverted for outpatient treatment10%
UR/case mgmt. services since: 1989.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, patient education, outpatient service predetermination, referrals to alternative settings, written reports, transplant management, disease management, maternity program.
Occasional services: Onsite case management, review of lab work, retrospective review, second surgical opinion, outpatient psychiatric and substance abuse services.
Medical services reviewed/managed: Group health, dental, chiropractic, rehabilitation, psychiatric/substance abuse, pediatric.
Compensation: $3.63 to $4.56 per employee per month; $275 to $515 per case; $95 to $175 per hour.
Officers: M. Ruth Coleman, president; Norman Kozokoff, medical director; Connie Jones, vp-health services; Deborah V. Warner, director-sales/marketing; Dave Lang, controller.
Contact: Marty Moore, client representative, 216-463-5671.
HEALTH DIRECT
1011 E. Touhy Ave., Suite 500,
Des Plaines, Ill. 60018-2808; 847-391-9500; fax: 847-390-7715
Utilization Review/Case Management
1996 revenues
Total gross revenue$58,000,000
UR revenue$3,000,000
Case mgmt. revenue$500,000
UR/case mgmt. direct to employers4%
Svcs. to managed care/insurance providers2%
Other services94%
Staff
Total UR/case management employees32
Professionals28
UR/case mgmt. employees on retainer4
Clients
Total55
Corporate/institutional employer clients49
Covered lives/reviewed admissions
Employee benefit plan lives served209,000
Acute care inpatient admissions reviewed8,300
UR/case mgmt. services since: 1980.
Parent: Advocate Health Care.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, review of lab work, patient education, retrospective review, second surgical opinion, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports, high risk maternity screening, surgical case review, special case review, medical information helpline.
Occasional services: Onsite case management, free prescreening, hospital bill audits.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, podiatric.
Compensation: $1.75 to $4.50 per employee per month; $350 to $500 per case; $115 to $145 per hour; percent of savings; risk sharing.
Officers: Jenifer Cline, interim president/COO; Kerry Finnegan, vp-sales/marketing; Les Preuss, vp-finance; Jay Gore, vp-MIS; Steve Tiwald, Medicare/consulting.
Health International Inc.
14770 N. 78th Way, Scottsdale, Ariz. 85260; 800-333-3760; fax: 602-948-2523
Utilization Review/Case Management
1996 revenues
Total gross revenue$12,000,000
UR revenue/case mgmt. revenue$12,000,000
UR/case mgmt. direct to employers100%
Staff
Total UR/case management employees112
Professionals94
UR/case mgmt. employees on retainer18
Clients
Total114
Corporate/institutional employer clients114
Covered lives/reviewed admissions
Employee benefit plan lives served466,373
Workers compensation lives served113,325
Diverted for outpatient treatment50%
UR/case mgmt. services since: 1987.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, review of lab work, patient education, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports, high risk maternity screening and case management, online access to performance statistics, prospective large case management, exclusive delivery networks, claims analysis to confirm savings.
Occasional services: Onsite case management, retrospective review, second surgical opinion.
Medical services reviewed/managed: Group health, rehabilitation, psychiatric/substance abuse, workers comp/disability.
Compensation: Per employee per month.
Officers: Dr. Donald K. Kelly, chairman/CEO; Suzanne D. Kelly, vice chairman; Michael C. Peerboom, president/COO; Dr. Kenneth R. Roepke, vp/chief medical officer; Ronald L. Eggleston, vp/medical administration.
Contact: Michael C. Peerboom.
Health Risk Management Inc.
8000 W. 78th St., Minneapolis, Minn. 55439; 612-829-3500; fax: 612-946-7694
Utilization Review/Case Management
1996 revenues
Total gross revenue$54,507,000
UR revenue$16,771,000
Case mgmt. revenue$5,164,000
UR/case mgmt. direct to employers35%
Svcs. to managed care/insurance providers5%
Other services60%
Staff
Total UR/case management employees260
Professionals162
UR/case mgmt. employees on retainer32
Clients
Total106
Corporate/institutional employer clients94
Covered lives/reviewed admissions
Employee benefit plan lives served710,000
Workers compensation lives served41,000
Acute care inpatient admissions reviewed79,000
Diverted for outpatient treatment2%
UR/case mgmt. services since: 1984.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, patient education, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Occasional services: Onsite case management, review of lab work, free prescreening, retrospective review, second surgical opinion.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric.
Branch offices: Milwaukee.
Dr. Gary McIlroy, CEO; Marlene Travis, president/COO; Thomas P. Clark, senior vp/CFO; John Higbee, chief information officer; Adele Kimpell, executive vp-operations.
Contact: Steve Wallfred.
Health Services
Advisory Group Inc.
301 E. Bethany Home Road, Suite 157-B, Phoenix, Ariz. 85012; 602-264-6382; fax: 602-241-0757
Utilization Review/Case Management
1996 revenues
Total gross revenue$4,231,033
UR/case mgmt. revenue$620,440
UR/case mgmt. direct to employers3%
Svcs. to managed care/insurance providers12%
Other services85%
Staff
Total UR/case management employees10
Professionals9
UR/case mgmt. employees on retainer72
Clients
Total8
Corporate/institutional employer clients6
Covered lives/reviewed admissions
Employee benefit plan lives served10,500
Acute care inpatient admissions reviewed4,400
Diverted for outpatient treatment4.7%
UR/case mgmt. services since: 1982.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, patient education, second surgical opinion, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Occasional services: Review of lab work, retrospective review, hospital bill audits.
Medical services reviewed/managed: Group health, dental, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, podiatric, prescription, home health, skilled nursing facility.
Compensation: $0.80 to $2.15 per employee per month; $98 per case; $35 to $200 per hour.
Officers: Dr. Lawrence J. Shapiro, president/CEO; Dr. Herbert S. Rigberg, vp-medical affairs; Mary Ellen Dalton, director-private review; Paula L. Hann, CFO; Debra L. Nixon, director-corporate development.
Contact: Debra L. Nixon.
Healthcare Advantage Inc.
829 St. Charles Ave., New Orleans, La. 70130; 504-568-9009; fax: 504-568-0301
Utilization Review/Case Management
1996 revenues
Total gross revenue$6,747,591
UR revenue$1,230,514
Case mgmt. revenue$90,427
UR/case mgmt. direct to employers5%
Svcs. to managed care/insurance providers15%
Other services80%
Staff
Total UR/case management employees52
Professionals7
Clients
Total152
Corporate/institutional employer clients150
Covered lives/reviewed admissions
Employee benefit plan lives served147,058
Workers compensation lives served20,696
UR/case mgmt. services since: 1989.
Parent: Touro Infirmary, Franciscan Missionaries of Our Lady Health System, Sister of Charity of the Incarnate Word Health System.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, review of lab work, patient education, retrospective review, outpatient service predetermination, referrals to alternative settings, written reports.
Occasional services: Onsite case management, free prescreening, second surgical opinion, hospital bill audits.
Medical services reviewed/managed: Group health, dental, rehabilitation, workers comp/disability, pediatric.
Branch offices: Alexandria, Baton Rouge, Lake Charles and Shreveport, La.
Compensation: $1.75 to $3.25 per employee per month; $125 to $150 per hour.
Officers: Jane Cooper, president/CEO; Mindy Brown, vp-medical management; Maureen Digby, manager-utilization management; Dr. Ken Coignet, medical director; Julie Dawson, director-utilization management.
Contact: Christine A. Reichardt, RFP coordinator.
HealthDIRECT Inc. (HDI)
74 Scott Swamp Road, Farmington, Conn. 06032; 860-677-2331;
fax: 860-678-0995
Utilization Review/Case Management
1996 revenues
Total gross revenue$2,440,000
UR/case mgmt. direct to employers1%
Svcs. to managed care/insurance providers97.7%
Other services1.3%
Staff
Total UR/case management employees21
Clients
Total8,000
Covered lives/reviewed admissions
Workers compensation lives served138,750
Acute care inpatient admissions reviewed132
UR/case mgmt. services since: 1992.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, review of lab work, patient education, retrospective review, second surgical opinion, outpatient service predetermination, referrals to alternative settings, written reports.
Occasional services: Hospital bill audits, outpatient psychiatric and substance abuse services.
Medical services reviewed/managed: Chiropractic, rehabilitation, workers comp/disability, physical therapy.
Compensation: $25 to $600 per case; $75 to $90 per hour.
Officers: Jack Reed, president/CEO; Louis Mangano, senior vp/COO.
Contact: Laura Callahan, account executive.
HealthNetwork Inc.
1420 Kensington Road, Suite 203,
Oak Brook, Ill. 60521-2106; 630-954-2900; fax: 630-954-1518
Utilization Review/Case Management
1996 revenues
Total gross revenue$6,661,346
Case mgmt. revenue$460,200
UR/case mgmt.7.7%
Other services92.3%
Staff
Total UR/case management employees13
Professionals13
Clients
Total43
Corporate/institutional employer clients36
Covered lives/reviewed admissions
Employee benefit plan lives served128,800
Acute care inpatient admissions reviewed10,540
Diverted for outpatient treatment37%
UR/case mgmt. services since: 1985.
Parent: IASD Health Services Corp.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, free prescreening, second surgical opinion, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Occasional services: Onsite case management, review of lab work, patient education, retrospective review, hospital bill audits.
Medical services reviewed/managed: Group health, rehabilitation, psychiatric/substance abuse, workers comp/disability.
Compensation: $1.50 to $2.15 per employee per month; $65 to $85 per hour.
Officers: George C. Phillips Jr., president; David Gillies, vp-sales/marketing; Gordon Mallet, vp-provider recruitment; Donna Wolak, vp-finance; Lore Stanley, vp-operations.
Contact: Mark Paulson, corporate communications officer.
Hines & Associates
115 E. Highland Ave., Elgin, Ill. 60120; 847-741-1291; fax: 847-741-1391
Utilization Review/Case Management
1996 revenues
Total gross revenue*$5,600,000
UR revenue*$1,774,000
Case mgmt. revenue*$3,827,000
UR/case mgmt. direct to employers4%
Svcs. to managed care/insurance providers96%
Staff
Total UR/case management employees115
Professionals80
UR/case mgmt. employees on retainer97
Clients
Total372
Corporate/institutional employer clients14
Covered lives/reviewed admissions
Employee benefit plan lives served255,220
UR/case mgmt. services since: 1987.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, review of lab work, patient education, free prescreening, retrospective review, second surgical opinion, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports, maternity management, peer review, PPO channeling.
Occasional services: Hospital bill audits.
Medical services reviewed/managed: Group health, dental, chiropractic, rehabilitation, psychiatric/substance abuse, disability, pediatric.
Branch offices: San Diego; Denver; Tallahassee, Fla.; Bloomingdale, Bloomington, Champaign, Rockford, Western Springs, Ill.; Des Moines and Dubuque, Iowa; New Orleans; Bay City, Mich.; Omaha, Neb.; Cleveland; Dallas; Charleston, S.C.; Greeneville, Tenn.; North Virginia, Va.; Arlington and Portsmouth, Va.; Appleton and Brookfield, Wis.
Compensation: $1.05 to $1.65 per employee per month; $100 to $2,500 per case; $88 to $98 per hour.
Officers: Judity Hines, president; Eileen Zurblis, executive vp; Lynn Britbach, Mary Hasterok, vps; Grace Richard, director-marketing.
Contact: Grace Richard, 800-735-1200.
**Estimate.
Human Behavior Associates
191 Military Drive, Suite A, Benicia, Calif. 94510; 707-747-0117; fax: 707-747-6646
Utilization Review/Case Management
1996 revenues
Total gross revenue$400,000
UR revenue$100,000
Case mgmt. revenue$200,000
UR/case mgmt. direct to employers50%
Svcs. to managed care/insurance providers25%
Other services25%
Staff
Total UR/case management employees2
Professionals1
UR/case mgmt. employees on retainer2
Clients
Total18
Corporate/institutional employer clients17
Covered lives/reviewed admissions
Employee benefit plan lives served40,700
Acute care inpatient admissions reviewed30
Diverted for outpatient treatment25%
UR/case mgmt. services since: 1988.
Services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, patient education, retrospective review, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Medical services reviewed/managed: Psychiatric/substance abuse.
Branch offices: Alameda, Calif.
Compensation: $1 to $6.10 per employee per month.
Officers: James B. Wallace, president; P. James Weymouth, director-marketing.
Contact: P. James Weymouth, 415-563-3993.