A
ACORN Behavioral HealthCare Management Corp.
134 N. Narberth Ave., Narberth,
Pa. 19072-2299; 610-664-8350;
fax: 610-664-8373
Utilization Review/Case Management
1996 revenues
Total gross revenue$6,000,000
UR revenue$3,000,000
Case mgmt. revenue$2,500,000
UR/case mgmt. direct to employers90%
Other services10%
Staff
Total UR/case management employees10
UR/case mgmt. employees on retainer6
Clients
Total290
Corporate/institutional employer clients290
Covered lives/reviewed admissions
Employee benefit plan lives served475,049
UR/case mgmt. services since: 1975.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, patient education, free prescreening, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Occasional services: Retrospective review.
Medical services reviewed/managed: Psychiatric/substance abuse.
Compensation: $1.39 to $7.99 per employee per month.
Officers: Mel S. Goldsmith, president/CEO; Dorothy Harrison, executive vp-operations; Mel Wondolowski, senior vp-corporate relations/marketing/sales.
Contact: Mel Wondolowski, 800-223-7050 ext. 8307.
ADMAR Corp.'s HealthWatch
1551 N. Tustin Ave., Suite 300,
Santa Ana, Calif. 92705; 714-953-9600;
fax: 714-953-6309
Utilization Review/Case Management
1996 revenues
Total gross revenue$16,743,000
UR revenue$1,250,000
Case mgmt. revenue$91,000
Staff
Total UR/case management employees21
Professionals21
UR/case mgmt. employees on retainer100
Clients
Total56
Corporate/institutional employer clients17
Covered lives/reviewed admissions
Employee benefit plan lives served238,526
Acute care inpatient admissions reviewed31,966
Diverted for outpatient treatment1.2%
UR/case mgmt. services since: 1978.
Parent: The Principal Financial Group.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, review of lab work, 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 maternity management.
Occasional services: Patient education.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, pediatric.
Compensation: $1.30 to $3.40 per employee per month; $200 per case (case management); $110 to $150 per hour.
Officers: Richard Toral, chairman/CEO; Virginia Pascual, chief administrative officer; Ed Evans, CFO; Joseph Briand, vp-sales/marketing; P.J. Kehoe, vp-information services.
Contact: Joseph Briand, 714-953-9600 ext. 286.
ADVO-CARE
HC 4, Box 3090, Reeds Spring, Mo. 65737; 417-338-9871; fax: 417-338-9871
Case Management
1996 revenues
Total gross revenue$40,000
Case mgmt. revenue$40,000
Case mgmt. direct to employers25%
Svcs. to managed care/insurance providers75%
Staff
Total case management employees1
Professionals1
Clients
Total6
UR/case mgmt. services since: 1993.
Frequent services: Discharge planning, onsite and telephone case management, referrals to alternative settings, written reports.
Occasional services: Preadmission certification, concurrent hospital treatment review, length of stay determination, review of lab work, patient education, retrospective review, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services.
Medical services reviewed/managed: Group health, rehabilitation, psychiatric/substance abuse, workers comp/disability.
Compensation: Per hour, $60 to $75.
Contact: Sharon Peterson.
Alicare Medical Management
730 Broadway, New York,
N.Y. 10003-9511; 212-539-5287;
fax: 212-473-1354
Utilization Review/Case Management
1996 revenues
Total gross revenue$3,208,000
UR revenue$1,719,000
Case mgmt. revenue$395,000
UR/case mgmt. direct to employers56%
Svcs. to managed care/insurance providers10%
Other services34%
Staff
Total UR/case management employees56
Professionals40
Clients
Total120
Covered lives/reviewed admissions
Employee benefit plan lives served200,000
Acute care inpatient admissions reviewed18,876
Diverted for outpatient treatment8%
UR/case mgmt. services since: 1985.
Parent: ALICO Services Corp.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, retrospective review, second surgical opinion, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports, 24-hour nurse helpline, network referral, automated health information library, 24-hour utilization review (primary or back-up only).
Occasional services: Onsite case management, review of lab work, patient education.
Medical services reviewed/managed: Group health, dental, chiropractic, rehabilitation, psychiatric/substance abuse, disability, pediatric.
Branch offices: Salem, N.H.
Compensation: Per employee per month; per case; per hour.
Officers: Claire Levitt, president; Annette Duclos-Watson, vp/COO.
Contact: Kathy Oliver, sales executive, 212-539-5721.
American Claims
Evaluation Inc.
1 Jericho Plaza, Third Floor, Wing B, Jericho, N.Y. 11753; 516-938-8000;
fax: 516-938-0405
Utilization Review/Case Management
1996 revenues
Total gross revenue$5,240,000
UR/case mgmt. revenue$5,240,000
UR/case mgmt. direct to employers31.5%
Svcs. to managed care/insurance providers68.5%
Staff
Total UR/case management employees 40
Clients
Total350
Corporate/institutional employer clients175
UR/case mgmt. services since: 1982.
Frequent services: Hospital bill audits, vocational rehabilitation services, DRG validation, RN directed negotiations, provider discounts.
Medical services reviewed/managed: Group health, rehabilitation, workers comp/disability, pediatric.
Branch offices: Dallas; Moses Lake and Spokane, Wash.
Compensation: Per case; per hour; contingency as a percent of savings.
Officers: Gary Gelman, president/CEO; Gary J. Knauer, CFO/treasurer; Bonnie Jackson, vp-operations; Steve Renz, president-RPM.
American Health
921 E. Wind Drive, Suite 104, Columbus, Ohio 43081; 614-818-3222;
fax: 614-818-3223
Utilization Review/Case Management
1996 revenues
Total gross revenue*$8,000,000
UR/case mgmt. direct to employers15%
Svcs. to managed care/insurance providers85%
Staff
Total UR/case management employees80
UR/case mgmt. employees on retainer23
Clients
Total1,000
Covered lives/reviewed admissions
Employee benefit plan lives served1,000,000
UR/case mgmt. services since: 1985.
Parent: American Health Holding Inc.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, review of lab work, second surgical opinion, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services, written reports, 24-hour health counseling.
Occasional services: Onsite case management, referrals to alternative settings.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, pediatric.
Branch offices: Indianapolis; Columbus, Ohio; Pittsburgh.
Compensation: $0.85 to $1.65 per employee per month; $80 to $95 per hour.
Officers: Ivan Gilbert, chairman; Michael Reidelbach, president; Joan Yochel, vp; Merry Korn, vp-marketing.
Contact: Merry Korn.
**Estimate.
Associates for Health Care Inc.
18650 W. Corporate Drive, Suite 310, Brookfield, Wis. 53045-6344; 414-879-0100; fax: 414-879-0876
Utilization Review/Case Management
1996 revenues
Total gross revenue$6,000,000
UR/case mgmt. revenue$2,000,000
UR/case mgmt. direct to employers15%
Svcs. to managed care/insurance providers15%
Other services70%
Staff
Total UR/case management employees12
Professionals12
Clients
Total75,417
Corporate/institutional employer clients316
Covered lives/reviewed admissions
Employee benefit plan lives served190,000
Workers compensation lives served15,000
Acute care inpatient admissions reviewed25,244
Diverted for outpatient treatment11%
UR/case mgmt. services since: 1984.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, second surgical opinion, outpatient service predetermination, outpatient psychiatric and substance abuse services, written reports.
Occasional services: Onsite case management, review of lab work, patient education, retrospective review, referrals to alternative settings.
Medical services reviewed/managed: Group health, rehabilitation, psychiatric/substance abuse, pediatric.
Compensation: $1.75 to $2 per employee per month.
Officers: Richard L. Blomquist, chairman/treasurer; David P. Dobias, senior vp; Gary Wroblewski, vp-PPO development; Vickie Chaltas, vp-payor relations; Dirk W. Carson, vp-marketing.