M
Managed Healthcare
Unlimited Inc.
5199 E. Pacific Coast Highway, Suite 216, Long Beach, Calif. 90804; 800-726-8712 or 310-494-2875;
fax: 310-986-9050
Utilization Review/Case Management
1996 revenues
Total gross revenue$67,095
UR revenue$2,141
Case mgmt. revenue$8,000
UR/case mgmt. direct to employers3%
Svcs. to managed care/insurance providers12%
Other services85%
Staff
Total UR/case management employees3
Professionals3
UR/case mgmt. employees on retainer5
Clients
Total2
Covered lives/reviewed admissions
Employee benefit plan lives served2,000
Acute care inpatient admissions reviewed31
Diverted for outpatient treatment7%
UR/case mgmt. services since: 1995.
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, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports, demand management.
Occasional services: Onsite case management, second surgical opinion, hospital bill audits.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric.
Compensation: $0.95 to $1.50 per employee per month (demand management/UR only); $75 to $95 per hour (fee for service case management).
Officers: Rose D. Leidl, CEO; Liana B. Teteberg, COO; Dr. Peter J. Leidl, medical director/CFO.
Contact: Rose D. Leidl, 800-726-8712 or 310-986-5934.
MedCost Inc.
1399 Ashleybrook Lane, Suite 100, P.O. Box 25347, Winston-Salem, N.C. 27114-5347; 910-760-3090;
fax: 910-760-2352
Utilization Review/Case Management
1996 revenues
Total gross revenue$3,700,000
UR revenue$3,100,000
Case mgmt. revenue$600,000
UR/case mgmt. services41%
Other services59%
Staff
Total UR/case management employees40
Professionals35
Clients
Total80
Corporate/institutional employer clients*35
Covered lives/reviewed admissions
Employee benefit plan lives served477,708
Acute care inpatient admissions reviewed23,184
Diverted for outpatient treatment2%
UR/case mgmt. services since: 1984.
Parent: North Carolina Baptist Hospitals Inc. and Carolina HealthCare System.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, patient education, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Occasional services: Retrospective review, second surgical opinion, hospital bill audits, outpatient psychiatric and substance abuse services.
Medical services reviewed/managed: Group health, rehabilitation, psychiatric/substance abuse, pediatric, prenatal program, health tips program, personal health management.
Compensation: Per employee per month; per hour.
Officers: Otto W. Mueller, president; Billie J. Davis, vp; Kathryn C. Showalter, manager-managed care operation; Judith R. Beauchamp, manager-medreview serviecs; Dr. William B. Lorentz Jr., medical director; Sarah M. Browning, systems manager.
Contact: Sharon Lambros, 910-760-3090 ext. 204.
**Estimate.
Medical Foundation Services
3625 N.W. 82nd Ave., Suite 211, Miami, Fla. 33166; 305-593-0404 ext. 101;
fax: 305-477-6622
Utilization Review/Case Management
1996 revenues
Total gross revenue$1,100,000
UR revenue$800,000
Case mgmt. revenue$300,000
UR/case mgmt. direct to employers75%
Svcs. to managed care/insurance providers25%
Staff
Total UR/case management employees18
UR/case mgmt. employees on retainer4
Clients
Total30
Corporate/institutional employer clients30
Covered lives/reviewed admissions
Employee benefit plan lives served10,000
Acute care inpatient admissions reviewed3,000
Diverted for outpatient treatment6%
UR/case mgmt. services since: 1976.
Parent: Baptist Health Systems of South Florida.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, retrospective review, outpatient service predetermination, referrals to alternative settings, written reports.
Occasional services: Review of lab work, patient education, second surgical opinion, hospital bill audits, outpatient psychiatric and substance abuse services, high risk maternity.
Medical services reviewed/managed: Group health, workers comp/disability. Compensation: $1.45 to $2.05 per employee per month; $75 to $750 per case; $85 to $125 per hour.
Officers: Rose Strain, director.
Contact: Rose Strain, director, 305-593-0404 ext. 101 or Richard Dietrich, marketing manager, 305-593-0404 ext. 105.
Medical Rehabilitation Consultants Inc.
111 W. Cataldo, Suite 200, Spokane, Wash. 99201; 509-328-9700;
fax: 509-328-9777
Utilization Review/Case Management
1996 revenues
Total gross revenue$1,000,000
UR revenue$120,000
Case mgmt. revenue$700,000
UR/case mgmt. direct to employers1%
Svcs. to managed care/insurance providers81%
Other services18%
Staff
Total UR/case management employees13
Professionals13
UR/case mgmt. employees on retainer1
Clients
Total200
Corporate/institutional employer clients200
UR/case mgmt. services since: 1987.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, onsite and telephone case management, review of lab work, patient education, retrospective review, second surgical opinion, hospital bill audits, outpatient service predetermination, written reports.
Occasional services: Discharge planning, outpatient psychiatric and substance abuse services, referrals to alternative settings.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, forensic, trust advisory liability.
Branch offices: Denver; Boise, Idaho; Great Falls, Mont.; Las Vegas; Salt Lake City; Seattle and Walla Walla, Wash.
Compensation: $1.60 to $2.10 per employee per month; $55 to $5,500 per case; $60 to $150 per hour.
Officers: Mary M. Glidden, president; Jeff H. Glidden, vp.
Contact: Jeff H. Glidden.
Medical Review
Institute of America
670 East 3900 South, Suite 300, Salt Lake City, Utah 84107; 800-654-2422; 801-261-3189
Utilization Review
1996 revenues
Total gross revenue*$2,750,000
UR/case mgmt. direct to employers5%
Svcs. to managed care/insurance providers90%
Other services5%
Staff
Total UR employees35
UR employees on retainer350
Clients
Total700
Corporate/institutional employer clients20
UR services since: 1982.
Parent: Medical Opinions Inc.
Frequent services: Concurrent hospital treatment review, length of stay determination, review of lab work, retrospective review, second surgical opinion, outpatient psychiatric and substance abuse services, written reports, physician specialist review of inpatient/outpatient treatment and charges.
Occasional services: Telephone case management.
Medical services reviewed/managed: Group health, dental, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, medical fraud, legal cases.
Compensation: Per hour; flat fee per case.
Officers: William Low, president; Joni Pierce, vp/operations manager.
**BI estimate.
Medicus Resource Management
833 N. Park Road, Wyomissing, Pa. 19610; 800-647-2500; fax: 610-371-0310
Utilization Review/Case Management
1996 revenues
Total gross revenue$950,000
UR revenue$600,000
Case mgmt. revenue$350,000
UR/case mgmt. direct to employers80%
Svcs. to managed care/insurance providers20%
Staff
Total UR/case management employees8
Professionals6
UR/case mgmt. employees on retainer30
Clients
Total86
Corporate/institutional employer clients75
Covered lives/reviewed admissions
Employee benefit plan lives served58,500
Workers compensation lives served800
Acute care inpatient admissions reviewed3,500
UR/case mgmt. services since: 1989.
Parent: Berkshire Health Plan.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, second surgical opinion, outpatient service predetermination, referrals to alternative settings, written reports.
Occasional services: Review of lab work, patient education, retrospective review, hospital bill audits, outpatient psychiatric and substance abuse services.
Medical services reviewed/managed: Group health, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric.
Compensation: $1.70 to $2 per employee per month.
Officers: Edward J. Wargo, president; David L. Starbuck, medical director; Lawrence Cobaugh, CFO.
Contact: Misty L. Wintsch, director-customer/provider relations.
MedSmart International
1675 Scenic Ave., Suite 101,
Costa Mesa, Calif. 92626; 800-652-1134;
fax: 800-748-1137
Utilization Review/Case Management
1996 revenues
Total gross revenue$6,295,600
UR revenue$314,780
Case mgmt. revenue*$5,036,480
UR/case mgmt. direct to employers9%
Svcs. to managed care/insurance providers76%
Other services15%
Staff
Total UR/case management employees16
Professionals12
UR/case mgmt. employees on retainer22
Clients
Total22
Corporate/institutional employer clients2
Covered lives/reviewed admissions
Acute care inpatient admissions reviewed1,325
Diverted for outpatient treatment37%
UR/case mgmt. services since: 1994.
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; second surgical opinion; outpatient service predetermination; referrals to alternative settings; written reports; episode of care, including all provider services, case management and HIV care events.
Occasional services: Free prescreening, retrospective review, hospital bill audits, outpatient psychiatric and substance abuse services.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, maternity, podiatric.
Branch offices: Denver; Chicago.
Compensation: $750 to $5,000 per case; $100 to $350 per hour.
Officers: Dorian Knape, president; Sue Sedaka, vp; Vi Karr, COO.
Contact: Susan Sedaka.
**Includes 3,147,800 for episode of care package.
Med-Valu Inc.
485 Metro Place S., Suite 200, Dublin, Ohio 43017; 614-764-2282;
fax: 614-766-0004
Utilization Review/Case Management
1996 revenues
Total gross revenue$4,000,000
UR revenue$3,850,000
Case mgmt. revenue$150,000
UR direct to employers2%
Svcs. to managed care/insurance providers94%
Other services4%
Staff
Total UR/case mgmt. employees49
Professionals49
UR/case mgmt. employees on retainer50
Clients
Total40
Corporate/institutional employer clients2
Covered lives/reviewed admissions
Employee benefit plan lives served1,200,000
Workers compensation lives served200,000
Acute care inpatient admissions reviewed29,035
Diverted for outpatient treatment10%
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, free prescreening, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports, referral tracking.
Occasional services: Onsite management, retrospective review, second surgical opinion.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric.
Compensation: $0.95 to $1.15 per employee per month; $45 to $80 per case; $70 to $100 per hour.
Officers: Michael Linde, president/CEO; Frank Anzelmo, vp-systems/treasurer; Mary Ellen O'Grady, vp-sales/secretary.
Contact: Mary Ellen O'Grady.
MedView Services Inc.*
32991 Hamilton Court, Suite 300, Farmington Hills, Mich. 48334; 810-488-5260; fax: 810-488-3649
Utilization Review/Case Management
1996 revenues
Total gross revenue$46,000,000
UR revenue$1,597,000
Case mgmt. revenue$16,241,000
UR/case mgmt. direct to employers4%
Svcs. to managed care/insurance providers35%
Other services61%
Staff
Total UR/case management employees292
Professionals223
UR/case mgmt. employees on retainer47
Clients
Total624
Corporate/institutional employer clients175
Covered lives/reviewed admissions
Acute care inpatient admissions reviewed2,553
UR/case mgmt. services since: 1983.
Parent: Value Health Services Inc.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, retrospective review, outpatient service predetermination, referrals to alternative settings, written reports.
Occasional services: Review of lab work, patient education, free prescreening, second surgical opinion, hospital bill audits, outpatient psychiatric and substance abuse services.
Medical services reviewed/managed: Group health, dental, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric.
Officers: Jim Buncher, president/CEO; Debra Cerre-Ruedisili; Shannon Johnston, senior vp/chief administrative officer; Pat Sullivan, senior vp/chief marketing officer.
Contact: Eileen Hanrahan, director-marketing, 810-488-5260 ext. 514.
**MedView and Community Care Network (CCN) are wholly owned subsidiaries of Value Health Services Inc. Please refer to CCN's listing as well.
MedWatch
120 International Parkway, Suite 170, Lake Mary, Fla. 32795-2679
Utilization Review/Case Management
1996 revenues
Total gross revenue$2,970,000
UR revenue$1,980,000
Case mgmt. revenue$990,000
UR/case mgmt. direct to employers75%
Svcs. to managed care/insurance providers20%
Other services5%
Staff
Total UR/case management employees17
Professionals13
UR/case mgmt. employees on retainer36
Clients
Total356
Corporate/institutional employer clients352
Covered lives/reviewed admissions
Employee benefit plan lives served150,000
Workers compensation lives served5,000
Acute care inpatient admissions reviewed6,890
Diverted for outpatient treatment35%
UR/case mgmt. services since: 1989.
Parent: Alliance Underwriters.
URAC certified.
Services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, patient education, free prescreening, retrospective review, second surgical opinion, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric.
Compensation: $1.10 to $1.65 per employee per month; $200 to $350 per case; $75 to $85 per hour.
Officers: Lynn Jennings, president; Dennis Orgill, Judy Garber, Arlene McKechnie, vps; Vince Butler, secretary/treasurer.
Contact: Arlene McKechnie or Judy Garber.
Dr. Donald P. Milione
7012 18th Ave., Brooklyn, N.Y. 11204; 718-232-9595; fax: 718-232-6800
Utilization Review
1996 revenues
Total gross revenue$100,000
UR revenue$20,000
UR/case mgmt. direct to employers10%
Svcs. to managed care/insurance providers10%
Other services80%
Staff
Total UR/case management employees4
Professionals4
Clients
Total20
Corporate/institutional employer clients10
UR/case mgmt. services since: 1996.
Frequent services: Patient education, written reports, independent examinations.
Occasional services: Onsite and telephone case management, review of lab work, referrals to alternative settings.
Medical services reviewed/managed: Chiropractic, workers comp/disability.
Branch offices: New York.
Compensation: $300 to $500 per case; $150 per hour.
Officers: Dr. Donald P. Milione, C.G. Sammis, Christine Mauro, Maria Allegretti.
MultiPlan Inc.
115 Fifth Ave., New York, N.Y. 10003-1004; 800-677-1098;
fax: 212-780-0420
Utilization Review/Case Management
1996 revenues*
Total gross revenue$1,200,000
UR revenue$960,000
Case mgmt. revenue$240,000
Staff
Total UR/case management employees25
Professionals22
UR/case mgmt. employees on retainer15
Clients
Total25
Corporate/institutional employer clients25
Covered lives/reviewed admissions*
Acute care inpatient admissions reviewed55,000
Diverted for outpatient treatment5%
UR/case mgmt. services since: 1970.
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, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, high-risk maternity.
Branch offices: Salem, N.H.
Compensation: Per employee per month (UR); per hour (case management).
Officers: Donald Rubin, chairman/co-CEO; Harvey Sigelbaum, president/co-CEO; Sidney L. Meyer, executive vp; Ronald Hersch, senior vp-marketing/sales; Lorraine Woods, director-utilization management services.
Contact: Lorraine Woods.
**Estimate.