1997 DIRECTORY OF MANAGED CARE PROVIDERS ( FLORIDA)

Florida Managed Health Care L.L.C.
100 Rialto Place, Suite 615, Melbourne, Fla. 32901; 407-728-9500;
fax: 407-984-0030
Specialty: mental health
Staff/Facilities
Primary practitioners40
Hospitals2
Users: Group Health
Employer/payer groups2
Employees & dependents3,000
Total Users3,000
Operational date: October 1994.
For profit.
Service area: Florida: Brevard County.
Services: Mental health, substance abuse. Services available unbundled. May be customized to meet employer specifications. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by per diem, discount off customary rates; is compensated by employers/payers, insurers; charges flat fee per employee, by percent of savings, by percent of services by doctors/hospitals.
UR: Standard procedures, excluding second surgical opinion. UR provided by the PPO.
Officers: Dr. Daniel Stump, manager; William Reibsame, manager; Philip Dorothy, manager.
Contact: Lee Rocque.
FOCUS Healthcare Management Inc.
7101 Executive Center Drive, Suite 375, Brentwood, Tenn. 37207; 800-873-0055 or 615-377-9936; fax: 615-661-4042
Specialty: workers compensation
Staff/Facilities*
Primary practitioners2,325
Specialists11,686
Hospitals146
Total Users466,652
Operational date: May 1988.
Service area: Florida: 70 counties.
**Includes leased providers/facilities.
See FOCUS Healthcare Management Inc. consolidated listing under Tennessee.
Foundation Health, A Florida Health Plan
1340 Concord Terrace, Sunrise, Fla. 33323; 954-858-3000; fax: 954-846-8778
Staff/Facilities
Primary practitioners1,818
Board-certified85%
Specialists4,857
Hospitals112
Pharmacies1,472
Primary care locations1,424
Users
Employees & dependents79,427
Medicare24,866
Medicaid23,087
Total127,380Parent: Foundation Health Systems Inc.
Operational date: November 1984.
Licensed in: Florida.
NCQA one year accredited.
Model type: IPA.
Service area: Florida: Brevard, Broward, Charlotte, Clay, Dade, Duval, Hillsborough, Lee, Martin, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Putnam, Seminole, St. Lucie and Volusia counties.
Services: General medical, dental, vision, prescription drug, mental health, life insurance. Services available unbundled. May be customized to meet employer specifications.
Rating options: Adjusted community rating.
Offers self-insured products.
Point-of-service contracts: 3.4% of members are enrolled.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: Steven B. Griffin, COO; Dr. William D. Kirsh, vp/chief medical officer; William R. Whitaker, senior vp-sales/chief marketing officer; Clare Muscillo, vp-operations; Dr. Jack H. Pincus, vp-provider development; Rachel Haltiwanger, vp-finance.
Contact: Ellen Wallace, manager-proposal unit, 954-858-3447.
See Foundation Health Systems consolidated listing under California.
Foundation Health, A Florida Health Plan
1340 Concord Terrace, Sunrise, Fla. 33323; 954-858-3000; fax: 954-846-8778
Staff/Facilities
Primary practitioners2,294
Board-certified85%
Specialists6,757
Hospitals106
Pharmacies1,472
Users
Employees & dependents6,055
Total Users6,055
Ownership: Foundation Health Systems Inc.
Operational date: January 1997.
Service area: Florida: 31 counties.
Services: General medical, dental, vision, prescription drug, mental health, vision, life insurance. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, DRGs; is compensated by employers/payers; charges percent of services by doctors/hospitals.
UR: Standard procedures excluding hospital bill audits. UR provided by the PPO.
Officers: Steven B. Griffin, COO; Dr. William D. Kirsh, vp/chief medical officer; William R. Whitaker, senior vp-sales/chief marketing officer; Clare Muscillo, vp-operations; Dr. Jack H. Pincus, vp-provider development; Rachel Haltiwanger, vp-finance.
Contact: Ellen Wallace.
See Foundation Health Systems consolidated listing under California.
Guardian Resources Inc.*
2739 U.S. Highway 19 North, Suite 350, Holiday, Fla. 34691; 813-938-2222; 813-938-2880
Staff/Facilities
Primary practitioners53,168
Board-certified64%
Specialists123,128
Hospitals1,992
Pharmacies427
Users: Group Health
Employer/payer groups482
Single coverage107,100
Family coverage86,700
Employees & dependents290,540
Total Users290,540
Operational date: January 1993.
For profit.
Service area: Alabama, California, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee and Texas.
Services: General medical, vision, mental health, workers compensation. Services available unbundled. May be customized to meet employer specifications. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, DRGs; is compensated by employers/payers, TPAs; charges flat fee per employee, by percent of savings.
UR: Standard procedures, including high-risk pregnancy program.
UR provided by outside contractors.
Officers: Steven S. McEnerney, president; Allen K. Cranford, executive vp; Jere Gulau, CFO; Arnold Vedrin, director-marketing; James L. Nanck, director-network development.
Contact: Allen Crawford.
**Figures are consolidated, including all PPO plans in this organization.
Guardian Resources Inc.
2739 U.S. Highway 19 North, suite 350, Holiday, Fla. 34691; 813-938-2222; 813-938-2880
Staff/Facilities
Primary practitioners8,691
Board-certified74%
Specialists25,608
Hospitals178
Pharmacies210
Users: Group Health
Employer/payer groups51
Single coverage20,000
Family coverage15,000
Employees & dependents53,000
Total Users53,000
Service Area: Florida: statewide.
See Guardian Resources consolidated listing under Florida.
HIP Health Plan
of Florida Inc.
300 S. Park Road, Hollywood, Fla. 33021; 954-962-3008; fax: 954-961-4471
Staff/Facilities
Primary practitioners1,219
Board-certified75%
Specialists2,976
Hospitals64
Pharmacies234
Users
Employees & dependents144,335
Medicare18,757
Total163,092Operational date: January 1985.
Licensed in: Florida.
Model type: IPA.
Service area: Florida: Broward, Dade, Palm Beach, Hillsborough, Pinellas, Pasco and Hernando counties.
Rating options: Community rating by class.
Point-of-service contracts: 1% of members are enrolled.
Officers: Steven Cohen, CEO/president; Steven W. Chapkin, senior vp-marketing/sales; Pamela Adams, senior vp-corporate development; Dr. Mark Bloom, vp/medical director; Laurie Levine, vp-finance.
See HIP Health Plans consolidated listing under New York.
Health Options Inc.
P.O. Box 1798, Jacksonville, Fla. 32231; 904-905-3039; fax: 904-905-4849
Staff/Facilities
Primary practitioners2,980
Board-certified67%
Specialists8,967
Hospitals138
Users
Employer/payer groups15,677
Single coverage173,412
Family coverage130,578
Employees & dependents582,159
Medicare86,779
Total668,938
Revenues
First-half 1997$637,200,000
1996$1,034,100,000Parent: Blue Cross & Blue Shield of Florida.
Operational date: September 1984.
Federally qualified.
Licensed in: Alabama, Florida.
NCQA fully accredited.
Model type: Group/IPA.
For profit.
Service area: Florida: 39 counties. Member of HMO Blue USA.
Services: General medical, mental health. May be customized to meet employer specifications.
Rating options: Community rating by class.
Offers self-insured products.
Point-of-service contracts: 13% of members are enrolled.
Non-federally qualified programs.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: William Flaherty, chairman of the board/CEO; Michael Cascone, Jr., president/COO; R. Chris Doerr, senior vp/CFO; Thomas E. Albright, senior vp/chief marketing executive; William O'Nale, HMO product manager.
Contact: William O'Nale.
HealthCare COMPARE Corp.
3200 Highland Ave., Downers Grove, Ill. 60515; 630-241-7900; fax: 630-241-7856
Staff/Facilities
Primary practitioners*5,024
Specialists8,085
Hospitals**139
Service area: Florida: 66 counties.
**Includes some specialists.
***Includes specialty hospitals.
See HealthCare COMPARE Corp./The AFFORDABLE Medical Networks consolidated listing under Illinois.
HealthStar Inc.
7411 Fullerton St., Jacksonville, Fla. 32256; 904-363-0163; fax: 904-642-6446
Staff/Facilities
Primary practitioners2,634
Specialists4,894
Hospitals115
Users: Group Health
Employees & dependents167,000
Users: Workers Compensation
Single coverageNA
Total Users*167,000
Operational date: 1994.
Service area: Florida: statewide.
**Figure does not include workers comp.
See HealthStar Inc. consolidated listing under Illinois.
Heritage/Summit HealthCare of Florida Inc.
P.O. Box 3623, Lakeland, Fla. 33802-3623; 941-665-6629 ext. 2379; fax: 941-665-5177
Specialty: workers comp
Staff/Facilities
Primary practitioners336
Board-certified80%
Specialists2,864
Hospitals115
Pharmacies2,558
Users: Group Health
Employer/payer groups40
Single coverage7,200
Family coverage6,000
Employees & dependents40,000
Users: Workers Compensation
Employer/payer groups8,791
Single coverage140,000
Total Users180,000
Ownership: Summit Holdings Southeast.
Operational date: August 1996.
For profit.
Service area: Florida: Broward, Dade, Hillsborough, Osceola, Orange, Palm Beach, Pinellas, Polk and Seminole counties.
Services: General medical, prescription drug, workers compensation. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, discount off customary rates; is compensated by insurers, TPAs; charges flat fee per employee, by percent of savings, percent of premium.
UR: Standard procedures excluding length of stay determination and discharge planning. UR provided by outside contractors.
Officers: Bill Bull, president; Russ Wall, secretary/treasurer; Rick Hodges, vp.
Contact: John Rader, director-network development.
Kemper Preferred Provider Network
1601 SW 80th Terrace, Plantation, Fla. 33324; 954-452-4000 ext. 1100;
fax: 954-452-4049
Specialty: workers compensation
Contracts with HealthCare COMPARE Corp./The Affordable Medical Networks for workers comp in Arizona, Arkansas, California, Iowa, Indiana, Mississippi, Nevada, New Mexico, Oklahoma, Oregon, Rhode Island, South Carolina, Texas, Utah and Washington; Cerulean for workers comp in Georgia; Comprehensive Managed Care for workers comp in Minnesota; Crawford & Co. for workers comp in South Dakota; FingerLakes Blue Cross & Blue Shield for workers comp in New York; Focus for Workers comp in Alabama, Connecticut, Illinois, Kansas, Louisiana, Missouri, New Jersey, North Carolina, Tennessee and Virginia; HealthPartners Inc. for workers comp in Minnesota; HealthStar for workers comp in Georgia, Kentucky and Ohio; MagnaCare for workers comp in New York; Medview for workers comp in Colorado, Hawaii, Indiana, Maine, Massachusetts, Michigan, New Hampshire, Pennsylvania, Vermont and Wisconsin; MetraComp for workers comp in Florida; Workers Comp Advantage for workers comp in New Jersey and Pennsylvania.
Officers: David K. Patterson, president/CEO; Peg Haennicke, senior vp; Dr. F. Warren Tingley, senior vp/chief medical officer; Mary Ann Palmer, senior vp-systems/operations; Norman K. Maes, vp-Kemper Preferred Provider Network.
Contact: Norman K. Maes, 954-452-4000 ext. 1042.
Med Advantage
3452 Lake Lynda Ave., Suite 250, Orlando, Fla. 32817; 407-282-5131; fax: 407-282-9240
Specialty: physical therapy, occupational therapy, podiatry
Staff/Facilities
Specialists86
Users: Group Health
Employer/payer groups152
Ownership: Medical Advantage Inc.
Operational date: May 1993.
For profit.
Service area: Florida: statewide.
Services: Physical therapy, occupational therapy, podiatry. Services available unbundled. May be customized to meet employer specifications. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by percent discount off customary rates; is compensated by employers/payers, insurers, TPAs; charges by percent of savings.
UR: UR provided by outside contractors.
Officers: John B. Witty, president; John C. Barrett, vp.
Medco Value Plus
7011 Grand National Drive, Orlando, Fla. 32819; 407-345-9421; fax: 407-363-7928
Staff/Facilities
Primary practitioners869
Board-certified95%
Patients/practitioner10
Specialists3,546
Hospitals47
Users: Group Health
Employer/payer groups72
Single/family coverage3,849
Employees & dependents8,853
Ownership: Medco Review Inc.
Operational date: October 1991.
For profit.
Service area: Arkansas: Craighead, Critte, Drew, Garland, Johnson, Lonoke, Miller, Pope, Pulaski and Shelby counties; Kansas: Allen, Bourbon, Douglas, Ford, Harper, Jackson, Johnson, Leavenworth, Russell, Sumner, Woodson and Wyandotte counties; Missouri: 44 counties; Tennessee: Davidson and Shelby counties and the city of Memphis.
Contracts with The Araz Group, Beech Street-N.Y., Community Care Network, Dental Health Alliance, Health Care Value Management, Intergroup, Managed Care Consultants, Medco Value Plus, Mednet USA, Medview, Preferred Health Network, Preferred Plan, Primary Health Services, PPO Oklahoma, Qualmed, Select Netplus, Signature, Sound Health, Southeast Medical Alliance, Virginia Health Network.
Services: General medical, dental, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, DRGs; is compensated by employers/payers, insurers, TPAs; charges flat fee per employee, by percent of savings.
UR: Standard procedures, including employee assistance program. UR provided by outside contractors.
Officers: Harold Green, vp-managed care; Dr. George Linney, medical director; Dennis Reineke, president/CFO; Frank Kinder, vp-sales/marketing; Lance Serine, vp.
MultiPlan Inc.
115 Fifth Ave., New York, N.Y. 10003; 212-780-2000; fax: 212-843-3517
Staff/Facilities
Primary practitioners2,449
Board-certified79.9%
Specialists6,508
Hospitals130
Users: Group Health
Employer/payer groups71
Employees & dependents1,544,189
Service area: Florida: statewide, excluding Baker, Lafayette and Liberty counties.
See MultiPlan Inc. consolidated listing under New York.
National Ear Care Plan
6825 E. Tennessee Ave., Suite 415, Denver, Colo. 80224-1632; 303-399-1212; fax: 303-399-7719
Specialty: hearing
Staff/Facilities
Primary practitioners69
Service area: Florida: 50 cities.
See National Ear Care Plan consolidated listing under Colorado.
National Preferred Provider Network Inc.
419 E. Main St., Middletown, N.Y. 10940; 914-343-1600; fax: 914-343-6113
Staff/Facilities
Primary practitioners7,873
Specialists17,476
Hospitals174
Users: Group Health
Employer/payer groups42
Employees & dependents369,741
Total Users369,741
Service area: Florida.
See National Preferred Provider Network Inc. consolidated listing under New York.