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1997 DIRECTORY OF MANAGED CARE PROVIDERS (CALIFORNIA)

Posted On: Dec. 28, 1997 12:00 AM CST

Golden West Dental & Vision Plan Inc.
888 W. Ventura Blvd., Camarillo, Calif. 93010; 805-987-8941; fax: 805-987-2005
Specialty: dental, vision
Staff/Facilities
Primary practitioners1,171
Patients/practitioner172
Specialists614
Primary care locations822
Users
Employer/payer groups1,881
Single coverage28,189
Employees & dependents57,611
Total171,024
Revenues
1996$16,241,484Operational date: March 1973.
Licensed in: California.
Model type: IPA/Staff/Network.
For profit.
Service area: California: 58 counties.
Services: Dental, vision. Services available unbundled. May be customized to meet employer specifications.
Rating options: Community rating by class.
Enrollment options: Individual enrollment is allowed.
Officers: Karl Lehmann, president; Larry Chermak, vp; Dr. William Spellman, vp-dental; Jacqueline Stolz, vp-marketing; Cathy Farrington, CFO.
Contact: Jacqueline Stolz.
Golden West Dental
& Vision Plan Inc.
888 W. Ventura Blvd., Camarillo, Calif. 93010; 805-987-8941; fax: 805-987-2005
Specialty: dental
Staff/Facilities
Primary practitioners396
Specialists614
Users: Group Health
Employer/payer groups390
Single coverage28,189
Family coverage19,361
Employees & dependents57,611
Users: Workers Compensation
Total Users171,024
Operational date: March 1992.
For profit.
Service area: California: 58 counties.
Services: Dental. Services available unbundled. May be customized to meet employer specifications.
Compensation: Is compensated by employers/payers; charges by percent of services by doctors/hospitals.
UR: Precertification. UR provided by the PPO.
Officers: Karl Lehmann, president; Larry Chermak, vp; Dr. William Spellman, vp-dental; Jacqueline Stolz, vp-marketing; Cathy Farrington, CFO.
Contact: Jacqueline Stolz, vp-marketing.
Guardian Resources Inc.
2739 U.S. Highway 19 North, Suite 350, Holiday, Fla. 34691; 813-938-2222; 813-938-2880
Staff/Facilities
Primary practitioners17,475
Board-certified81%
Specialists38,355
Hospitals342
Users: Group Health
Employer/payer groups69
Single coverage12,000
Family coverage7,000
Employees & dependents27,400
Total Users27,400
Service area: California: statewide.
See Guardian Resources consolidated listing under Florida.
Health Net/Select
21600 Oxnard St., Woodland Hills, Calif. 91367; 818-676-6775; fax: 818-676-6992
Staff/Facilities
Primary practitioners10,556
Board-certified70.6%
Patients/practitioner113
Specialists20,470
Hospitals389
Pharmacies3,200
Primary care locations619
Users
Employer/payer groups2,119
Single coverage226,886
Family coverage306,750
Employees & dependents1,216,551
Total1,340,994Operational date: March 1979.
Federally qualified.
Licensed in: California.
NCQA one year accredited.
Model type: Group/IPA.
For profit.
Service area: California: 48 counties.
Services: Services available unbundled. May be customized to meet employer specifications.
Rating options: Community rating by class; adjusted community rating.
Point-of-service contracts: 5.6% of members are enrolled.
Non-federally qualified programs.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: Dr. Arthur Southam, president/CEO; Robert White, executive vp; Linda Pollnow, senior vp-operations/provider network; John McDonald, senior vp-marketing; Michael Close, senior vp-commercial sales.
Contact: David Olsen, vp-investor relations.
See Foundation Health Systems consolidated listing under California.
**Does not include second-quarter 1997 gross revenues.
HealthCare COMPARE Corp.
3200 Highland Ave., Downers Grove, Ill. 60515; 630-241-7900; fax: 630-241-7856
Staff/Facilities
Primary practitioners*14,718
Specialists20,363
Hospitals**276
Service area: 57 counties.
**Includes some specialists. ***Includes specialty hospitals.
See HealthCare COMPARE Corp./The AFFORDABLE Medical Networks consolidated listing under Illinois.
Human Behavior Associates
191 Military E., Suite A, Benicia, Calif. 94510; 707-747-0117; fax: 707-747-6646
Specialty: mental health
Staff/Facilities
Primary practitioners6,500
Board-certified28%
Patients/practitioner26
Specialists200
Hospitals175
Users: Group Health
Employer/payer groups43
Family coverage170,000
Employees & dependents170,000
Total Users170,000
Operational date: December 1987.
For profit.
Service area: California: statewide; Guam; Hawaii; Nevada: statewide; Oregon: statewide; Japan: the cities of Sasebo and Yokusuk; 75 additional metropolitan areas.
Services: Mental health, employee assistance program services. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem; is compensated by employers/payers; charges flat fee per employee.
UR: Standard procedures excluding retrospective review and second surgical opinion. Also provides employee assistance program.
UR provided by the PPO and by outside contractors.
Officers: James B. Wallace, president; Yolanda Calderon, director-operations; P. James Weymouth, director-marketing.
Contact: P. James Weymouth.
Interplan Corp.*
2575 Grand Canal Blvd., Suite 200, Stockton, Calif. 95207; 209-473-0811; fax: 209-473-0863
Staff/Facilities
Primary practitioners10,151
Board-certified80%
Patients/practitioner110
Specialists18,819
Hospitals343
Users: Group Health
Employer/payer groups2,015
Single/family coverage262,065
Employees & dependents601,000
Users: Workers Compensation
Employer/payer groups1,424
Single coverage525,000
Total Users1,126,000
Operational date: September 1984.
For profit.
Service area: California, Nevada.
Services: General medical, dental, vision, mental health, workers compensation, tertiary care centers, ancillary providers. Services available unbundled.
Compensation: Negotiates hospital charges by per diem, per case; is compensated by employers/payers, insurers; charges flat fee per employee, by percent of savings.
UR: Standard procedures, including specialty referrals. UR provided by the PPO.
Officers: Daniel P. Sheehy, president; Phoebe Brown, senior vp; Kimberly Frank, vp.
**Figures are consolidated, including all PPO plans in this organization.
Interplan Corp.
2575 Grand Canal Blvd., Suite 200, Stockton, Calif. 95207; 209-473-0811; fax: 209-473-0863
Staff/Facilities
Primary practitioners9,934
Patients/practitioner112
Specialists18,270
Hospitals335
Users: Group Health
Employer/payer groups2,003
Single/family coverage255,565
Employees & dependents587,800
Users: Workers Compensation
Employer/payer groups1,424
Single coverage525,000
Total Users1,112,800
Service Area: California: statewide.
See Interplan Corp. consolidated listing under California.
Kaiser Foundation Health Plan Inc.
1950 Franklin St., Oakland, Calif. 94612; 510-987-1000; fax: 510-987-4303
Staff/Facilities*
Primary practitioners2,253
Board-certified86%(N. Calif.)/96%(S. Calif.)
Specialists5,389
Hospitals37
Pharmacies241
Primary care locations127
Users
Employer/payer groups35,123
Single coverage1,028,407
Family coverage675,598
Employees & dependents4,555,869
Medicare481,639
Medicaid92,803
Total5,149,508
Revenues
1996$8,414,003,000Federally qualified.
NCQA fully accredited**.
Model type: Group.
Service area: California: 30 counties.
Services: General medical, vision, prescription drug, mental health, workers compensation, durable medical equipment, hospitalization, lab, x-ray, preventive medicine, health education, substance abuse. Services available unbundled. May be customized to meet employer specifications.
Rating options: Adjusted community rating.
Offers self-insured products.
Point-of-service contracts: 0.1% of members are enrolled.
Officers: Dr. David M. Lawrence, chairman/CEO; Richard Barnaby, president/COO; Dr. W.H. Caulfield Jr., executive director-Permanente Medical Group; Dr. Oliver Goldsmith, medical director-Southern California Permanente Medical Group; Joyce Berger, senior vp-operations, Northern California; Ed Carlson, senior vp-operations, Southern California.
Contact: Tim Louie, analyst, 626-405-6526.
**As of December 1996. ***Southern California; Northern California product is one year accredited.
See Kaiser Permanente consolidated listing under California.
Kaiser Permanente*
1 Kaiser Plaza, Oakland, Calif. 94612; 510-271-6489
Staff/Facilities**
Primary practitioners6,630
Board-certified87%
Specialists14,644
Hospitals198
Pharmacies7,481
Primary care locations500
Users
Employees & dependentsÃ…6,982,300
Medicare756,300
Medicaid282,800
Total8,020,600
Revenues
1996$13,241,000,000Federally qualified**.
Licensed in: California, Colorado, Connecticut, District of Colombia, Georgia, Hawaii, Idaho, Kansas, Maryland, Massachusetts, Missouri, New York, North Carolina, Ohio, Oregon, Texas, Vermont, Virginia and Washington.
Not for profit.
Service area: California, Colorado, Connecticut, District of Colombia, Georgia, Hawaii, Idaho, Kansas, Maryland, Massachusetts, Missouri, New York, North Carolina, Ohio, Oregon, South Carolina, Texas, Vermont, Virginia and Washington.
Member of The HMO Group***. Contracts with CCN for general medical in California; Pearle Vision for vision and Delta Dental for dental in Georgia; Hawaii Dental Services for dental in Hawaii; Dental Benefit Providers Inc. in Maryland, Ohio; MedicalControl for general medical in Texas; contracts for general medical in Oregon.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: Dr. David M. Lawrence, chairman/CEO; Richard Barnaby, president/COO; Susan E. Porth, senior vp-corporate services/CFO; Kathy Swenson, senior vp-marketing/sales; Kirk E. Miller, senior vp/general counsel; Robert M. Crane, senior vp/chief administrative officer.
Contact: Brian Raymond, account services manager, 510-271-5882.
**Figures are consolidated, including all HMO/POS plans in this organization. Ã…*BI estimate. **Information specific to HMO products. ****All non-California HMO products.
Lifeguard Inc.
P.O. Box 5506, San Jose, Calif. 95150-5506; 408-943-9400;
fax: 408-383-4209
Staff/Facilities
Primary practitioners3,080
Board-certified74%
Patients/practitioner68
Specialists6,411
Hospitals104
Pharmacies1,289
Primary care locations2,000
Users
Employer/payer groups2,632
Single coverage40,308
Family coverage95,734
Employees & dependents210,563
Medicare5,742
Total217,086
Revenues
First-half 1997$138,923,710
1996$244,876,085Operational date: February 1979.
Federally qualified.
Licensed in: California.
NCQA one year accredited.
Model type: Group/IPA/Network.
Not for profit.
Service area: California: 25 counties. Member of UltraLink.
Services: General medical. May be customized to meet employer specifications.
Rating options: Community rating by class.
Point-of-service contracts: 16% of members are enrolled.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: Mark G. Hyde, president/CEO; Dr. S. Joseph Aita, medical director; Maryam Bolouri, vp/chief information officer; Holly McCann, vp/general counsel; Thomas H. Carter, vp-marketing/sales.
Contact: Barbara Marich, product manager.
Lifeguard Inc.
P.O. Box 28363, San Jose, Calif. 95159-8363; 800-995-0380 or 408-943-9400
Staff/Facilities
Primary practitioners15,500*
Patients/practitioner0.2
Hospitals441
Pharmacies3,988
Users: Group Health
Employer/payer groups97
Employees & dependents1,789
Operational date: October 1995.
Not for profit.
Service area: California: 25 counties.
Contracts with California Foundation and Medical Care in California.
Services: General medical, mental health.
Compensation: Negotiates hospital charges on fee-for-service basis; is compensated by employers/payers; charges on fee-for service basis.
UR: Standard procedures. UR provided by the PPO.
Officers: Mark G. Hyde, president/CEO; Dr. S. Joseph Aita, medical director; Holly McCann, vp/chief legal counsel; Maryam Bolouri, vp/chief information officer; Thomas H. Carter, vp-marketing/sales.
Contact: Karen Grogg-Joshi, product manager, 408-383-4216.
**Includes specialists.
Managed Health Network
1600 Los Gamos Drive, Suite 300, San Rafael, Calif. 94903; 415-491-7200; fax: 415-472-8187
Specialty: mental health
Staff/Facilities
Primary practitioners22,000
Hospitals1,100
Users: Group Health
Employees & dependents7,200,000
Total Users7,200,000
Ownership: Foundation Health Systems.
For profit.
AAHC/URAC accreditation status: Health Utilization Management Standards.
Service area: Nationwide. Also serves Puerto Rico.
Services: Mental health. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, DRGs, case rates; is compensated by employers/payers, insurers; charges flat fee per employee.
UR: Standard procedures, excluding second surgical opinion. UR provided by the PPO.
Officers: Mike Evans, president/CEO; Jonathon Wormhoudt, executive vp; David Buhler, CFO; Robert Glas, chief information officer; Stuart Weinstein, senior vp-sales/marketing; Dr. Robert Fusco, corporate medical director.
MultiPlan Inc.
115 Fifth Ave., New York, N.Y. 10003; 212-780-2000; fax: 212-843-3517
Staff/Facilities
Primary practitioners*NA
Specialists*NA
Hospitals276
Users: Group Health
Employer/payer groups72
Employees & dependents2,068,707
Service area: California: statewide, excluding Alpine and Modoc counties.
**Practitioner network not yet established.
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 practitioners125
Service area: California: 102 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 practitioners21,225
Specialists49,423
Hospitals402
Users: Group Health
Employer/payer groups40
Employees & dependents205,055
Total Users205,055
Service area: California.
See National Preferred Provider Network Inc. consolidated listing under New York.