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1997 DIRECTORY OF MANAGED CARE PROVIDERS

Reprints

Michigan
Blue Care Network of Southeast Michigan
25925 Telegraph, P.O. Box 5043, Southfield, Mich. 48086-5043; 248-354-7450
Staff/Facilities
Primary practitioners1,275
Board-certified84%
Patients/practitioner234
Specialists2,518
Hospitals51
Pharmacies1,009
Primary care locations715
Users
Employer/payer groups6,030
Single coverage56,572
Family coverage67,407
Employees & dependents279,008
Medicare7,734
Total286,742
Revenues
First-half 1997$199,678,471
1996$349,092,516Parent: Blue Cross & Blue Shield of Michigan.
Operational date: May 1981.
Federally qualified.
Licensed in: Michigan.
NCQA fully accredited.
Model type: IPA.
Not for profit.
Service area: Michigan: Macomb, Monroe, Oakland, St. Clair, Washtenaw and Wayne counties.
Member of HMO Blue USA.
Services: General medical, dental*, vision*, prescription drug*, mental health*, home health, wellness, substance abuse*. May be customized to meet employer specifications.
Rating options: Community rating: $139.45 single, $348.03 family.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: Janet B. Ofodile, president/CEO; Dr. Michael Stevens, chief medical officer; Marilyn Ogg, COO; Dr. Gregory Gilmet, associate medical director-quality management; Gary Gray, operations director.
Contact: Customer services department, 800-662-6667 or 248-354-7479.
**Provided through ancillary network.
Blue Preferred
600 E. Lafayette, Detroit, Mich. 48226; 313-225-9000
Staff/Facilities
Primary practitioners*7,893
Board-certified*64%
Specialists*6,514
Hospitals*153
Pharmacies2,045
Users: Group Health
Employer/payer groups10,000
Employees & dependents**728,535
Ownership: Blue Cross & Blue Shield of Michigan.
Operational date: April 1985.
Not for profit.
Service area: Michigan: 81 counties and the cities of Alpena, Battle Creek, Detroit, Flint, Grand Rapids, Hastings, Lansing, Oscoda, Muskegon, Saginaw and Traverse City.
Services: General medical, prescription drug, mental health.
May be customized to meet employer specifications. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by DRGs; is compensated by employers/payers; charges by percent of savings, by approved fee schedule.
UR: Standard procedures, including PPO physician retrospective prefiling; excluding length of stay determination, outpatient service predetermination. UR provided by the PPO.
Officers: Marianne Udow, senior vp-corporate strategy/health care administration; Kevin Seitz, vp-PPO/ancillary services; Catherine Schmitt, director-PPO programs.
Contact: Melanie A. Yanchuk, 248-448-8242.
**As of September 1997. ***As of March 1997.
CCN
5251 Viewridge Court, San Diego, Calif. 92123; 800-247-2898; 619-278-1262
Staff/Facilities
Primary practitioners638
Specialists2,222
Hospitals48
Service area: Michigan: 62 counties.
Services: General medical, mental health, workers compensation, ancillary services.
**Does not include workers compensation users.
See CCN consolidated listing under California.
CNA Managed Care-Detroit
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Primary practitioners401
Specialists966
Hospitals16
Primary care locations15Service area: Michigan: Detroit.
See CNA Managed Care POS consolidated listing under Illinois.
CNA Managed Care-Central Michigan
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners1,623
Hospitals18
Service area: Michigan: Central Michigan.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Detroit
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners5,540
Hospitals32
Service area: Michigan: Detroit.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Northern Michigan
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners10
Hospitals1
Service area: Michigan: Northern Michigan.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-West Michigan
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners1,163
Hospitals13
Service area: Michigan: West Michigan.
See CNA Managed Care PPO consolidated listing under Illinois.
CAPP CARE Inc.
West Tower, 4000 MacArthur Blvd., Suite 10000, Newport Beach, Calif. 92660; 800-937-2277; fax: 714-251-2222
Staff/Facilities
Primary practitioners*2,191
Board-certified60.9%
Patients/practitioner44.5
Hospitals41
Service area: Michigan: 54 counties.
**Includes specialists.
See CAPP CARE Inc. consolidated listing under California.
ChiroSource Inc.
P.O. Box 130, Clayton, Calif. 94517; 510-672-5333; fax: 510-672-6657
Specialty: chiropractic
Staff/Facilities
Primary practitioners52
Service area: Michigan: statewide.
See ChiroSource Inc. consolidated listing under California.
CIGNA Managed Care Network-Southeast Michigan
26913 Northwestern Highway, Suite 300, Southfield, Mich. 48034; 248-386-6028; fax: 248-386-6039
Staff/Facilities
Primary practitioners1,171
Board-certified72.4%
Patients/practitioner33.1
Specialists3,207
Hospitals52
Pharmacies1,457
Users
Employer/payer groups690
Total34,845Operational date: January 1993.
Licensed in: Michigan, Ohio.
Model type: IPA.
Service area: Michigan: Genesee, Jackson, Kalamazoo, Kent, Lapeer, Livingston, Macomb, Monroe, Oakland, Ottawa, St. Clair, Washtenaw and Wayne counties; Ohio: Lucas and Wood counties.
Point-of-service contracts: 62.7% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: Jeanne McCarthy, general manager; Dr. David Cogan, medical director; Robert Weaver, provider relations manager; Marilyn Spitaleri, quality assurance manager; Carl Biats, sales director/manager.
Contact: Pat Cosby.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA PPO-Michigan
26913 Northwestern Highway, Suite 300, Southfield, Mich. 48034; 800-654-9631; fax: 248-386-6039
Staff/Facilities
Primary practitioners1,866
Board-certified74.6%
Patients/practitioner17.7
Specialists3,851
Hospitals81
Users: Group Health
Employer/payer groups393
Total Users33,136
Operational date: April 1989.
Service area: Michigan: Calhoun, Genesee, Jackson, Kalamazoo, Kent, Lapeer, Livingston, Macomb, Monroe, Oakland, Ottawa, Saint Clair, Washtenaw and Wayne counties; Ohio: Lucas and Wood counties.
Officers: Ron Dziedzicki, director/manager-operations/executive director; Jeanne McCarthy, general manager; Dr. David Cogan, medical director; Carl Biats, sales director/manager; Robert Weaver, provider relations manager.
Contact: Andrew Green, 860-726-3586
See CIGNA HealthCare PPO consolidated listing under Connecticut.
Co/op Optical
2424 E. Eight Mile Road, Detroit, Mich. 48234; 313-366-5100; fax: 313-366-2246
Specialty: vision
Staff/Facilities
Primary practitioners61
Primary care locations156
Users
Employer/payer groups180
Employees & dependents213,248
Total213,248
Revenues
First-half 1997$6,259,509
1996$6,458,281Operational date: January 1987.
Licensed in: Michigan.
Model type: Staff/Network.
Not for profit.
Service area: Michigan: seven southeastern counties in; Kent County. Member of First Look in Alabama, Arizona, Colorado, Connecticut, Delaware, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Mississippi, North Carolina, Ohio, South Carolina, Tennessee, Utah, Vermont, Virginia, West Virginia and Wisconsin.
Member of First Look.
Services: Vision. Services available unbundled. May be customized to meet employer specifications.
Offers self-insured products.
Officers: Ken Morris, president; Patrick Korth, CEO; Ralph Subastian, vp-operations; Debora Matthews, vp-finance; M. Kay Brady, vp-development/marketing.
Contact: Patrick Korth.
CorVel Corp.
1920 Main St., Suite 1090, Irvine, Calif. 92714; 714-851-1473; fax: 714-851-1469
Staff/Facilities
Primary practitioners920
Board-certified100%
Specialists4,501*
Hospitals48
Service area: Michigan.
**Includes ancillary providers.
See CorVel Corp. consolidated listing under California.
Delta Dental Plan of Michigan Inc.-DeltaCare
P.O. Box 30416, Lansing, Mich. 48909-7916; 517-349-6000; fax: 517-347-5237
Specialty: dental
Staff/Facilities
Primary practitioners236
Board-certified100%
Patients/practitioner50.8
Specialists69
Primary care locations*103
Users
Employer/payer groups21
Single coverage4,437
Family coverage7,545
Employees & dependents31,962
Revenues
First-half 1997$2,477,219
1996$5,320,357Operational date: July 1984.
Licensed in: Michigan.
Model type: Network.
Not for profit.
Service area: Michigan: statewide.
Services: Dental. Services available unbundled. May be customized to meet employer specifications.
Rating options: Community rating by class.
Officers: C. Richard Seitz, president/CEO; Dr. Thomas J. Fleszar, executive vp/COO; Katherine K. Downer, vp-professional relations/inquiry services; E. Craig Lesley, vp-marketing; Thomas B. Dixson, vp-administration.
Contact: Leslie Gaines or Bill Albert.
**Reflects total offices.
Delta Dental Plan of Michigan Inc.-DeltaPreferred Option
P.O. Box 30416, Lansing, Mich. 48909-7916; 517-349-6000; 517-347-5237
Specialty: dental
Staff/Facilities
Primary practitioners989
Board-certified100%
Specialists157
Users: Group Health
Employer/payer groups174
Single coverage187,773
Family coverage458,441
Employees & dependents1,396,203
Total Users1,396,203
Operational date: May 1987.
Not for profit.
Service area: Michigan: statewide.
Services: Dental. Services available unbundled. May be customized to meet employer specifications.
Compensation: Is compensated by employers/payers, TPAs; charges flat fee per employee.
UR: Precertification, case management, cost management. UR provided by the PPO.
Officers: C. Richard Seitz, president/CEO; Dr. Thomas Fleszar, executive vp/COO; Katherine K. Downer, vp-professional relations/inquiry services; E. Craig Lesley, vp-marketing; Thomas B. Dixson, vp-administration.
Contact: Leslie Gaines or Bill Albert.
Dencap Dental Plans Inc.
45 E. Milwaukee St., Detroit, Mich. 48202; 313-972-1400; fax: 313-972-4662
Specialty: dental
Staff/Facilities
Primary practitioners140
Patients/practitioner130
Specialists15
Primary care locations95
Users
Employer/payer groups220
Single coverage3,900
Family coverage4,900
Employees & dependents18,000
Total18,000
Revenues
First-half 1997$769,000
1996$1,245,000Parent: Dencap Dental Plans.
Operational date: September 1984.
Licensed in: Michigan.
Model type: IPA.
For profit.
Service area: Michigan: Genesee, Ingham, Kalamazoo, Livingston, Macomb, Oakland, St.Clair, Washtenaw, Wayne.
Services: Dental. Services available unbundled. May be customized to meet employer specifications.
Rating options: Community rating: $10.50 single, $25.00 family; community rating by class.
Offers self-insured products.
Enrollment options: Individual enrollment is allowed.
Officers: Joseph T. Lentine, president; Dr. James Feldman, dental director; Roger Roberts, director-marketing; Tim Bailey, operations manager.
Contact: Joseph T. Lentine.
Ethix Great Lakes
1301 W. Long Lake Road, Suite 360, Troy, Mich. 48098; 800-356-4951; fax: 248-952-6287
Staff/Facilities
Primary practitioners2,658
Board-certified75%
Patients/practitioner47
Specialists3,942
Hospitals68
Users: Group Health
Employer/payer groups990
Employees & dependents125,753
Ownership: NYLCare Health Plans Inc.
Operational date: September 1989.
For profit.
Service area: Michigan: 29 counties.
Services: General medical, mental health, podiatry.
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.
UR: Standard procedures. UR provided by the PPO.
Officers: Kimberly A. Fiori, vp-operations; Julie Bolhuis, controller; Dr. Hector Inchaustegui, medical director.
Contact: Kimberly Fiori.
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 practitioners6,832
Specialists11,709
Hospitals119
Total Users51,850
Operational date: February 1993.
Service area: Michigan: 87 counties.
**Includes leased providers/facilities.
See FOCUS Healthcare Management Inc. consolidated listing under Tennessee.
Health Alliance Plan
2850 W. Grand Blvd., Detroit, Mich. 48202; 313-874-7914; fax: 313-874-7479
Staff/Facilities
Primary practitioners1,410
Board-certified82%
Patients/practitioner323
Specialists3,826
Hospitals33
Pharmacies1,253
Primary care locations505
Users
Employer/payer groups3,977
Single coverage92,127
Family coverage46,368
Medicare36,839
Medicaid28,156
Total454,968
Revenues
1996$857,171,292Operational date: 1961.
Federally qualified.
Licensed in: Michigan.
NCQA fully accredited.
Model type: Group/IPA.
Not for profit.
Service area: Michigan: Genesee, Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenau and Wayne counties.
Services: General medical, vision, prescription drug, mental health. May be customized to meet employer specifications.
Rating options: Community rating: $178.26 single, $463.47 family.
Offers self-insured products.
Point-of-service contracts: 1.3% of members are enrolled.
Non-federally qualified programs.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: James Walworth, president; Fran Parker, senior vp/COO; Joe Schmitt, senior vp/CFO; Steve Nelson, acting vp-marketing; Don Hirt, associate vp-research/planning.
HealthCare COMPARE Corp.
3200 Highland Ave., Downers Grove, Ill. 60515; 630-241-7900; fax: 630-241-7856
Staff/Facilities
Primary practitioners*1,545
Specialists2,915
Hospitals**44
Service area: Michigan: 59 counties.
**Includes some specialists. ***Includes specialty hospitals.
See HealthCare COMPARE Corp./The AFFORDABLE Medical Networks consolidated listing under Illinois.
HealthPlus
of Michigan
2050 S. Linden Road, P.O. Box 1700, Flint, Mich. 48501-1700; 810-230-2000; fax: 810-230-2208
Staff/Facilities
Primary practitioners381
Board-certified70%
Patients/practitioner352
Specialists751
Hospitals11
Pharmacies950
Users
Single coverage9,638
Family coverage30,931
Employees & dependents94,537
Medicare6,785
Medicaid19,374
Total120,696
Revenues
First-half 1997$103,436,226
1996$176,745,433Operational date: October 1977.
Federally qualified.
Licensed in: Michigan.
NCQA fully accredited.
Model type: IPA, Network.
Not for profit.
Service area: Michigan: Arenac, Bay, Genesee, Lapeer, Livingston, Midland (city and township), Oakland (north of M-59), Saginaw, Sanilac (Greenleaf and Evergreen townships pnly), Shiawassee, St. Clair (Berlin township only) and Tuscola counties.
Services: General medical, prescription drug, mental health. May be customized to meet employer specifications.
Rating options: Community rating: $184.92 single, $474.26 family.
Offers self-insured products.
Point-of-service contracts: 7.6% of members are enrolled.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: Paul Fuhs, CEO; Dr. Lowell Weiner, medical director; Keith Collin, CFO; John Mathewson, vp-marketing; Dan Champney, vp-legal/human resources.
Contact: Nancy Starks.
HealthStar Inc.
38701 W. Seven Mile Road, Suite 190, Livonia, Mich. 48152; 313-542-0977; fax: 313-542-0978
Staff/Facilities
Primary practitioners723
Specialists1.344
Hospitals35
Operational date: November 1996.
Service area: Michigan: Calhoun, Hillsdale, Kalamazoo, Macomb, Muskegon, Oakland, St. Clair and Wayne counties.
See HealthStar Inc. consolidated listing under Illinois.