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1997 DIRECTORY OF MANAGED CARE PROVIDERS

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

Kentucky
Advantage Care Inc.
120 Prosperous Place, Suite 100, Lexington, Ky. 40509; 606-264-4600;
fax: 606-264-4662
Staff/Facilities
Primary practitioners461
Board-certified70%
Patients/practitioner101.7
Specialists615
Hospitals40
Pharmacies400
Primary care locations220
Users
Employer/payer groups371
Single coverage14,511
Family coverage11,255
Employees & dependents47,293
Total47,879
Revenues
First-half 1997$35,134,000
1996$43,696,460Parent: Lexington Clinic.
Operational date: April 1993.
Licensed in: Kentucky.
Model type: Group/Network.
For profit.
Service area: Kentucky: 51 counties in Central and Eastern Kentucky. Contracts with MedImpact for prescription drug in Kentucky; Mental Health Network for mental health in Kentucky.
Services: General medical, prescription drug, mental health. May be customized to meet employer specifications.
Rating options: Community rating by class; adjusted community rating.
Offers self-insured products.
Point-of-service contracts: 12.2% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: Jeffrey P. Johnson CEO; Allen Van Fossen, chief marketing officer; Dr. Mitchael Estridge, medical director; Martha C. Riddell, vp-health services.
Contact: Nancy Atkins, sales manager, 606-264-6701.
Beech Street Corp.
173 Technology, Irvine, Calif. 92618; 800-233-2478 or 714-727-1353; fax: 714-727-1319
Staff/Facilities*
Primary practitioners648
Specialists2,047
Hospitals18
Users: Group Health
Single coverage11,397
Family coverage40,091
Employees & dependents103,607
Users: Workers Compensation
Single coverage2,128
Total Users105,735
Operational date: 1987.
Service area: Kentucky: 62 counties.
**Includes leased providers/facilities.
See Beech Street Corp. consolidated listing under California.
CCN
5251 Viewridge Court, San Diego, Calif. 92123; 800-247-2898; 619-278-1262
Staff/Facilities
Primary practitioners848
Specialists2,014
Hospitals26
Service area: Kentucky: 79 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-Kentucky
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners924
Hospitals18
Service area: Kentucky.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Louisville
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners1,716
Hospitals18
Service area: Kentucky: Louisville.
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 practitioners222*
Board-certified61.3%
Patients/practitioner102.7
Hospitals5
Service area: Kentucky: Boone, Bullitt, Campbell, Daviess, Fleming, Grant, Hardin, Hart, Jefferson, Kenton, Meade, Oldham and Pendleton counties.
**Includes specialists.
See CAPP CARE Inc. consolidated listing under California.
Center Care
1225 Fairway St., P.O. Box 148, Bowling Green, Ky. 42102-0148; 800-972-7038 or 502-796-2160; fax: 502-796-2106
Staff/Facilities
Primary practitioners103
Board-certified62.4%
Patients/practitioner485
Specialists176
Hospitals57
Pharmacies420
Users: Group Health
Employees & dependents50,400
Ownership: Commonwealth Health Corp.
Operational date: January 1990.
For profit.
Service area: Kentucky: 16 counties; Tennessee: 15 counties.
Services: General medical. 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, excluding second surgical opinion and hospital bill audits. UR provided by the PPO and outside contractors.
Officers: John Mark Fones, senior vp; Teresa J. Wilson, vp-managed care services; Jim "X" Lucas, general manager-sales/member services; Sean McGuinness, sales representative; Dr. Gary Howerton, medical director.
Contact: Sean McGuinness.
ChiroSource Inc.
P.O. Box 130, Clayton, Calif. 94517; 510-672-5333; fax: 510-672-6657
Specialty: chiropractic
Staff/Facilities
Primary practitioners4
Service area: Kentucky: statewide.
See ChiroSource Inc. consolidated listing under California.
CIGNA Managed Care Network of Louisville
600 Vine St., Suite 602, Cincinnati, Ohio 45202; 513-629-2640; 513-629-2639
Staff/Facilities
Primary practitioners504
Board-certified69.5%
Patients/practitioner34
Specialists951
Hospitals17
Pharmacies265
Users
Employer/payer groups169
Total17,151Operational date: January 1993.
Licensed in: Kentucky.
Model type: IPA.
Service area: Indiana: Clark, Floyd and Harrison counties; Kentucky: Boyle, Bullitt, Fayette, Jefferson, Lincoln, Marion, Mercer, Oldham, Shelby and Taylor counties.
Point-of-service contracts: 46.3% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: James D. Massie, general manager; Dr. William Jantsch, medical director; Marybeth Elkamp, director/manager-operations/provider relations manager; Krista Ball, UM health services manager.
Contact: Lana Feeback.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA PPO-Louisville
600 Vine St., Suite 602, Cincinnati, Ohio 45202; 513-629-2640; 513-629-2639
Staff/Facilities
Primary practitioners510
Board-certified69.2%
Patients/practitioner16.5
Specialists1,209
Hospitals18
Users: Group Health
Employer/payer groups203
Total Users8,426
Operational date: January 1993.
Service area: Indiana: Clark, Floyd and Harrison counties; Kentucky: Boyle, Bullitt, Fayette, Jefferson, Lincoln, Marion, Mercer, Oldham, Shelby and Taylor counties.
Officers: James D. Massie, general manager; Dr. William Jantsch, medical director;Marybeth Elkamp, director/manager-operations/provider relations manager; Steven Keller, manager/sales director.
Contact: Andrew Green, 860-726-3586.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CompLink Managed Care
P.O. Box 2638, 1225 Fairway, Bowling Green, Ky. 42102; 800-570-6745 or 502-796-5164; fax: 502-796-2107
Specialty: workers comp
Staff/Facilities
Primary practitioners50
Board-certified42%
Specialists73
Hospitals9
Users: Workers Compensation
Employer/payer groups17
Single coverage4,965
Ownership: Commonwealth Health Corp.
Operational date: April 1985.
For profit.
Service area: Kentucky: Allen, Barren, Butler, Edmonson, Logan, Monroe, Simpson and Warren counties.
Services: Workers compensation. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by fee schedule; is compensated by employers/payers; charges flat fee per employee.
UR: Standard procedures, excluding hospital bill audits. UR provided by the PPO and outside contractors.
Officers: John Mark Fones, senior vp; Teresa Wilson, vp; X. Lucas, general manager-sales; Tracy Dye, case manager; Dr. Gary Howerton, medical director.
Contact: Tracy Dye.
CorVel Corp.
1920 Main St., Suite 1090, Irvine, Calif. 92714; 714-851-1473; fax: 714-851-1469
Staff/Facilities
Primary practitioners684
Board-certified93%
Specialists3,182*
Hospitals67
Service area: Kentucky.
**Includes ancillary providers.
See CorVel Corp. consolidated listing under California.
Cumberland Healthcare Inc.
489 E. Main St., Suite 300, Lexington, Ky. 40507; 888-893-2264; fax: 606-255-9134
Staff/Facilities
Primary practitioners74
Patients/practitioner37
Specialists832
Hospitals5
Users: Group Health
Employer/payer groups2
Single coverage440
Family coverage743
Employees & dependents2,700
Operational date: January 1997.
For profit.
Service area: Kentucky: Bell, Clay, Jackson, Knox, Laurel, Pulaski and Whitley counties.
Services: General medical, prescription drug, mental health, transplant. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, DRGs; is compensated by employers/payers; charges flat fee per employee.
UR: Standard procedures excluding hospital bill audits and outpatient service predetermination. UR provided by the PPO.
Officers: Dr. Tom Moore, board president; Lowell Jones, board vp; Elmer Cummings, secretary/treasurer; Dr. Bruce Barton, Dr. William Pratt, Dr. Bobby Turner, John Henson, John Burgett, board members.
Contact: Harold L. Bischoff.
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 practitioners544
Specialists1,291
Hospitals33
Total Users6,763
Operational date: September 1993.
Service area: Kentucky: 101 counties.
See FOCUS Healthcare Management Inc. consolidated listing under Tennessee.
Guardian Resources Inc.
2739 U.S. Highway 19 North, Suite 350, Holiday, Fla. 34691; 813-938-2222; 813-938-2880
Staff/Facilities
Primary practitioners425
Board-certified72%
Specialists854
Hospitals45
Pharmacies57
Users: Group Health
Employer/payer groups14
Single coverage1,000
Family coverage1,300
Employees & dependents3,800
Total Users3,800
Service area: Kentucky: statewide.
See Guardian Resources consolidated listing under Florida.
HMO Kentucky
9901 Linn Station Road, Louisville, Ky. 40233; 502-423-2320; fax: 502-423-6507
Staff/Facilities
Primary practitioners1,529
Specialists2,867
Hospitals87
Users
Total56,000
RevenuesParent: Anthem Inc.
Operational date: December 1985.
Federal qualification pending.
Licensed in: Kentucky.
Model type: Mixed.
Service area: Kentucky: statewide.
Member of HMO Blue USA nationwide.
Contracts with Anthem Prescription Management for prescription drugs in Kentucky.
Services: General medical, prescription drug, mental health. May be customized to meet employer specifications.
Rating options: Adjusted community rating.
Offers self-insured products.
Point-of-service contracts: Percent of members enrolled not available.
Officers: James Murphy, president/CEO; Jeff Schmidlin, vp-finance; Dr. Joseph Berman, medical director; Brad Buxton, senior vp; Tom Schifano, sales.
HealthCare COMPARE Corp.
3200 Highland Ave., Downers Grove, Ill. 60515; 630-241-7900; fax: 630-241-7856
Staff/Facilities
Primary practitioners*679
Specialists1,163
Hospitals**32
Service area: Kentucky: 95 counties.
**Includes some specialists. ***Includes specialty hospitals.
See HealthCare COMPARE Corp./The AFFORDABLE Medical Networks consolidated listing under Illinois.
Healthsource
Kentucky Inc.*
100 Mallard Creek Road, Suite 300, Louisville, Ky. 40207; 502-899-7500;
fax: 502-899-1982
Staff/Facilities
Primary practitioners421
Board-certified80%
Patients/practitioner70
Specialists846
Hospitals20
Pharmacies765
Primary care locations21
Users
Employer/payer groups9
Total13,104
Revenues
First-half 1997$11,894,000
1996$22,969,447Parent: CIGNA HealthCare*.
Operational date: July 1995.
Licensed in: Indiana, Kentucky.
Model type: IPA.
For profit.
Service area: Indiana: Clark, Floyd, Harrison, Scott and Washington counties; Kentucky: Bullitt, Hardin, Henry, Jefferson, Nelson, Oldham, Shelby, Spencer, Trimble and Washington counties.
Contracts with Vision Service Plan for vision in Indiana and Kentucky.
Services: General medical, dental, vision, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Rating options: Adjusted community rating.
Offers self-insured products.
Point-of-service contracts: 10% of members are enrolled.
Officers: Steve White, CEO; Dr. Alex Moore, medical director; Dan Atherton, vp-marketing; Paul Stamp, provider relations director.
Contact: Cooley Smith, 502-899-7500 ext. 4223.
**Healthsource Inc. was acquired by CIGNA HealthCare in June 1997.
HealthStar Inc.
9300 Shelbyville Road, Suite 215, Louisville, K.Y. 40222; 502-425-9447; fax: 502-425-8020
Staff/Facilities
Primary practitioners1,470
Specialists2,730
Hospitals79
Users: Group Health
Employees & dependents48,000
Users: Workers Compensation
Single coverageNA
Total Users*48,000
Operational date: 1991.
Service area: Kentucky: statewide.
**Figure does not include workers comp.
See HealthStar Inc. consolidated listing under Illinois.
Humana Inc.
500 W. Main St., Louisville, Ky. 40202; 502-580-1000; fax: 502-580-3127
Staff/Facilities*
Primary practitioners9,100
Specialists**28,600
Hospitals600
Users*
Employees & dependents1,172,700
TotalOperational date: 1984.
Federally qualified.
Model type: Group, IPA, Staff.
For profit.
Service area: .
Services: General medical, dental, vision, prescription drug, mental health, workers compensation.
Officers: .
**As of Dec. 31, 1996. ***Includes ancillary providers.
Humana Inc.
500 W. Main St., Louisville, Ky. 40202; 502-580-1000; fax: 502-580-3127
Staff/Facilities*
Primary practitioners*37,800
Hospitals630
Users*
Employees & dependents1,586,900
Total Users
Operational date: 1961.
For profit.
Service area: .
Services: General medical, dental, vision, prescription drug, mental health.
Officers: .
**As of Dec. 31, 1996. **Includes specialists.