Ethix Southwest
9901 1H-10 West; Suite 300, San Antonio, Texas 78230, 800-292-0260; 210-690-2225
Staff/Facilities
Primary practitioners2,739
Specialists6,257
Hospitals117
Users: Group Health
Employer/payer groups6,771
Family coverage52,871
Employees & dependents132,178
Ownership: NYLCare Health Plans Inc.
Operational date: October 1985.
For profit.
AAHC/URAC accreditation status: Health Utilization Management Standards.
Service area: Texas: 86 counties in Central and southern Texas.
Services: General medical, mental health. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by per diem, discount off customary rates; is compensated by employers/payers, providers, insurers, TPAs; charges flat fee per employee, by percent of services by doctors/hospitals.
UR: Standard procedures excluding hospital bill audits. UR provided by the PPO.
Officers: Lori Haglund, president; Dr. Rowland Reyna, medical director; Anne McCollough, director-operations/provider relations; Terry Fehlhaber, assistant director-operations/information systems.
Exclusive Healthcare Inc.
14900 Landmark, Suite 530, Dallas, Texas 75240; 972-702-2400; fax: 972-720-8011
Staff/Facilities
Primary practitioners886
Board-certified90%
Patients/practitioner10
Specialists3,008
Hospitals28
Pharmacies400
Primary care locations708
Users
Employer/payer groups134
Single coverage4,830
Family coverage3,951
Employees & dependents14,626
Total14,626
Revenues
First-half 1997$13,093,281
1996$24,520,483Parent: Mutual of Omaha Health Plans Inc.
Operational date: December 1992.
Licensed in: Texas.
Model type: Group/IPA.
For profit.
Service area: Texas: Collin, Dallas, Denton, Ellis, Johnson, Kaufman, Parker, Rockwall and Tarrant counties.
Services: General medical, dental, vision, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Rating options: Community rating by class; adjusted community rating.
Offers self-insured products.
Point-of-service contracts: 6% of members are enrolled.
Officers: Donald Triano, executive director; Doug Arrington, director-health services; Kara Butler, director-provider relations; Lisa Santos, director-utilization management/quality improvement; Dr. James Coughlin-medical director.
Contact: Jim Schaefer.
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 practitioners3,064
Specialists13,663
Hospitals200
Total Users2,870,948
Operational date: April 1989.
Service area: Texas: 186 counties.
**Includes leased providers/facilities.
See FOCUS Healthcare Management Inc. consolidated listing under Tennessee.
Foundation Health, a Texas Health Plan
5525 N. MacArthur Blvd., Suite 850, Irving, Texas 75038; 972-756-5000;
fax: 972-756-0232
Staff/Facilities
Primary practitioners675
Board-certified90%
Patients/practitioner30
Specialists2,290
Hospitals55
Pharmacies356
Users
Employer/payer groups275
Medicaid4,300
Total21,000Parent: Foundation Health Systems Inc.
Operational date: May 1994.
Licensed in: Texas.
Model type: IPA.
Service area: Texas: 38 counties.
Services: General medical, vision, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Rating options: Community rating by class; adjusted community rating.
Enrollment options: Individual is enrollment allowed.
Officers: Sandra Watrous, interim executive director, John Anderson, director sales/marketing; Dr. James Jacobsen, medical director; David Koper, director-contracts.
Contact: Kim Clement, senior account executive, 972-756-5010.
See Foundation Health Systems consolidated HMO/POS listing under California.
Foundation Health National Life Insurance Co.
P.O. Box 16, Rancho Cordova, Calif. 95714; 800-824-1896; fax: 916-631-3369
Staff/Facilities
Primary practitioners675
Board-certified90%
Patients/practitioner30
Specialists2,290
Hospitals55
Pharmacies356
Users
Employer/payer groups40
Employees & dependents900
Ownership: Foundation Health Systems Inc.
Operational date: July 1994.
Service area: Texas: 38 counties.
Services: General medical, vision, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications. Individual enrollment is allowed.
UR: Standard procedures excluding length of stay determination, outpatient service predetermination, case management. UR provided by the PPO.
Officers: Sandra Watrous, interim executive director; Dr. James Jacobsen, medical director; John Anderson, director-sales/marketing; David Koper, director-contracts.
Contact: Kim Clement.
See Foundation Health Systems consolidated PPO 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 practitioners5,083
Board-certified59%
Specialists13,351
Hospitals301
Users: Group Health
Employer/payer groups47
Single coverage9,500
Family coverage7,000
Employees & dependents24,900
Total Users24,900
Service area: Texas: statewide.
See Guardian Resources consolidated listing under Florida.
Health Care Partners
18587 Sigma Road, Suite 200, San Antonio, Texas 78258; 210-490-9008; fax: 210-490-4948
Staff/Facilities
Primary practitioners300
Specialists168
Hospitals10
Total Users4,393
Operational date: 1989.
For profit.
Service area: Texas: Bexar County.
Contracts with FOCUS in Arkansas; Medview in Arizona, Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas and Utah; National Healthcare Alliance in Texas.
Services: General medical, 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; is compensated by employers/payers, insurers, TPAs; charges flat fee per employee, by percent of savings.
UR: Standard procedures. UR provided by the PPO.
Officers: Robert D. Brown, CEO/chairman; Maureen Brown, CFO; Douglas Jenkins, medical director; Margeret Morrell, vp.
Contact: Julie Vaughn, 800-880-4427.
HealthCare COMPARE Corp.
3200 Highland Ave., Downers Grove, Ill. 60515; 630-241-7900; fax: 630-241-7856
Staff/Facilities
Primary practitioners*5,543
Specialists8,450
Hospitals**232
Service area: Texas: 184 counties.
**Includes some specialists. ***Includes specialty hospitals.
See HealthCare COMPARE Corp./The AFFORDABLE Medical Networks consolidated listing under Illinois.
HealthSmart Preferred Care Inc.
3223 S. Loop 289, Suite 210, Lubbock, Texas 79423; 800-687-0500 or 806-473-2500; fax: 806-473-2525
Staff/Facilities
Primary practitioners8,000
Board-certified85%
Specialists10,000
Hospitals200
Users: Group Health
Employer/payer groups4,000
Employees & dependents230,000
Users: Workers Compensation
Employer/payer groups300
Single coverage30,000
Total Users260,000
Operational date: January 1994.
For profit.
Service area: Kansas: four southwestern counties; New Mexico: statewide; Oklahoma: 10 western and southwestern counties; Texas: statewide.
Services: General medical, workers compensation. Services available unbundled. May be customized to meet employer specifications. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by per diem, DRGs, case rates; is compensated by employers/payers, insurers, TPAs; charges flat fee per employee, by percent of savings, by percent of services by doctors/hospitals.
UR: Standard procedures. UR provided by the PPO.
Officers: David M. Adams, president; Dr. Bill Johnson, medical director; Jane Williamson, senior vp-operations; Bobby Clark, vp-sales/marketing; Mark Blakemore, vp-network development.
HealthStar Inc.
14860 Montfort Drive, Suite 130, Dallas, Texas 75240; 972-980-2928; fax: 972-387-0721
Staff/Facilities
Primary practitioners3,150
Specialists5,850
Hospitals267
Users: Group Health
Employees & dependents65,000
Users: Workers Compensation
Single coverage55,000
Total Users120,000
Operational date: 1987.
Service area: Texas: statewide.
See HealthStar Inc. consolidated listing under Illinois.
Kaiser Foundation Health Plan of Texas
12720 Hillcrest Road, Suite 600, Dallas, Texas 75230; 972-458-5000; fax: 972-458-5116
Staff/Facilities
Primary practitioners70
Board-certified85%
Specialists106
Hospitals3
Pharmacies9
Primary care locations9
Users
Employer/payer groups1,139
Single coverage29,191
Family coverage21,499
Employees & dependents124,755
Medicare4,502
Total128,640
Revenues
First-half 1997$95,841,209
1996$173,245,000Operational date: June 1979.
Federally qualified.
Licensed in: Texas.
NCQA fully accredited.
Model type: Group.
Not for profit.
Service area: Texas: Collin, Dallas, Denton, Ellis, Hood, Hunt, Johnson, Kaufman, Parker, Rockwall, Tarrant and Wise counties.
Services: General medical, vision, prescription drug, mental health, 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: 2.12% of members are enrolled.
Non-federally qualified programs.
Officers: Dr. William Gillespie, president/executive medical director; Dr. Laurie Richardson, vp/director-Permanente Medical Association of Texas; Deborah Stokes, vp/director-finance; Maureen West, vp/director-business development; Jamie Novell, vp/director-Dallas/Fort Worth market; Lister Robinson, vp/director-quality resource management; Dresdene Flynn-White, vp/director-human resources.
Contact: Russ Plum, director-sales, 972-458-5065.
See Kaiser Permanente consolidated listing under California.
Medical Care Referral Group (MCRG)
4100 Rio Bravo, Suite 211, El Paso, Texas 79902; 915-532-2408; fax: 915-532-1772
Staff/Facilities
Primary practitioners184
Specialists354
Hospitals5
Pharmacies31
Total Users70,000
Ownership: Assured Benefits Administrators.
Operational date: October 1985.
For profit.
Service area: Texas: El Paso County.
Services: General medical, dental, vision, prescription drug, mental health, 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 employers/payers; charges flat fee per employee.
UR: Standard procedures. UR provided by outside contractors.
Officers: Joe Halow, president; Lorri Halow, executive vp; Eddie Garcia, vp-administration; Sue Ann Austin, marketing director.
Contact: Joe Halow.
MedicalControl
8625 King George Drive, Suite 300, Dallas, Texas 75235; 214-630-6368; fax: 214-689-6949
Staff/Facilities
Primary practitioners9,119
Board-certified85%
Specialists16,118
Hospitals468
Users: Group Health
Employer/payer groups2,137
Employees & dependents694,945
Operational date: December 1983.
For profit.
AAHC/URAC accreditation status: Health Network Standards.
Service area: Arkansas: 50 counties; Louisiana: 40 counties; New Mexico: 28 counties; Oklahoma: 67 counties; Texas: 215 counties.
Services: General medical, 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; charges flat fee per employee, by percent of savings.
UR: Standard procedures including demand management. UR provided by outside contractors.
Officers: Robert O. Brooks, COO; Roger A. Chapman, senior vp-network services; Patrick W. Kennedy, senior vp-information management; Allen Sandlin, vp-administration.
Contact: Maria Baker.
MultiPlan Inc.
115 Fifth Ave., New York, N.Y. 10003; 212-780-2000; fax: 212-843-3517
Staff/Facilities
Primary practitioners*NA
Specialists*NA
Hospitals207
Users: Group Health
Employer/payer groups59
Employees & dependents1,604,004
Service area: Texas: 195 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 practitioners55
Service area: Texas: 27 cities.
See National Ear Care Plan consolidated listing under Colorado.
National HealthCare Alliance
770 S. Post Oak Lane, Suite 445, Houston, Texas 77056; 713-888-1902; fax: 713-888-1986
Staff/Facilities
Primary practitioners6,971
Board-certified78%
Patients/practitioner32.3
Specialists19,928
Hospitals208
Users: Group Health
Employer/payer groups97
Single coverage88,762
Family coverage131,421
Employees & dependents484,403
Users: Workers Compensation
Employer/payer groups112
Single coverage3,790
Total Users488,193
Operational date: June 1984.
For profit.
Service area: Texas: 173 counties.
Services: General medical, vision, prescription drug, mental health, workers compensation, 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, DRGs; is compensated by employers/payers, insurers, TPAs; charges flat fee per employee, by percent of savings.
UR: Standard procedures. UR provided by the PPO.
Officers: Robert Woolfolk, chairman/CEO; Melvin Thorne, president; Dr. John Baird, medical director; Don Turner, controller; Dennis Hardy, director-marketing.
Contact: Melvin Thorne.
National Preferred Provider Network Inc.
419 E. Main St., Middletown, N.Y. 10940; 914-343-1600; fax: 914-343-6113
Staff/Facilities
Primary practitioners7,572
Specialists17,810
Hospitals363
Users: Group Health
Employer/payer groups48
Employees & dependents575,975
Total Users575,975
Service area: Texas.
See National Preferred Provider Network Inc. consolidated listing under New York.
NYLCare Health Plans of the Gulf Coast Inc.
2425 W. Loop S., Suite 1000, Houston, Texas 77027; 713-624-5000;
fax: 713-624-5296
Staff/Facilities
Primary practitioners1,978
Board-certified70%
Patients/practitioner500
Specialists9,021
Hospitals98
Pharmacies1,037
Primary care locations*1,960
Users
Employer/payer groups1,885
Single coverage79,212
Family coverage31,918
Employees & dependents364,658
Medicare35,566
Total400,224
Revenues
First-half 1997$126,982,890
1996$450,634,480Parent: NYL Care Health Plans Inc.
Operational date: March 1983.
Federally qualified.
Licensed in: Louisiana and Texas.
NCQA one year accredited.
Service area: Louisiana: Acadia, Allen, Beauregard, Calcasieu, Cameron, Evangeline, Iberia, Jefferson Davis, Lafayette, St. Landry, St. Martin, St. Mary and Vermillion parishes. Texas: 64 counties.
Services: General medical. Services available unbundled. May be customized to meet employer specifications.
Rating options: Community rating by class; adjusted community rating.
Offers self-insured products.
Point-of-service contracts: 12.1% of members are enrolled.
Non-federally qualified programs.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual is enrollment allowed.
Officers: Thomas S. Lucksinger, president/CEO; Michael G. Mirt, president-Houston area.
**Figure includes PCPs with multiple locations.
See NYLCare Health Plans Inc. consolidated listing under New York.
NYLCare Health Plans of the Southwest Inc.
4500 Fuller Drive, Irving, Texas 75038; 972-650-5500; fax: 972-650-5700
Staff/Facilities
Primary practitioners1,075
Board-certified71%
Patients/practitioner125
Specialists2,674
Hospitals73
Pharmacies760
Primary care locations1,150
Users
Employer/payer groups5,519
Employees & dependents171,159
Medicare24,718
Total195,877
Revenues*
First-half 1997$105,622,019
1996$211,235,257Parent: NYLCare Health Plans Inc.
Operational date: August 1983.
Federally qualified.
Licensed in: Texas.
NCQA fully accredited.
Service area: Texas: 57 counties.
Services: General medical, dental, vision, prescription drug, mental health, life insurance, accident insurance, durable medical equipment. Services available unbundled. 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% of members are enrolled.
Non-federally qualified programs.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual is enrollment allowed.
Officers: Steve Yerxa, president/CEO; Dr. Joseph Cheek, vp-chief medical officer; Nate Eudaly, senior vp/CFO; Susan Pohly, vp-security/quality; Elizabeth Philipp, vp-network management.
**Premium revenues only.
See NYLCare Health Plans Inc. consolidated listing under New York.
NYLCare PPO of the Gulf Coast
9901 1H-10W, Suite 300, San Antonio, Texas 78230, 210-690-9699; fax: 210-690-2225
Staff/Facilities
Primary practitioners2,739
Specialists5,779
Hospitals117
Users: Group Health
Employer/payer groups1,289
Family coverage20,393
Employees & dependents50,983
Ownership: NYLCare Health Plans Inc.
Operational date: October 1985.
For profit.
Service area: Texas: 86 South and Central counties.
Contracts with Express Scripts for prescription drug and Value Behavioral Health for mental health in South and Central Texas.
Services: General medical.
Compensation: Negotiates hospital charges by per diem, discount off customary rates; is compensated by employers/payers.
UR: Standard procedures excluding hospital bill audits. UR provided by the PPO.
Officers: Lori Haglund, senior vp-operations; Dr. Rowland Reyna, medical director; Anne McCollough, director-/provider relations/operations; Terry Fehlhaber, assistant director-operations/information systems.
NYLCare PPO of the Southwest
4500 Fuller Drive, Irving, Texas 75038; 972-650-5500; fax: 972-650-5703
Staff/Facilities
Primary practitioners1,483
Specialists4,575
Hospitals74
Pharmacies1,137
Users: Group Health
Employees & dependents177,214
Total Users177,214
Ownership: NYLCare Health Plans Inc.
Operational date: October 1987
For profit.
Service area: Texas: 70 counties
Services: General medical, dental, prescription drug, mental health, durable medical equipment. 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; charges discounted fee-for-service.
UR: Standard procedures excluding hospital bill audits and outpatient service predetermination. UR provided by the PPO and outside contractors.
Officers: Steve Yerxa, president/CEO; Dr. Joseph Cheek, vp/chief medical officer; Nate Eudalay, senior vp/CFO; Susan Pohly, vp-service/quality; Elizabeth Philipp, vp-network management.