F
FARA PPO Network
4641 Fairfield St.,
Metairie, La. 70471;
504-888-8672; fax: 504-888-3420
www.fara.com
Staff/facilities
Primary practitioners 50,000
Board-certified 95%
Specialists 120,000
Hospitals 2,400
Pharmacies 300
Under direct contract
Primary practitioners 600
Specialists 1,400
Hospitals 60
Enrollment
Total 200,000
Group health plans 1,500
Workers comp 198,500
Customer savings:
Percent of savings 28%
Amount of savings $2,500,000
Operational date: 1993.
For profit.
Services:
Direct: general medical, vision, chiropractic, mental, workers compensation.
Leased: general medical, vision, chiropractic, mental, workers compensation. Unbundled services available. Can be customized to meet employers' needs.
UR: preadmission hospital review, precertification, concurrent hospital treatment review, length of stay determination, discharge planning, retrospective review, second surgical opinion, hospital bill audits, case management. UR services provided by the PPO.
Compensation: The PPO negotiates hospital charges by per diem rate, percent discount off customary rates. The PPO is compensated by employers/payers, insurers, claims administrators. The PPO charges flat fee per eligible employee, percent of savings.
Service area:
Direct: Louisiana.
Leased: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin.
Contact: Reed A. Bell, president.
First Choice Health Network Inc.
601 Union St., Suite 1100,
Seattle, Wash. 98101;
206-268-2406; fax: 206-667-8062
www.fchn.com
Staff/facilities
Primary practitioners 3,132
Specialists 6,263
Hospitals 107
Under direct contract
Primary practitioners 3,132
Specialists 6,263
Hospitals 96
Enrollment
Total 650,000
Group health plans 650,000
Customer savings:
Percent of savings 20%
Operational date: 1985.
For profit.
Services:
Direct: general medical, dental, vision, chiropractic, mental. Unbundled services available.
UR: preadmission hospital review, precertification, concurrent hospital treatment review, length of stay determination, discharge planning, retrospective review, second surgical opinion, outpatient service predetermination, case management. UR services provided by the PPO.
Compensation: The PPO negotiates hospital charges by per diem rate, DRGs, percent discount off customary rates, case rates. The PPO is compensated by employers/payers, insurers, claims administrators. The PPO charges flat fee per eligible employee.
Service area:
Direct: Alaska, Idaho, Montana, Washington.
Leased: Oregon.
Officers: Gary Gannaway, president/CEO; Dave Peel, senior vp/CFO; Ross Heyl, senior vp/chief marketing officer; Dr. Joe Leinonen, chief medical officer; Julie Keeffe, senior vp-medical management/member services..
First Choice of the Midwest Inc.
1741 S. Cleveland Ave.,
Suite 110, Sioux Falls, S.D. 57103;
605-332-5955; fax: 605-332-5953
www.1choicem.com
Staff/facilities
Primary practitioners 735
Board-certified 98%
Specialists 2,670
Hospitals 47
Under direct contract
Primary practitioners 735
Specialists 2,670
Hospitals 47
Enrollment
Total 37,040
Group health plans 22,240
Individual 2,500
Workers comp 12,300
Customer savings:
Percent of savings 14%
Operational date: 1997.
For profit.
Services:
Direct: general medical, vision, chiropractic, mental, workers compensation.
Leased: general medical, vision, chiropractic, mental, workers compensation. Unbundled services available. Can be customized to meet employers' needs.
UR: precertification, concurrent hospital treatment review, length of stay determination, discharge planning, retrospective review, hospital bill audits, outpatient service predetermination, case management. UR services provided by the PPO.
Compensation: The PPO negotiates hospital charges by per diem rate, percent discount off customary rates. The PPO is compensated by employers/payers, insurers, claims administrators. The PPO charges flat fee per eligible employee, percent of savings.
Service area:
Direct: Iowa, Minnesota, Nebraska, North Dakota, South Dakota, Wyoming.
Leased: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming.
Accreditation status: Health Utilization Management Standards, Health Network Standards, Workers Compensation Utilization Management Standards.
The First Health Network*
3200 Highland Ave.,
Downers Grove, Ill. 60515;
630-241-7900; fax: 630-241-7856
www.firsthealth.com
Staff/facilities
Primary practitioners 88,141
Board-certified 73%
Specialists 115,269
Hospitals 3,115
Pharmacies 50,000
Under direct contract
Primary practitioners 88,141
Specialists 115,269
Hospitals 3,115
Enrollment
Total 14,800,000
Operational date: 1982.
For profit.
Parent: First Health Group Corp.
Services:
Direct: general medical, chiropractic, mental, prescription, workers compensation, home health care, durable medical equipment. Unbundled services available.
UR: preadmission hospital review, precertification, concurrent hospital treatment review, length of stay determination, discharge planning, retrospective review, second surgical opinion, hospital bill audits, outpatient service predetermination, case management, PPO redirection. UR services provided by the PPO.
Compensation: The PPO negotiates hospital charges by per diem rate, percent discount off customary rates. The PPO is compensated by employers/payers, insurers, claims administrators. The PPO charges percent of savings, performance based PEPM.
Service area:
Direct: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico.
Accreditation status: Health Utilization Management Standards, Workers Compensation Utilization Management Standards.
Officers: James C. Smith, president/
CEO; Mary Anne Carpenter, executive vp-service products; Edward L. Wristen, executive vp/COO; A. Lee Dickerson-executive vp-provider networks/bill review administration; Dr. Scott P. Smith, vp-clinical management services/national medical director.
Contact: William Hensley, vp-communications.
*Formerly HealthCare COMPARE Corp.
FOCUS Healthcare Management Inc.
720 Cool Springs Blvd.,
Franklin, Tenn. 37067;
615-377-9936; fax: 615-661-6417
www.focus-ppo.com
Specialty: Workers compensation
Staff/facilities
Primary practitioners 42,379
Board-certified 99%
Specialists 133,055
Hospitals 1,892
Under direct contract
Primary practitioners 42,379
Specialists 133,055
Hospitals 1,892
Operational date: 1986.
For profit.
Services:
Direct: general medical, dental, vision, chiropractic, mental, prescription, workers compensation, long-term care. Unbundled services available. Can be customized to meet employers' needs.
Compensation: The PPO negotiates hospital charges by per diem rate, percent discount off customary rates. The PPO is compensated by employers/payers, insurers. The PPO charges percent of services rendered by participating doctors/hospitals.
Service area:
Direct: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Wisconsin.
Accreditation status: Workers Compensation Network Standards.
Officers: Thomas F. Cox, president; Thomas Shivers, vp-sales/marketing; Dona-Marie Geoffrion, vp-product development/quality improvement; Barbara Daiker, vp-network improvement; Dr. Peter Fagan, medical director.
Contact: Gina G. Farrar.GGHI (Group Health Inc.)
441 Ninth Ave.,
New York, N.Y. 10001;
212-615-0808; fax: 212-563-8529
www.ghi.com
Staff/facilities
Primary practitioners 12,100
Board-certified 75%
Specialists 17,900
Hospitals 228
Pharmacies 3,900
Under direct contract
Primary practitioners 12,100
Specialists 17,900
Hospitals 228
Enrollment
Total 1,645,000
Group health plans 1,631,000
Individual 14,000
Customer savings:
Percent of savings 50%
Amount of savings $400,000,000
Operational date: 1937.
Services:
Direct: general medical, dental, vision, chiropractic, mental, prescription, hospitalization, substance abuse, durable medical equipment, home health. Unbundled services available. Can be customized to meet employers' needs.
UR: preadmission hospital review, precertification, concurrent hospital treatment review, length of stay determination, discharge planning, retrospective review, second surgical opinion, hospital bill audits, outpatient service predetermination, case management. UR services provided by the PPO, outside contractor(s).
Compensation: The PPO negotiates hospital charges by per diem rate, DRGs. The PPO is compensated by employers/payers, individuals. The PPO charges flat fee per eligible employee, percent of services rendered by participating doctors/hospitals.
Service area:
Direct: New York.
Leased: California, Connecticut, Florida, New Jersey, Pennsylvania.
Officers: Frank J. Branchini, president/CEO; Donna Lynne, executive vp/COO; Steven Kessler, senior vp-sales; Dr. Aran Ron, medical director; James Swenson, senior vp-actuary.
General American Private Healthcare Systems PPO Network*
13045 Tesson Ferry Road,
St. Louis, Mo. 64128;
314-525-6624; fax: 314-525-6622
www.group.genam.com
Operational date: 1985.
For profit.
Parent: General American Life.
Service area:
Direct: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Guam, Puerto Rico.
Accreditation status: Health Utilization Management Standards.
Officers: Warren Winer, executive vp-group life/health; Dr. Chelmer Barrow Jr., medical director; Tamarra Breiner, vp-marketing/product development; Brenda Gain, director-medical management; Donna Wagner, second vp-managed care.
Contact: Tom McKeever, product manager.
*General American Life is one of 14 owners of the Private Healthcare Systems PPO network. See Private Healthcare Systems listing for more information.
GENEX Services Inc.
440 E. Swedesford Road,
Suite 3050, Wayne, Pa. 19087;
610-964-5100; fax: 610-964-1919
www.genexservices.com
Specialty: Workers compensation
Staff/facilities
Primary practitioners 246,682
Hospitals 3,157
Operational date: 1978.
For profit.
Leased: workers compensation. UR services provided by the PPO.
Service area:
Leased: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming.
Accreditation status: Workers Compensation Utilization Management Standards.
Officers: Peter C. Madeja, president/
CEO; Delphia Frisch, senior vp-operations; Paul M. Bode, senior vp-sales/marketing; Richard A. Baron, vp/CEO.
Contact: Paul N. Wituschek, director-marketing, 610-964-5180.
Golden West Dental & Vision Plan Inc.
888 W. Ventura Blvd.,
Camarillo, Calif. 93010;
805-987-8941; fax: 805-987-2205
www.goldenwestdental.com
Specialty: Dental
Staff/facilities
Primary practitioners 857
Specialists 648
Under direct contract
Primary practitioners 857
Specialists 648
Enrollment
Total 200,473
Individual 20,000
Other 180,473
Operational date: 1973.
For profit.
Services:
Direct: dental. Unbundled services available. Can be customized to meet employers' needs.
UR: precertification. UR services provided by the PPO.
Compensation: The PPO charges percent of services rendered by participating doctors/hospitals.
Service area:
Direct: California.
Officers: Karl Lehmann, president; Larry Chermak, vp; Dr. William Spellman, vp-dental; Cathy Farrington, CFO.
Contact: Chris McConathy, sales manager, 800-995-4124.
Great West PPO/New England Financial PPO
8505 E. Orchard Road,
Englewood, Colo. 80111;
303-689-3000; fax: 303-689-3198
www.gwla.com or www.nefn.com
Staff/facilities
Primary practitioners* 32,828
Pharmacies 53,653
Under direct contract
Primary practitioners 294,851
Enrollment
Total 1,168,980
Group health plans 1,168,980
Operational date: 1984.
For profit.
Services:
Direct: general medical, mental, prescription, physical therapy.
Leased: general medical, mental, prescription.
UR: Can be customized to meet employers' needs.
Compensation: The PPO negotiates hospital charges by per diem rate, DRGs, percent discount off customary rates, combination per diem/discount. The PPO is compensated by employers/payers, insurers. The PPO charges flat fee per eligible employee.
Service area:
Direct: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming.
Leased: Alaska, California, Connecticut, Florida, Indiana, Iowa, Kentucky, Maine, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Mexico, Oregon, South Dakota, Virginia, Washington, West Virginia, Wisconsin.
Officers: William McCallum, president/
CEO; Jim Motz, executive vp-employee benefits; Marty Rosenbaum, senior vp-employee benefits operations; Steve Miller, senior vp-group sales, Dr. Steve Gorshow, medical director/employee benefits.
Contact: Michelle Keel, 303-689-5135.
*Includes specialists.
GUILFORD InteComp Network
248 West Quadrangle,
2 Hamill Road,
Baltimore, Md. 21210;
410-532-2336; fax: 410-532-7797
Specialty: Workers compensation/disability management
Staff/facilities
Primary practitioners 284
Board-certified 65%
Specialists 467
Hospitals 161
Under direct contract
Primary practitioners 284
Specialists 467
Hospitals 52
Enrollment
Total 32,000
Workers comp* 32,000
Customer savings:
Percent of savings 31%
Operational date: 1992.
For profit.
Parent: The GUILFORD Group Ltd.
Services:
Direct: workers compensation, disability management. Unbundled services available. Can be customized to meet employers' needs.
UR: retrospective review, second surgical opinion, case management, coordinated injury management. UR services provided by the PPO.
Compensation: The PPO negotiates hospital charges by per diem rate. The PPO is compensated by employers/payers, insurers. The PPO charges flat fee per eligible employee, percent of savings.
Service area:
Direct: Alabama, California, District of Columbia, Florida, Georgia, Illinois, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, New Jersey, Pennsylvania, Tennessee, Texas, Utah, Virginia, Wisconsin.
Officers: Marcia P. DeWitt, president/
CEO; Betty Noble, COO; Thomas W. Northrop, director-national network development.
*Workers comp. enrollment includes disability management