Return to Virginia Business - September 2002

Related story:
- What is driving up the cost of health care?

For more information on each of the companies listed below, visit the Virginia Association of Health Plans.

Aetna, Inc.
7600A Leesburg Pike
Falls Church, VA 22043
Tel: (703) 903-7100
Web: www.aetna.com

Key Staff
General Manager- Jeffrey Lucht
Medical Director (Falls Church) -William Fried, MD
Director of Provider Relations -Voke' Ukeuku
Network Manger -Douglas Tardio

Managed Care Enrollment1
HMO 134,692
POS 165,834
PPO 103,608
Medicaid HMO N/A
FAMIS (SCHIP) N/A
Medical Managed Care N/A
Medicare Risk HMO N/A
Total 404,134

Market Segment
Small Group2 HMO/POS PPO
Large Group3 HMO/POS PPO

Network Providers
PCPs 2,543
Physician Specialists 7,948
Hospitals 52

CareFirst BlueCross BlueShield
550 12 th Street SW
Washington, DC 20065
Tel: (202) 479-8000
Web: www.carefirst.com

Key Staff:
President and CEO - William L. Jews
President (CareFirst BlueChoice, Inc.) - Eric R. Baugh, MD
Medical Director - Linton Wray, MD
Dir. of Government Affairs - Julie Hatton

Managed Care Enrollment1
HMO 39,968
POS 53,014
PPO 96,456
Medicaid HMO N/A
FAMIS (SCHIP) N/A
Medicare Risk HMO N/A
Other MCHIP N/A
Total 189,438

Market Segment
Individual HMO/POS
Small Group2 HMO/POS PPO
Large Group3 HMO/POS PPO
Administrative Services Only HMO/POS PPO

Network Providers
PCPs (HMO) 659
PCPs (PPO) 672
Physician Specialists (HMO) 2,355
Physician Specialists (PPO) 3,143
Hospitals (HMO) 11
Hospitals (PPO) 11

Carilion Health Plans, Inc.
110 Campbell Avenue, Suite 107
Roanoke, VA 24011
Tel: (540) 857-5200
Web: www.carilionhealthplans.com

Key Staff
CEO - Carolyn Chrisman
Chief Medical Officer - Rome Walker, MD
COO - James L. Gore
Director, Utilization Management - Peggy Callahan
Manager, Quality Management - Ruth Ayers
Manager, Claims - Bret Kolb
Manager, Benefit Services - Scottie Krupa
Director, Finance - Randi Kaplan
Manager, Provider Relations - Lynn Rock
Manager, Contracts and Compliance - Mel Elkin
Manager, Underwriting - Gail Caplinger
Director, Information Management - Mattie Tenzer

Managed Care Enrollment1
HMO (inc. POS) 26,228
PPO 2,618
Medicaid Managed Care N/A
FAMIS (CMSIP) N/A
Medicare Risk HMO N/A
Other MCHIP N/A
Total 28,846

Market Segment
Individual
Small Group2- HMO/POS
Large Group3 HMO/POS
Administrative Services Only HMO/POS PPO

Network Providers
PCPs (HMO) 321
PCPs (PPS) 483
Physician Specialists (HMO) 653
Physician Specialists (PPO) 755
Hospitals (HMO) 12
Hospitals (PPO) 18

CIGNA HealthCare
7501 Boulders View Drive
Suite 500
Richmond, VA 23225
Tel: (804) 267-5100
Web: www.cigna.com

Key Staff
President & GM (VA and M-A) - Matthew Manders
Quality (VA and M-A) - Chris Ordonia
Customer Service (VA and M-A) - John Hughes
Government Affairs (VA and M-A) - Katie Wade
Client Relations (VA.) - Linda Butz
Medical Director (VA) - Nicholas Gettas MD
Medical Director (M-A) - Olakuule Olaniyan MD
Sales (VA) - Susan Schick
Sales (M-A) - Mike Triplett
Provider Relations (VA) - Debbie Wheeler
Provider Relations (M-A) - Yvonne Van Lowe
Provider Contracting (VA) - Jerry Dioguardi
Provider Contracting (M-A) Rob Van Dyke

Managed Care Enrollment1
HMO (inc. POS) 231,021
PPO 121,873
FAMIS (CMSIP) N/A
Medicare Risk HMO N/A
Medicaid Managed Care N/A
Other MCHIP N/A
Total 352,894

Market Segment
Individual
Small Group2 HMO/POS
Large Group3 HMO/POS PPO
Administrative Services Only HMO/POS PPO

Network Providers
PCPs - (VA) 1,737, (M-A) 773
Physician Specialists - (VA) 4,320, (M-A) 1,355
Hospitals - (VA) 27, (M-A) 15

Coventry Health Care, Inc.
9881 Mayland Drive
Richmond, VA 23233
Tel: (804) 747-3700
Web: www.southernhealth.com

Key Staff (Southern Health Services, Inc.)
President and CEO - Cosby M. Davis, III
CFO - Drew A. Joyce
COO - Jennifer A. Adkins
VP, Marketing - Brian E. Corbey
VP, Network Management - William J. O'Donnell
Medical Director - Mark Wenger MD
Regulatory Compliance - Laura Lee O. Viergever

Managed Care Enrollment1
HMO 33,702
POS 100,520
PPO 395
Medicaid HMO 11,875
FAMIS (CMSIP) 1,255
Medicare Risk HMO N/A
Other MCHIP N/A
Total 147,747

Market Segment
Small Group2 HMO/POS PPO
Large Group3 HMO/POS PPO
Administrative Services Only HMO/POS PPO

Network Providers
PCPs 1,672
OB/GYNs 381
Physician Specialists 4,005
Hospitals 55

John Deere Health
2578 East Stone Drive, Suite A
Kingsport, TN 37660
Tel: (423) 378-5122
Web:www.johndeerehealth.com

Key Staff
Manager, Operations - Marie Shumaker
Medical Directors - James Schrenker MD,
Johnny White MD
Marketing Manager - Russ Thornberry
Manager, Medicare Contracts - Tina Brill
Director of Government Affairs - Cynthia Groene
Director, Administration - Thomas B. Jones
Quality Improvement Manager - Jama Frazier

Managed Care Enrollment1
HMO 2,163
POS 11,185
PPO N/A
Medicaid Managed Care N/A
FAMIS (SCHIP) N/A
Medicare Risk HMO 2,825
Other MCHIP N/A
Total 16,173

Market Segment
Small Group2 HMO/POS
Large Group3 HMO/POS

Network Providers
PCPs 485
Physician Specialists 624
Hospitals 12

Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
2101 East Jefferson Street
Rockville, MD 20852
Tel: (301) 816-2424
Web: www.kaiserpermanente.org/mid-atlantic

Key Staff
CEO - Marilyn Kawamura
Sales and Marketing - David Russell
Director of Member Services - Kay W. Lewis
Director of Contracts - Patricia Barth
Director of Government Relations - Gail M. Thompson

Managed Care Enrollment1
HMO 123,023
POS 7,528
PPO N/A
Medicaid Managed Care N/A
FAMIS (SCHIP) N/A
Medicare Risk HMO 6,792
Other MCHIP N/A
Total 137,343

Market Segment
Individual HMO/POS
Small Group2 HMO/POS
Large Group3 HMO/POS

Network Providers
PCPs 112
Physician Specialists 885
Hospitals 10

Mid-Atlantic Medical Services, Inc. (MAMSI)
4 Taft Court
Rockville, MD 20850
Tel: (301) 294-5131
Web: www.mamsi.com

Key Staff
Chairman - Mark D. Groban MD
President and CEO - Thomas P. Barbera
Medical Director - Vera Dvorak MD
President MD IPA - Susan Goff
Senior Executive VP and CFO - Robert E. Foss

Managed Care Enrollment1
HMO 151,400
POS 36,300
PPO 30,100
Medicaid Managed Care N/A
FAMIS (SCHIP) N/A
Medicare Risk HMO N/A
Other MCHIP N/A
Total 217,800

Market Segment
Individual HMO/POS
Small Group2 HMO/POS PPO
Large Group3 HMO/POS PPO
Administrative Services Only HMO/POS

Network Providers
PCPs 2,295
Physician Specialists 5,346
Hospitals 79

Sentara Healthcare
4417 Corporation Lane
Virginia Beach, VA 23462
Tel: (757) 552-7401
Web: www.sentara.com

Key Staff
President - Michael M. Dudley
Senior VP and CFO - Ronald Bennion
Medical Director - Robert Gormley MD
Senior VP and COO - Bruce Holstein
VP, Sales - Stacey Viles
Director of Government Relations - Molly Underhill

Managed Care Enrollment1
HMO 130,905
POS 12,544
PPO 13,895
Medicaid Managed Care 81,270
FAMIS (SCHIP) 8,868
Medicare Risk HMO N/A
Other MCHIP N/A
Total 247,482

Market Segment
Small Group2 HMO/POS PPO
Large Group3 HMO/POS PPO
Administrative Services Only HMO/POS PPO

Network Providers
PCPs 2,381
Physician Specialists 5,857
Hospitals 65

Trigon Blue Cross Blue Shield and Trigon-Affiliated HMOs
2015 Staples Mill Road
Richmond, VA 23230
Tel: (804) 354-7000
Web: www.trigon.com

Key Staff
Chairman and CEO - Thomas G. Snead, Jr.
Senior VP, Market Growth - Paul F. Nezi
President, HealthKeepers, Inc, ,
President, Peninsula Health Care, Inc.,
President, Priority Health Care, Inc - William P. Bracciodieta MD
Chief Medical Officer - William P. Bracciodieta MD
Senior VP, Operations - Kathy A. Merry
VP, Public Policy - Leonard L. Hopkins, Jr.

Managed Care Enrollment1
HMO 288,051
POS 259,455
PPO 1,209,506
Medicaid Managed Care 54,981
FAMIS (SCHIP) 7,662
Medicare Risk HMO N/A
Other MCHIP N/A
Total 1,833,606

Market Segment
Individual HMO/POS PPO
Small Group2 HMO/POS PPO
Large Group3- HMO/POS PPO
Administrative Services Only HMO/POS

Network Providers
PCPs (# All HMOs) 2,311
PCPs (# POS ) 4,468
Physician Specialists (# All HMOs) 8,355
Physician Specialists (# PPO) 27,505
Physician Specialists (# PAR) 28,166
Hospitals (# All HMOs) 65
Hospitals (# PPO) 106
Hospitals (# PAR) 106
United HealthCare
4416 East-West Highway,
Suite 310
Bethesda, MD 20814
Tel: (240) 497-6161

Key Staff
CEO - Robert Fleshner

Managed Care Enrollment1
HMO 68,564
POS 6,171
PPO 11,919
Medicaid Managed Care N/A
FAMIS (SCHIP) N/A
Medicare Risk HMO N/A
Other MCHIP N/A
Total 86,654

Market Segment
Small Group2 HMO/POS PPO
Large Group3 HMO/POS PPO
Administrative Services Only HMO/POS PPO

Network Providers
PCPs 4,992
Physician Specialists 14,279
Hospitals 167

United HealthCare
4416 East-West Highway, Ste. 310
Bethesda. Md. 20814
Tel: (240) 497-6161
Web: www.uhc.com

Key Staff
CEO - Robert Fleshner

Managed Care Enrollment1
HMO 68,564
POS 6,171
PPO 11,919
Medicaid Managed Care N/A
FAMIS (SCHIP) N/A
Medicare Risk HMO N/A
Other MCHIP N/A
Total 86,654

Market Segment
Small Group2 - HMO/POS
Large Group3 HMO/POS
Administrative services only HMO/POS PPO

Network Providers
PCPs 4,992
Physician Specialists 14,279
Hospitals 167

Virginia Premier Health Plan, Inc.
600 East Broad Street, Suite 400
Richmond, VA 23219
Tel: (804) 819-5151

Key Staff
CEO - James S. Parrott
Director of Business Development and Community Relations - Terone B. Green
Medical Director - Harold Green MD
Director of Operations, Richmond - Mitch Gregory
Director of Operations, Tidewater - Constance Goodman
Director of Medical Management - Linda Hines MS, RN

Managed Care Enrollment1
HMO N/A
POS N/A
PPO N/A
Medicaid HMO 59,027
FAMIS (SCHIP) 6,551
Medicare Risk HMO N/A
Other MCHIP N/A
Total 65,578

Market Segment
Individual HMO/POS

Network Providers
PCPs 1,151
Physician Specialists 4,450
Hospitals 49

Wellpoint Health Networks
120 S. Via Merida
Thousand Oaks, CA 91362
Tel: (877) 864-2723
Web: www.unicare.com

Key Staff
COO, NCPPO - Cindy Follmer
VP, State Government Relations - Bob Scarlett
Director, Legislative Affairs - Jerry Steffl

Managed Care Enrollment1
HMO N/A
POS N/A
PPO 45,000
Medicaid HMO 27,915
FAMIS (SCHIP) 9,031
Medicare Risk HMO N/A
Other MCHIP N/A
Total 81,846

Market Segment
Individual HMO/POS PPO
Small Group2 - HMO/POS
Large Group3 HMO/POS

Network Providers
PCPs (UniCare) 7,352
PCPs (NCPPO) 6,176
Physician Specialists (UniCare) N/A
Physician Specialists (NCPPO) 10,259
Hospitals (UniCare) 45
Hospitals (NCPPO) 66

Notes
1Managed Care Enrollment as of Jan. 31, 2002
2Small Group = 2-49 Employees 3Large Group = 50+ Employees
VA = Virginia M-A = Mid-Atlantic N/A = Not Applicable

Return to Virginia Business - September 2002