Virginia Business Online: Managed Health Care Providers in Virginia




	Return to Virginia Business - September 2004
	Managed Health Care Providers in Virginia Related story: - Prescription: reduce numbers by making insurance more affordable for small businesses Virginia Business September 2004 Aetna Inc. 7600A Leesburg Pike Falls Church, VA 22043 (703) 903-7100 aetna.com Key Staff General Manager - Jeffrey Lucht Medical Director (Falls Church) - William Fried, MD Director of Provider Relations - Amy Turner (Northern Virginia), Carolyn Harrington (other areas of state) Government Relations - Linda Cooper Managed Care Enrollment1 HMO 106,645 POS 140,233 PPO 129,564 Medicaid HMO N/A FAMIS (SCHIP) N/A Medical Managed Care N/A Medicare Risk HMO N/A Total 376,442 Network Providers PCPs 3,056 Physician Specialists 5,283 Hospitals 55 OB/GYNs 1,441 CareFirst BlueCross BlueShield 840 First St. N.E. Washington, DC 20065 (202) 479-8000 carefirst.com Key Staff President and CEO - William L. Jews President (CareFirst BlueChoice, Inc.) - Eric R. Baugh, MD Medical Director - Eric R. Baugh, MD, Sr. VP, Medical Affairs and Network Management (CareFirst) Dir. of Government Affairs - Julie Hatton Managed Care Enrollment1 HMO 35,061 POS 33,013 PPO 110,226 Medicaid HMO N/A FAMIS (SCHIP) N/A Medicare Risk HMO N/A Other MCHIP N/A Total 178,300 Network Providers PCPs (HMO) 4,083 PCPs (PPO) 5,500 Physician Specialists (HMO) 15,068 Physician Specialists (PPO) 19,933 Hospitals (HMO) 73 Hospitals (PPO) 78 CIGNA HealthCare 7501 Boulders View Drive Suite 500 Richmond, VA 23225 (804) 267-5100 cigna.com Key Staff President and Market Leader (VA and M-A)- Mike Triplett Quality (VA and M-A) - Susan Kirkpatrick Medical Director (VA and M-A) - Nicholas Gettas MD Sales (VA) - Linda Burtz Sales (M-A) - Ron Vance Jr. Provider Contracting (VA) - Jerry Dioguardi Provider Contracting (M-A) - Eric Boklage Provider Relations (VA) - Debbie Wheeler Provider Relations (M-A) - Yvonne Van Lowe Government Affairs (VA and M-A) - Katie Wade Managed Care Enrollment1 HMO 160,287 Other MCHIP 19,319 PPO 154,400 Total 334,006 Network Providers PCPs HMO 2,032 PCPs PPO 2,226 Physician Specialist HMO 5,028 Physician Specialist PPO 5,092 Hospitals HMO 54 Hospitals PPO 96 Coventry Health Care Inc. 9881 Mayland Drive Richmond, VA 23233 (804) 747-3700 southernhealth.com Key Staff (Southern Health Services, Inc.) President and CEO - Cosby M. Davis, III Medical Director - Stephen Cavalieri, MD Regulatory Compliance - Laura Lee O. Viergever Director of Provider Relations - Andrew Thomas Managed Care Enrollment1 HMO 67,671 POS 62,965 PPO 15,946 Medicaid HMO 14,245 FAMIS 905 Medicare Risk HMO N/A Other MCHIP N/A Total 161,732 Network Providers PCPs HMO 2,059 PCPs PPO 2,121 Physician Specialists HMO 3,463 Physician Specialists PPO 3,575 Hospitals HMO 50 Hospitals PPO 56 John Deere Health 2578 E. Stone Drive, Suite A Kingsport, TN 37660 (423) 378-5122 johndeerehealth.com Key Staff Manager, Operations - Steve Wilson Director of Government Affairs - Cynthia Groene Director, Administration - Thomas B. Jones Managed Care Enrollment1 HMO 4,825 POS 8,482 PPO N/A Medicaid Managed Care N/A FAMIS (SCHIP) N/A Medicare Advantage Product(s) 3,560 Other MCHIP N/A Total 16,867 Network Providers PCPs 638 Physician Specialists 573 Hospitals 18 Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. 2101 E. Jefferson St. Rockville, MD 20852 (301) 816-2424 kaiserpermanente.org/mid-atlantic Key Staff President - Marilyn Kawamura Medical Director - Phillip Carney, MD Director of Provider Relations - April Gross Director of Government Relations - Gail M. Thompson Managed Care Enrollment1 HMO 106,111 POS 3,526 PPO N/A Medicaid Managed Care N/A FAMIS (SCHIP) N/A Medicare Advantage Product(s) 6,883 Other MCHIP N/A Total 116,520 Network Providers PCPs HMO (network physicians) 155 PCPs HMO (M-A Permanente Med. Group) 129 Physician Specialists (network physicians) 1,732 Physician Specialists (M-A Permanente Med. Group) 180 Hospitals 13 Mid-Atlantic Medical Services Inc. (MAMSI) 4 Taft Court Rockville, MD 20850 (301) 294-5131 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 Government Relations - Paul Dillon Managed Care Enrollment1 HMO 247,200 POS 41,700 PPO 44,400 Medicaid Managed Care N/A FAMIS (SCHIP) N/A Medicare Risk HMO N/A Other MCHIP N/A Total 333,000 Network Providers PCPs - HMO 2,550 PCPs - PPO 2,550 Physician Specialists HMO 5,750 Sentara Healthcare 4417 Corporation Lane Virginia Beach, VA 23462 (757) 552-7401 sentara.com Key Staff President - Michael M. Dudley Medical Director - George K. Heuser, MD Director of Government Relations - Molly Underhill Director of Provider Relations - Rachel L. Schneider Managed Care Enrollment1 HMO 111,935 POS 8,308 PPO 12,316 Medicaid Managed Care 96,204 FAMIS 6,995 Medicare Advantage Product(s) N/A Other MCHIP N/A Total 235,758 Network Providers PCPs HMO 2,138 PCPs PPO 2,673 Physician Specialists HMO 5,748 Physician Specialists PPO 7,193 Hospitals HMO 60 Hospitals PPO 72 Anthem Blue Cross Blue Shield and Anthem-Affiliated HMOs 2015 Staples Mill Road Richmond, VA 23230 (804) 354-7000 anthem.com Key Staff President - Thomas G. Snead Jr. VP, GM, Small Accounts - David P. Wade Chief Healthcare Officer - Randy C. Axelrod, MD VP, GM, Service Operations - Kathy A. Merry Executive Director, Government Relations - Leonard L. Hopkins, Jr. VP, GM, VA Group Business - Paul F. Nezi Managed Care Enrollment1 HMO 262,249 HMO /POS 18,901 POS 244,674 PPO 1,312,052 Medicaid HMO 62,330 FAMIS 5,409 Total 1,905,615 Network Providers PCPs (# All HMOs) 2,304 PCPs (# POS ) 4,537 Physician Specialists (# All HMOs) 9,998 Physician Specialists (# PPO) 28,688 Physician Specialists (# PAR) 29,227 Hospitals (# All HMOs) 68 Hospitals (# PPO) 99 Hospitals (# PAR) 99 Virginia Premier Health Plan, Inc. 600 E. Broad St. Suite 400 Richmond, VA 23219 (804) 819-5151 Key Staff CEO - James S. Parrott Sr. Medical Director - Melvin Pinn, MD MPH Director of Provider Relations - Patrick McMahan Managed Care Enrollment1 HMO N/A POS N/A PPO N/A Medicaid HMO 78,196 FAMIS (SCHIP) 7,139 Medicare Risk HMO N/A Other MCHIP N/A Total 85,335 Network Providers PCPs 1,232 Physician Specialists 5,755 Hospitals 49 Wellpoint Health Networks 120 S. Via Merida Thousand Oaks, CA 91362 (877) 864-2723 unicare.com Key Staff COO, NCPPO - Cindy Follmer VP, State Government Relations - Bob Scarlett Director, Legislative Affairs - Jerry Steffl Director of Group Sales - Mark Sucoloski, NCPPO 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 Network Providers PCPs (UniCare) 7,352 PCPs (NCPPO) 7,000 Physician Specialists (UniCare) N/A Physician Specialists (NCPPO) 13,000 Hospitals (UniCare) 45 Hospitals (NCPPO) 106 Return to Virginia Business - September 2004

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