Virginia Business Online: Managed Health Care Providers in Virginia




	Return to Virginia Business - September 2003
	Managed Health Care Providers in Virginia Related story: Letting consumers have a say Aetna, Inc. 7600A Leesburg Pike Falls Church, VA 22043 Tel: (703) 903-7100 Web: aetna.com Key Staff General Manager- Jeffrey Lucht Medical Director (Falls Church) -William Fried, MD Director of Provider Relations - Janice Seawright Government Relations - Linda Cooper Managed Care Enrollment1 HMO 103,037 POS 131,331 PPO 130,354 Medicaid HMO N/A FAMIS (SCHIP) N/A Medical Managed Care N/A Medicare Risk HMO N/A Total 364,722 Network Providers PCPs 3,038 Physician Specialists 6,680 Hospitals 63 OB/GYNs 400 CareFirst BlueCross BlueShield 840 First St. NE Washington, DC 20065 Tel: (202) 479-8000 Web: 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 41,815 POS 38,148 PPO 113,069 Medicaid HMO N/A FAMIS (SCHIP) N/A Medicare Risk HMO N/A Other MCHIP N/A Total 193,032 Network Providers PCPs (HMO) 728 PCPs (PPO) 780 Physician Specialists (HMO) 2,608 Physician Specialists (PPO) 4,288 Hospitals (HMO) 11 Hospitals (PPO) 11 CIGNA HealthCare 7501 Boulders View Drive Suite 500 Richmond, VA 23225 Tel: (804) 267-5100 Web: 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 (includes POS) 226,093 PPO 122,000 Total 388,093 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 Tel: (804) 747-3700 Web: 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 Medical Directors - Stephen Cavalieri, MD and Ian W. Bushell, MD, MHS-CL Regulatory Compliance - Laura Lee O. Viergever Managed Care Enrollment1 HMO 62,269 POS 66,618 PPO 6,472 Medicaid HMO 13,891 FAMIS 979 Medicare Risk HMO N/A Other MCHIP N/A Total 150,229 Network Providers PCPs HMO 2,609 PCPs PPO 2,640 Physician Specialists HMO 4,369 Physician Specialists PPO 4,411 Hospitals HMO 55 Hospitals PPO 64 John Deere Health 2578 East Stone Drive, Suite A Kingsport, TN 37660 Tel: (423) 378-5122 Web: johndeerehealth.com Key Staff Manager, Operations - Steve Wilson 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 Managers - Jama Frazier and Kathy Morelock Managed Care Enrollment1 HMO 2,703 POS 13,981 PPO N/A Medicaid Managed Care N/A FAMIS (SCHIP) N/A Medicare Risk HMO 3,531 Other MCHIP N/A Total 20,215 Network Providers PCPs 603 Physician Specialists 711 Hospitals 15 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. 2101 East Jefferson Street Rockville, MD 20852 Tel: (301) 816-2424 Web: kaiserpermanente.org/mid-atlantic Key Staff CEO - Marilyn Kawamura Sales and Marketing Director - David Russell Director of Member Services - Mary Kraynak Director of Contracts - Patricia Barth Director of Government Relations - Gail M. Thompson Managed Care Enrollment1 HMO 113,140 POS 5,288 PPO N/A Medicaid Managed Care N/A FAMIS (SCHIP) N/A Medicare Risk HMO 6,706 Other MCHIP N/A Total 125,134 Network Providers PCPs HMO (network physicians) 142 PCPs HMO (M-A Permanente Med. Group) 142 Physician Specialists (network physicians) 1,063 Physician Specialists (M-A Permanente Med. Group) 194 Hospitals 10 Mid-Atlantic Medical Services, Inc. (MAMSI) 4 Taft Court Rockville, MD 20850 Tel: (301) 294-5131 Web: 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 176,900 POS 39,900 PPO 33,500 Medicaid Managed Care N/A FAMIS (SCHIP) N/A Medicare Risk HMO N/A Other MCHIP N/A Total 250,300 Network Providers PCPs - HMO 2,401 PCPs - PPO 2,401 Physician Specialists HMO 5,635 Hospitals 79 Sentara Healthcare 4417 Corporation Lane Virginia Beach, VA 23462 Tel: (757) 552-7401 Web: 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 118,964 POS 8,416 PPO 14,990 Medicaid Managed Care 89,070 FAMIS 6,458 Medicare Risk HMO N/A Other MCHIP N/A Total 237,898 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 Tel: (804) 354-7000 Web: 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 East Broad Street, Suite 400 Richmond, VA 23219 Tel: (804) 819-5151 Key Staff CEO - James S. Parrott VP of Business Development / Community Relations - Terone B. Green Sr. Medical Director - Melvin Pinn, MD MPH VP of Medical Management - Linda Hines, MS RN Director of Finance - Tim Carpenter Managed Care Enrollment1 HMO N/A POS N/A PPO N/A Medicaid HMO 64,027 FAMIS (SCHIP) 5,902 Medicare Risk HMO N/A Other MCHIP N/A Total 69,929 Network Providers PCPs 1,135 Physician Specialists 4,584 Hospitals 49 Wellpoint Health Networks 120 S. Via Merida Thousand Oaks, CA 91362 Tel: (877) 864-2723 Web: 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 2003