Managed health care providers in Virginia

Virginia Business
September 2005

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 89,025
POS 13,560
PPO 126,883
Medicaid HMO N/A
FAMIS (SCHIP) N/A
Medical managed care N/A
Medicare Risk HMO N/A
Total 229,468

Network Providers
PCPs 3,582
Physician specialists 6,290
Hospitals 70
OB/GYNs 752

Anthem Blue Cross Blue Shield and Anthem-Affiliated HMOs/Wellpoint
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 308,923
HMO /POS 12,530
POS 244,674
PPO 1,741,138
Medicaid HMO 80,108
FAMIS 6,646
Total 2,169,172

Network Providers
PCPs (# All HMOs) 2,304
PCPs (# PPO ) 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

CareFirst BlueCross BlueShield
840 First St. N.E.
Washington, DC 20065
(202) 479-8000
carefirst.com

Key Staff
President and CEO - William L. Jews
Medical director - Eric R. Baugh, MD, Sr. VP, medical affairs and network management (CareFirst)
Dir. of government affairs - Julie Hatton

Managed Care Enrollment1
HMO 38,172
POS 4,739
PPO 96,268
Medicaid HMO N/A
FAMIS (SCHIP) N/A
Medicare Risk HMO N/A
Other MCHIP N/A
Total 139,179

Network Providers
PCPs (HMO) 4,300
PCPs (PPO) 5,975
Physician specialists (HMO) 16,163
Physician specialists (PPO) 21,288
Hospitals (HMO) 73
(PPO) 79

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) - Thomas Martel
Quality (VA and M-A) - Susan Kirkpatrick, Sherry Rodriguez
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) -Charlotta Runci
Provider relations (VA) - Debbie Wheeler
Provider relations (M-A) - Yvonne Van Lowe
Government affairs (VA and M-A) -
Jeffrey Tindall

Managed Care Enrollment1
HMO 20,646
Other MCHIP 36,426
PPO 93,920
Total 204,407

Network Providers
PCPs VA 2,032
PCPs M-A 2,226
Physician specialist VA 5,028
Physician specialist M-A 5,092
Hospitals VA 54
Hospitals M-A 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 135,787
PPO 15,952
Medicaid HMO 15,244
FAMIS 984
Medicare risk HMO N/A
Other MCHIP N/A
Total 167,967

Network Providers
PCPs HMO 2,400
PCPs PPO 2,413
Physician specialists HMO 3,584
Physician specialists PPO 3,598
Hospitals HMO 59
Hospitals PPO 62

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 4,787
POS 10,945
PPO N/A
Medicaid managed care N/A
FAMIS (SCHIP) N/A
Medicare Advantage product(s) 4,219
Other MCHIP N/A
Total 19,951

Network Providers
PCPs 487
Physician specialists 396
Hospitals 17

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 171,477
POS 5,669
PPO N/A
Medicaid managed care N/A
FAMIS (SCHIP) N/A
Medicare Advantage product(s) 9,730
Other MCHIP N/A
Total 186,876

Network Providers
PCPs HMO (network physicians) 160
PCPs HMO
(M-A Permanente Med. Group) 150
Physician specialists
(network physicians) 1,732
Physician Specialists
(M-A Permanente Med. Group) 180
Hospitals 11

United Healthcare/Mid-Atlantic Medical Services Inc. (MAMSI)
4 Taft Court
Rockville, MD 20850
(301) 294-5131
uhc.com

Key Staff
President and CEO - Thomas P. Barbera
Medical director - Vera Dvorak MD
Government relations - Beth Sammis

Managed Care Enrollment1
HMO 480,000
POS 105,000
PPO 125,000
Medicaid managed care N/A
FAMIS (SCHIP) N/A
Medicare Risk HMO N/A
Other MCHIP N/A
Total 810,000

Network Providers
PCPs - HMO 2,300
PCPs - PPO 2,300
Physician specialists HMO 5,350
Hospitals 79

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 95,027
POS 21,635
PPO 13,667
Medicaid managed care 111,379
Medicare Advantage product(s) N/A
Other MCHIP N/A
Total 319,904

Network Providers
PCPs HMO 865
PCPs PPO 804
Physician specialists HMO 1,893
Physician specialists PPO 2,039
Hospitals HMO 21
Hospitals PPO 21

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) 91,000
Medicare Risk HMO N/A
Other MCHIP N/A
Total 91,000

Network Providers
PCPs 1,135
Physician specialists 4,584
Hospitals 49

Notes
Amerigroup did not submit its company’s information by press time.
1Managed care enrollment as of Jan. 31, 2005 2Small Group = 2-49 Employees 3Large Group = 50+ Employees
VA = Virginia M-A = Mid-Atlantic N/A = Not Applicable Source: Virginia Association of Health Plans; www.vahp.org