2015 Membership Directory | CAHP

Transcription

2015 Membership Directory
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TA B L E O F C O N T E N T S
Letter from the President. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
About CAHP
O U R M I S S I O N — Advocating for Health Plans
The mission of CAHP is to serve our member health plans
by creating and sustaining an environment that permits them
to maintain viability and grow as organizations dedicated
to coordinating or providing high quality, affordable and
accessible health care to their members.
We do this by:
»» Advocating for the interests of health plans and
their members on legislative and regulatory issues
»» Educating policy makers, opinion leaders and
regulators on the implications of policy concepts,
issues and proposals
»» Promoting collaborative efforts among health plans,
providers, purchasers, brokers, other health care
associations and other stakeholders to assert policy
toward the provision of high quality, affordable and
accessible health care
»» Informing the media and the public about our
philosophy and the benefits health plans provide
»» Engaging the state’s political leaders
»» Promoting opportunities and forums for plan members
to meet, exchange ideas and discuss critical issues
affecting the industry and industry effectiveness
California Association of Health Plans
1415 L Street, Suite 850
Sacramento, CA 95814
916.552.2910
www.calhealthplans.org
■
2014 Conference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
■
2014 Seminars. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
■
CAHP Board of Directors. . . . . . . . . . . . . . . . . . . . . . . . 6
■
CAHP Staff. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
CAHP Associate, Partner
and Health Group Members. . . . . . . . . . . . . . . . . . . . . . . 13
CAHP Health Plan Members. . . . . . . . . . . . . . . . . . . . . . 35
2015 Plan Enrollment by County . . . . . . . . . . . . . . . . . 38
Health Plan Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Letter from the President
W
e are pleased to provide you with the
2015 CAHP Membership Directory.
This publication is the source for concise,
up-to-date information about each of the
health plans in California.
CAHP IS PROUD TO REPRESENT
CALIFORNIA’S HEALTH PLANS,
WHICH ENSURE ACCESS TO
QUALITY HEALTH CARE FOR
OVER 22 MILLION CALIFORNIANS.
Aetna Health of California, Inc.
AIDS Healthcare Foundation
Alameda Alliance for Health
Our members include for-profit, not-for-profit,
Anthem Blue Cross
and public full service licensed Knox-Keene
Blue Shield of California
health plans. They serve commercial, Medi-Cal, Medicare, and
Covered California consumers.
California Health & Wellness
CalOptima
CalViva Health
The directory also highlights CAHP’s conference sponsors,
Care1st Health Plan
Associate and Partner Members, and Health Group Members.
CenCal Health
All contribute to the success of CAHP in our representation
Central California Alliance for Health
of managed health plans in California.
Central Health Medicare Plan
As health care coverage continues to expand, we are focused
Cigna HealthCare of California, Inc.
on improving California’s Medicaid program and advancing
Community Health Group
affordability for the over 22 million Californians receiving
Contra Costa Health Plan
coverage from CAHP’s member plans.
Easy Choice, A WellCare Company
Throughout the year, CAHP hosts a series of issue-based
Chinese Community Health Plan
GEMCare Health Plan, Inc.
Health Net of California
seminars and our annual conference in Palm Desert. For more
Health Plan of San Joaquin
information please visit our website at www.calhealthplans.org.
Health Plan of San Mateo
You will also find a wide variety of resources and information.
Heritage Provider Network
Thank you for your interest in the California Association
of Health Plans.
Humana
Inland Empire Health Plan
Inter Valley Health Plan
Kaiser Permanente
Sincerely,
Kern Family Health Care
L.A. Care Health Plan
Molina Healthcare of California
Monarch Health Plan, Inc.
On Lok Lifeways
Partnership HealthPlan of California
San Francisco Health Plan
Charles Bacchi
Santa Clara Family Health Plan
President & CEO, California Association of Health Plans
SCAN Health Plan
Seaside Health Plan
Sharp Health Plan
SIMNSA Health Plan
Sutter Health Plus
UnitedHealthcare of California
Valley Health Plan
Ventura County Health Care Plan
Western Health Advantage
2
October 19–21 | 2015
JW MARRIOT T DESERT SPRINGS RESORT & SPA | PA L M D E S E R T
CAHP ANNUAL CONFERENCE
CAHP Conference 2014
CHARTING THE PATH TO A HEALTHIER CALIFORNIA
O C T O BE R 2 0 –2 2, 2 014 | H YAT T R EG E N C Y H U N T IN G T O N B E A C H
THE 2014 CAHP CONFERENCE title extended the metaphor of passing from a familiar environment
to a new landscape of coverage and challenges. Millions of Californians for the first time have
coverage for quality health care, but, containing health care costs is a far more difficult task.
State regulations, legislative mandates, federal guidance zig-zags, lawsuits, initiatives, and complex
Medi-Cal rate setting all complicate the ability of health plans to efficiently deliver affordable,
high quality care.
The program provided a review of the watershed year of 2014 and a look ahead as California’s
health care system continues to evolve.
Over 900 professionals came together to hear what has happened, what’s on the horizon,
and what might be beyond the horizon.
THE 2014 PROGRAM INCLUDED:
✺✺ Audience participation sessions with the chiefs of the nation’s two biggest
public programs of their kind:
■■
Peter Lee, Executive Director of Covered California
■■
Toby Douglas, Director of Department of Health Care Services
✺✺ Open discussion with new Director of Department of Managed Health Care
and her management team.
✺✺ The federal, state and system perspectives on where health care is heading
post-ACA.
✺✺ Breakout sessions on important issues of the day:
■■
The complexity of mental health care in commercial and Medi-Cal coverage
■■
Defining palliative care
■■
Data collection in a delegated system to drive quality and reduce costs
■■
■■
Legal discussion with top California attorneys on key court decisions
for health plans
Future of the small group market
✺✺ The program closed out with the best breakdown of what happened in health
care in the Legislature and why — the Year End Review and Implementation Preview.
4
CAHP Seminar Series 2014
FEBRUARY 6 • BURBANK MARRIOTT
APRIL 22 • BURBANK MARRIOTT
Making Medi-Cal Work:
Quality Care on a Tight Budget
Advances in Analytics: Shaping
Health Care Delivery through Data
133 ATTENDEES
120 ATTENDEES
SUPPORTED BY:
SUPPORTED BY:
• DST Health Solutions
• GSI Health
• Healthx, Inc.
• LogistiCare Solutions
• Magellan Health Services
• NurseWise
• Panviva
• Total Transit
• Treo Solutions
• WellCard Health
MARCH 19 • HILTON BAYFRONT —
SAN FRANCISCO AIRPORT
Making Sense of the 3Rs
85 ATTENDEES
SUPPORTED BY:
• Health Language
• Healthx
• Optum
• Treo Solutions
• Health Language
• HighPoint Solutions
• Healthx
• Softheon
• StorageCraft Technology Corporation
• Treo Solutions
• VARIS, LLC
MAY 22 • EMBASSY SUITES — SACRAMENTO
Trends in Healthcare Delivery:
Bringing Healthcare to the Individual
109 ATTENDEES
SUPPORTED BY:
• Capitol IT Partners
• Coram CVS/Specialty Infusion Services
• CVS Caremark
• Healthx
• Intel-GE Care Innovations
• LogistiCare Solutions
• Optum
• Plexis Healthcare Systems, Inc.
• Salix Pharmaceuticals
JULY 31 • BURBANK MARRIOTT
The Medi-Cal Program:
Beyond the Basics
250 ATTENDEES
SUPPORTED BY:
• LogistiCare Solutions LLC
• Magellan Rx Management
• Monument Systems LLC
• PerformRx
• Philips Lifeline
• Teva Pharmaceuticals
• Total Transit
• VARIS LLC
5
CAHP Board of Directors
Garry Maisel | CHAIRMAN OF THE BOARD
Richard Chambers
President & CEO
President
Peter Welch | VICE CHAIR
Jack Horn
President and General Manager
CEO
Mark Morgan | SECRETARY/TREASURER
Chris Wing
Anthem Blue Cross
President, California
SCAN Health Plan
President & CEO
Melissa Hayden Cook
Sharp Health Plan
President & CEO
Mark Reynolds
President, Northern California Market
Alex Uhm
Chief Operating Officer, California
Paul Markovich
President & CEO
Steven Sell
President
PA S T C H A I R P E R S O N S
Paul Markovich . . . . . . . . . . . . . . . . . . . . . . . . 2013-2 014
Jerry Fleming. . . . . . . . . . . . . . . . . . . . . . . . . . 2011-2 012
Maya Altman
Executive Director
Howard Kahn. . . . . . . . . . . . . . . . . . . . . . . . . . 2009-2 010
Curtis Terry. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2007-2 008
David Helwig . . . . . . . . . . . . . . . . . . . . . . . . . . 2005-2 006
Ken Wood. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2002-2 005
Mark G. Hyde . . . . . . . . . . . . . . . . . . . . . . . . . . 2001-2 002
Bradley Gilbert, M.D.
CEO
Ron Williams. . . . . . . . . . . . . . . . . . . . . . . . . . . 2000-2 001
Bruce Bodaken. . . . . . . . . . . . . . . . . . . . . . . . 1998-2 000
Arthur M. Southam, M.D. . . . . . . . . . . . . . 1995-1998
Kathleen Swenson . . . . . . . . . . . . . . . . . . . . 1994-1995
Wade Overgaard
Kaiser Permanente Health Plan
Senior Vice President,
California Health Plan Operations
6
R. Judd Jessup . . . . . . . . . . . . . . . . . . . . . . . . 1992-1994
Stuart Byer . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1987-1992
Anthony Pescetti. . . . . . . . . . . . . . . . . . . . . . 1985-1987
Maree Church. . . . . . . . . . . . . . . . . . . . . . . . . . 1983-1985
CAHP Staff
Charles Bacchi
Geri O’Neil
President & CEO
Business Development Manager
Nicole Kasabian Evans
Marjorie Purscell
Vice President, Communications
Meeting and Events Manager
Nick Louizos
Connie Flores
Vice President, Legislative Affairs
Administrative Services Manager
Athena Chapman
Selena Coppi Hornback
Director, State Programs
Legislative Assistant
Sunshine Moore
Senior Policy Analyst
7
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JOB#19926CL 1/15
Associate, Partner and Health Group Members
AAAHC Accreditation
for Health Plans
Chapter 1
Chapter 1: Member Rights, Responsibilities and Protections
Member Rights, Responsibilities
and Protections
C. Members (or a patient-designated person or legally authorized person) are provided information about
their health care and are provided the opportunity to participate in decisions related to their health care.
An accreditable organization recognizes the basic human rights of members. Such an organization has
the following characteristics:
A.
Members are treated with respect, consideration, and dignity and are afforded appropriate privacy.
Review Guidelines
YES
1.
The organization has a written policy on member rights and responsibilities.
2.
The organization distributes the policy to its members.
3.
The organization distributes the policy to network providers.
4.
Compliance is evaluated and verified during network provider site visits.
5.
There is evidence of a process for the implementation of interventions when problems and
concerns are identified.
Scoring
NO
Fully Compliant
Substantially
Compliant
Partially Compliant
4 of 5 elements are
present.
3 or 4 of 5 elements are
present.
Minimally Compliant
The organization has written policies addressing provider responsibility to provide members,
or their designated person or legally authorized individual, with complete information
concerning their diagnosis, evaluation, treatment, and prognosis.
2.
The organization has written policies addressing provider responsibility to give members
the opportunity to participate in decisions involving their health care, except when such
participation is contraindicated for medical reasons.
3.
Evidence is present that members have been informed of the policies outlined in guidelines
1 and 2 above (e.g., member handbook, provider manual, provider contracts, website, etc.).
4.
Evidence is present that network providers have been informed of the policies outlined in
guidelines 1 and 2 above (e.g., member handbook, provider manual, provider contracts,
website, etc.).
5.
Evidence of compliance is present in medical records (e.g., informed consents, progress
notes, etc.).
6.
There is evidence of a process for the implementation of interventions to correct identified
deficiencies.
NO
N/A
Scoring
Non-Compliant
For
For Health
Health Plans
Plans
2 of 5 elements are
present.
YES
1.
N/A
Accreditation
A
ccreditation
Handbook
H
andbook
All elements of the
review guidelines are
present.
Review Guidelines
1 or no element is
present.
Fully Compliant
Substantially
Compliant
All elements of the
present.
5 of 6 elements are
present.
Partially Compliant
3 or 4 of 6 elements
are present.
Minimally Compliant
2 of 6 elements are
present.
Non-Compliant
1 or no element is
present.
B. Member disclosures and records are treated confidentially, and members are given the opportunity to
approve or refuse their release, except when release is required by law.
D. The organization establishes member rights and makes information available to members and network
provider staff regarding services, fees, and other issues.
Review Guidelines
Review Guidelines
1.
2.
YES
NO
N/A
The organization distributes the policy to network providers and network provider staff.
3.
Compliance is evaluated and verified during network provider site visits.
4.
There is evidence of a process for the implementation of interventions when problems
and concerns are identified.
1.
Member rights including those specified in A, B, and C above.
2.
Member conduct, responsibilities, and participation.
3.
Services available at the organization for members
4.
Provisions for after-hours and emergency care.
5.
Fees for services.
6.
Scoring
Fully Compliant
All elements of the
present.
7.
Substantially
Compliant
3 of 4 elements are
present.
© 2015 A C C R E D I TAT I O N A S S O C I AT I O N
for
Partially Compliant
2 of 4 elements are
present.
A M B U L AT O R Y H E A LT H C A R E , I N C .
Minimally Compliant
1 of 4 elements is
present.
YES
NO
N/A
Documentation exists for:
The organization has a written (HIPAA- and Omnibus-compliant) policy regarding the
release of personal health information of members and maintains appropriate business
associate agreements.
Non-Compliant
No element is present.
11
Payment policies.
Members’ right to refuse to participate in research.
8.
Advance directives, as required by state or federal law and regulations.
9.
Credentials of health care professionals.
© 2015 A C C R E D I TAT I O N A S S O C I AT I O N
for
A M B U L AT O R Y H E A LT H C A R E , I N C .
12
The 2015 edition of the AAAHC Accreditation Handbook for Health Plans is a comprehensive
reference to our accreditation process and our Standards for health plans. It also provides you
with a set of resources and tools to help you maximize efficient, cost-effective delivery of services
to your members.
As an approved accrediting body for Qualified Health Plans (QHPs), we stand ready to help you
meet the requirements of the PPACA. Our focus, like yours, is care management, care coordination,
and high-quality outcomes for your members.
For more information, call Tom Tassone at 847-853-6060 or email [email protected].
Associate Members
3M Health Information Systems
Amgen
Billing/Claims Processing and IT/Software
Biotechnology
David Wetherelt
Joe Gelinas
Director, Business Development
125 Defreest Avenue
Troy, NY 12180
P (651) 261-2878
dwetherelt @ mmm.com
www.3mhis.com
Corporate Account Manager
1822 Calle Borrego
Thousand Oaks, CA 91360
P (805) 313-8135
F (805) 435-8174
jgelinas @ amgen.com
www.amgen.com
AAAHC
Accreditation
APS Healthcare
Carolyn Kurtz
Care Management
Vice President and General Counsel
5250 Old Orchard Road, Suite 200
Skokie, IL 60077
P (847) 853-6060
F (847) 853-9028
info @ aaahc.org
www.aaahc.org
Acorda Therapeutics, Inc.
Julie Fisher
Senior Vice President, Development
44 S Broadway, Suite 1200
White Plains, NY 10601
P (800) 305-3720 ext. 3198
F (866) 793-5578 jfisher@ apshealthcare.com
www.apshealthcare.com
Biotech Manufacturer
ARIAD Pharmaceuticals
Stephanie Roberts Pharmaceutical Company
Account Director, West Region
420 Saw Mill River Road
Ardsley, NY 10502
P (520) 241-8559
sroberts @ acorda.com
www.acorda.com
Amarin Corporation
Pharmaceutical
Amy Delacluyse
National Director of Accounts
1430 Route 206, Suite 200
Bedminster, NJ 07921
P (952) 484-5341
amy.delacluyse @ amarincorp.com
www.amarincorp.com
Amber Pharmacy
Specialty Pharmacy
Luis Torres
Vice President, Managed Care
10004 South 152nd Street
Omaha, NE 68138
P (888) 703-3551
C (407) 616-4626
ltorres @ amberpharmacy.com
www.amberpharmacy.com
Mike McDole
Corporate Account Director
26 Landsdowne Street
Cambridge, MA 02139
P (303) 548-8949
F (855) 324-1880
michael.mcdole @ ariad.com
www.ariad.com
ArkrayUSA, Inc.
Medical Supplies
Robert Wernsman
VP Consumer Health Division
5198 West 76th Street
Edina, MN 55439
P (210) 473-1919
wernsmanr@ arkrayusa.com
www.arkrayusa.com
Availity, LLC
Health Information Network
David Fularczyk
Health Plan Strategic
10752 Deerwood Park Blvd South, Suite 110
Jacksonville, FL 32256
P (414) 897-7598
C (414) 344-8113
dfularczyk @ availity.com
www.availity.com
15
Associate Members
Avanir Pharmaceuticals Inc.
Byram Healthcare
Pharmaceutical Manufacturer Medical Supplies
Julie Brown
Janet Ruehle
Account Manager
20 Enterprise, Suite 200
Aliso Viejo, CA 92656
P (425) 876-4760
F (949) 362-6265
jsbrown @ avanir.com
www.avanir.com
RVP of Managed Care
120 Bloomingdale Road, Suite 301
White Plains, NY 10605
P (877) 902-9726
jruehle @ byramhealthcare.com
www.byramhealthcare.com
AxelaCare Health Solutions, LLC
Business Process Outsourcing
Home Infusion Provider
Joseph Zavalishin
EVP, Strategic Contracting & Payer Relations
15501 College Boulevard
Lenexa, KS 66219
P (877) 342-9352
jzavalishin @ axelacare.com
www.axelacare.com
Beacon Health Options
Health Management Services
Mark Heit
SVP, Strategy and Development
5665 Plaza Drive, 4th Floor
Cypress, CA 90603
P (978) 270-0379
mark.heit @ beaconhealthoptions.com
www.beaconhealthoptions.com
BluePeak Advisors
Consultant
Sherry Pound
Principal
14648 Sunrise Canyon Road
Poway, CA 92064
P (808) 478-3975
spound @ bluepeakadv.com
www.bluepeakadv.com
Bristol-Myers Squibb
Pharmaceutical
Sabrina Aery
Senior State Access Manager
2130 Mountain Boulevard #206
Oakland, CA 94611
P (510) 336-0807
sabrina.aery@ bms.com
www.bms.com
16
Calibrated Healthcare Network LLC
Jovita Montes De Oca
CEO
1601 Monte Vista Ave., Suite 250
Claremont, CA 91711
P (866) 955-0044
F (909) 256-8903
jovita @ calibratedgroup.com
www.calibratedhealthcarenetwork.com
CalPACE
Association
Peter Hansel
Chief Executive Officer
1315 I Street, Suite 100
P (916) 469-3368
F (916) 428-4250
phansel @ calpace.org
www.calpace.org
CAPG, The Voice of
Accountable Physician Groups
Physician Organization Trade Association
Donald H. Crane
President & CEO
915 Wilshire Blvd., Suite 1620
Los Angeles, CA 90017
P (213) 624-CAPG (2274)
F (213) 683-0032
dcrane @ capg.org
www.capg.org
Catamaran
Pharmacy Benefit Management
Jason Paasch
Marketing Specialist
11900 West Lake Park Drive
Milwaukee, WI 53224
P (414) 760-4722
F (630) 577-3101
jason.paasch @ catamaranRx.com
www.catamaranrx.com
Associate Members
CAQH
Dell
Healthcare Technology & IT Software
IT Services
Ann Brisk
Pavan Bhatnagar
Director, Business Development
1900 K Street NW, Suite 650
Washington, DC 20006
P (801) 355-6158
F (202) 517-0397
abrisk @ caqh.org
www.caqh.org
Services Account Executive
Celgene Corporation
Biopharmaceutical
Chris Woolsey
National Account Manager
3433 Raben Way
Cameron Park, CA 95682
P (530) 558-5150
F (530) 672-2823
cwoolsey@ celgene.com
www.celgene.com
Clearwater Compliance LLC
Compliance
Bob Chaput
Marybeth Anderson
Services Account Executive
2300 West Plano Parkway
Plano, TX 75075
P (925) 522-9458
pavan_bhatnagar@ dell.com
marybeth_anderson @ dell.com
www.dell.com/payers
Diplomat Specialty Pharmacy
Specialty Pharmacy
Dennis Bradley
Specialist, Key Accounts
4100 S. Saginaw Street
Flint, MI 48507
P (616) 733-0243
dbradley@ diplomat.is
www.diplomat.is
DST Health Solutions, LLC
BPO, IT/Software, Billing/Claims
CEO
106 Windward Pt.
Hendersonville, TN 37075-5108
P (800) 704-3394
F (966) 734-1181
bob.chaput @ clearwatercompliance.com
www.clearwatercompliance.com
Senior Sales Executive
2500 Corporate Drive
Birmingham, AL 35242
P (214) 695-8372
jjsingletary@ dsthealthsolutions.com
www.dsthealthsolutions.com
Coram CVS/Specialty Infusion Services
Eisai Inc
Home Infusion Therapy
Jim Sepeda
Strategic Account Executive
3160 Corporate Place
Hayward, CA 94545
P (510) 732-8315
F (949) 462-8846
Jim.Sepeda @ coramhc.com
www.coramhc.com
Daiichi Sankyo
Pharmaceutical Company
Teri Ross, RN Account Manager
2 Hilton Court Parsippany, NJ 07054
P (949) 294-1509
F (949) 721-8793
tross @ dsi.com
www.dsi.com
Jill Singletary
Olaf Reinwald
Regional Account Manager
8969 Covey Court
Elk Grove, CA 95624
P (916) 417-9580
olaf_reinwald @ eisai.com
www.eisai.com
Emdeon
Healthcare IT Vendor
Pete Sarnataro
RVP, Payer Sales
P (720) 837-3498
psarnataro @ emdeon.com
www.emdeon.com
17
Associate Members
EnvisionRx
Genomic Health Inc.
Medical Diagnostics
Jason Johnson
Matt Mega
SVP, Market Leader Managed Care
531 Santa Ana
Newport Beach, CA 92663
P (949) 887-0863
jajohnson @ envisionrx.com
www.envisionrx.com
Associate Director, Managed Care Marketing
301 Penobscot Drive
Redwood City, CA 94063
P (804) 305-7343
mmega @ genomichealth.com
www.genomichealth.com
Essette, Inc.
GlaxoSmithKline
IT–Software
Pharmaceutical Manufacturer
Marc Lawrence
Julie Wade
SVP Business Development
636 Coffman Street, Suite 300
Longmont, CO 80501
P (800) 403-8220 ext 134
P (303) 500-6933
info @ essette.com
www.essette.com
Field VP, Regional Accounts West
231 Market Place, Suite 377
San Ramon, CA 94583
P (925) 855-1300
F (925) 855-1311
julie.h.wade @ gsk.com
www.gsk.com
Excelsior Solutions
HealthCare Scouts, Inc.
Pharmacy Consulting
CJ Rodriguez
Chairman, Pharmacy Analytics Board
7401 Metro Blvd, Suite 210
Edina, MN 55439
P (952) 562-5540
F (952) 562-5558
kdowell @ excelsiorsolutions.com
www.excelsiorsolutions.com
President
2699 Lee Road
Winter Park, FL 32789
P (800) 708-0605
info @ healthcarescouts.com
www.healthcarescouts.com
Firstsource Solutions USA, Inc.
Business Process Management
Nancy Maze
SVP Client Relations
4500 Campbell Drive
Fort Scott, KS 66701
P (620) 223-8217
F (620) 223-8216
nancy.maze @ na.firstsource.com
www.na.firstsource.com
FlexTech, Inc.
IT Consulting & Services
Craig Pfent
Founder, President & CEO
445 Butternut Drive
Holland, MI 49424
P (616) 392-9726
F (616) 392-5384
cpfent @flextech.com
www.flextech.com
18
Staffing/Recruiting
Ken Dowell
HealthEdge
IT/Software
Ray Desrochers
Executive VP, Sales & Marketing
30 Corporate Drive
Burlington, MA 01803
P (781) 285-1300
F (781) 419-6183
info @ healthedge.com
www.healthedge.com
HealthHelp
Utilization & Safety Management
Cherrill Farnsworth
President & CEO
650 North Sam Houston Parkway, Suite 250
Houston, TX 77069
P (281) 447-7000 ext. 1707
F (281) 447-0606
farnsworthc @ healthhelp.com
www.healthhelp.com
Associate Members
Health Integrated
Intel-GE Care Innovations
IT Software
Alycia Sepe, RN, BSN
Kerry Armstrong
VP, Business Development
10008 North Dale Mabry Highway
Tampa, FL 33618
P (804) 241-9604
asepe @ healthintegrated.com
www.healthintegrated.com
Senior Account Executive
3721 Douglas Blvd, Suite 100
Roseville, CA 95661
P (800) 450-0970
karmstrong @ careinnovations.com
www.careinnovations.com
HealthPlan Services
KP LLC
Health Management Services & IT
Member Communications
Jennifer Needle
Cindy Sonnenberg
Senior Account Manager
3501 East Frontage Road
Tampa, FL 33607
P (813) 289-1000 ext 7003242
jneedle @ healthplan.com
www.healthplan.com
Vice President, California Sales
13951 Washington Avenue
San Leandro, CA 94578
P (510) 435-7862
F (510) 588-4808
csonnenberg @ kpcorp.com
www.kpcorp.com
Healthx, Inc.
Software (Portal Development)
Krames Staywell
Chuck Rolfsen
Chief Revenue Officer
9339 Priority Way, West Dr., Suite 150
Indianapolis, IN 46240
P (877) 492-3633
crolfsen @ healthx.com www.healthx.com
HMS
Staci Kupersmit
Marketing Director, Payer Channel
136 East South Temple, Suite 900
Salt Lake City, UT 84111
P (267) 685-2548
[email protected]
www.kramesstaywell.com
Claims Processing
LexisNexis Risk Solutions
Carrie Cunningham
Fraud Detection
Vice President, Business Development
401 Park Avenue South
New York, NY 10016
P (916) 405-6780
ccunningham @ hms.com
www.hms.com
Carin Whitaker iHealth Technologies
Director of Sales
1000 Alderman Drive
Alpharetta, GA 30005
P (866) 396-7703
healthcare @ lexisnexis.com
www.lexisnexis.com/risk/healthcare.aspx
Business Process & Claims
Lilly USA, LLC
Richard Krichbaum
Vice President, Sales
100 Ashford Center North, Suite 400
Atlanta, GA 30338
P (770) 379-2812
F (770) 379-2850
rick.krichbaum @ ihealthtechnologies.com
www.ihealthtechnologies.com
Helen P. Liao
Senior Account Manager
Lilly Corporate Center
Indianapolis, IN 46285
P (925) 577-0511
hpliao @ lilly.com
www.lilly.com
Independent Living Systems
Healthcare Management Services
Laura A. Stine
Sales Manager
5200 Blue Lagoon Drive, Suite 500
Miami, FL 33126
P (305) 262-1292 ext 7019
F (305) 397-1869
lstine @ ilshealth.com
www.ilshealth.com
19
Associate Members
Local Health Plans of California
Medivation, Inc.
Policy and Legislative Association
Jennifer Kent
Kerri Miller, PharmD
Executive Director
1225 Eighth Street, Suite 440
P (916) 448-8292
jkent @ lhpc.org
www.lhpc.org
National Account Director
6402 South Zeno Court
Aurora, CO 80016
P (303) 954-0230
kerri.miller@ medivation.com
www.medivation.com
LogistiCare Solutions
Medline Industries & Continence Care
Care Coordination Solutions &
Transportation Benefit Management
Bill Walter
Vice President, Business Development
400 South Farrell Drive, Suite 209
Palm Springs, CA 92262
P (866) 246-5875
F (866) 245-8142
billw@ logisticare.com
www.logisticare.com
Lynk Software, Inc.
IT
Ron Kingsley
Project Manager-Healthcare Specialist
P.O. Box 5498
Scottsdale, AZ 85261
P (877) 998-1933
F (480) 998-4979
ron @ lynksoftware.com
www.lynksoftware.com
Medical Transportation
Management, Inc. (MTM)
Transportation and Home &
Community Based Services
Rhonda Hollingsworth
Director, Business Development Operations
16 Hawk Ridge Drive
Lake Saint Louis, MO 63367
P (636) 695-5563
F (636) 561-2962
rhollingsworth @ mtm-inc.net
www.mtm-inc.net
MedImpact Healthcare Systems, Inc.
Janeen McBride Vice President Business Development
10181 Scripps Gateway Court
San Diego, CA 92131
P (858) 790-6365
F (858) 790-6053
Janeen.mcbride @ medimpact.com
www.medimpact.com
20
Medical Supplies
Jake Mead
VP Payer Solutions
1 Medline Place
Mundelein, IL 60060
P (310) 780-5038
F (866) 726-9865
jmead @ medline.com
www.medline.com
MedSolutions
Brittany Dalton
Marketing Specialist
730 Cool Springs Blvd, Suite 800
Franklin, TN 37067
P (615) 468-4365
F (615) 468-4303
brittany.dalton @ medsolutions.com
www.medsolutions.com
Mission Road Pharmacy
Specialty Pharmacy
Ryan Skrable
VP Managed Markets
1155 North Mission Road
P (323) 227-4646
F (323) 227-8887
rskrable @ salveospecialty.com
www.mrpscripts.com
Moss Adams LLP
Financial & Business Consulting
Chris Pritchard
Partner, National Practice Leader
for Health Plans
101 Second St., 9th Floor
San Francisco, CA 92614
P (415) 677-8262
healthcare @ mossadams.com
www.mossadams.com
Associate Members
Munich Health North America
PerformRx and PerformSpecialty
Healthcare Reinsurer
PBM and Specialty Pharmacy
Michael Shevlin
John Butts
Senior Vice President
555 College Road East
Princeton, NJ, 08543
P (609) 577-2610
F (609) 951-8464
mshevlin @ munichhealth.com
www.munichhealthNARe.com
Director, Market Development
& Public Relations
200 Stevens Drive, 4th Floor
Philadelphia, PA 19113
P (215) 937-8073
F (215) 863-5100
jbutts @ performrx.com
www.performrx.com
Navitus Health Solutions
Premier Healthcare Exchange
Byron Mickle
Billing/Claims, Healthcare Technology
& Health Management
Senior Vice President, Sales & Marketing
2601 West Beltline Highway, Suite 600
Madison, WI 53713
P (608) 729-1543
F (608) 729-2543
byron.mickle @ navitus.com
www.navitus.com
Novo Nordisk, Inc.
Clara Pachomski
Executive Assistant
2 Crossroads Drive
Bedminster, NJ 07921
P (888) 311-3505
F (908) 658-3511
cpachomski @ phx-online.com
www.phx-online.com
Sheree Paloutzian
ProCare Rx
West Director of Managed Markets
22481 Marquam Hill Road
Bella Vista, CA 96008
P (530) 515-9331
F (530) 515-9331
sepz @ novonordisk.com
www.novonordisk-us.com
Optum
Healthcare Technology,
Management & Services
Eric Murphy
President, Payer Solutions
13625 Technology Drive
Eden Prairie, MN 55344
P (800) 765-6817
F (952) 833-7201
empower@ optum.com
www.optum.com
Pay-Plus Solutions, Inc.
Scott Burns
Vice President of Sales
1267 Professional Parkway
Gainesville, GA 30507
P (678) 248-3101
sburns @ procarerx.com
www.procarerx.com
Ramat Medical
Durable Medical Equipment, Rentals, Supplies,
Nurse Consulting, Furniture & Case Goods
Denise Wilson
Chief Operating Officer
5812 West Pico Boulevard
P (877) 726-2863
F (323) 938-2458
luisl @ ramatmed.com
www.ramatmed.com
Billing/Claims, Healthcare Technology
& Health Mgmt
Re-Solutions Intermediaries, LLC
Art Hoath
Chuck Newton
Executive VP Sales
18167 US Highway 19 North
Clearwater, FL 33764
P (877) 828-8770
ahoath @ ppsonline.com
www.ppsonline.com
Reinsurance Intermediaries
10 South 5th Street, Suite 1108
Minneapolis, MN 55402
P (804) 647-8360
cnewton @ re-solutions.net
www.re-solutions.net
21
Associate Members
Rockport Healthcare Services
Time Warner Cable Business Class
Skilled Nursing
IT/Telecommunications
Ted Chigaros
Charles McLaurin
Senior VP Managed Care
5900 Wilshire Blvd, Suite 1600
P (323) 326-6181
tchigaros @ rockporthc.com
Major Account Executive
17777 N Center Court Drive, 8th Floor
Cerritos, CA 90703
P (310) 863-9452
F (704) 414-9088
charles.mclaurin @twcable.com
www.business.twc.com
Summit Reinsurance Services, Inc.
Rob Wood, III
Regional Vice President
7030 Pointe Inverness Way, Suite 350
Fort Wayne, IN 46804
P (260) 469-3005
F (260) 469-3014
rwood @ summit-re.com
www.summit-re.com
Sunovion, Inc.
Marjorie Ormsby
Account Director
84 Waterford Drive
Marlboro, MA 01752
P (508) 481-6700
marjorie.ormsby@ sunovion.com
www.sunovion.com
Teladoc
Telemedicine
Lon Hecht
VP of Payer and Provider Markets
4100 Spring Valley Road, Suite 515
Dallas, TX 75244
P (732) 539-6086
lhecht @teladoc.com
www.teladoc.com
The Compliance Team
Accreditation Organization
Sandra C. Canally, RN
President PO Box 160
Spring House, PA 19477
P (215) 654-9110
F (215) 654-9068
info @thecomplianceteam.org
www.TheComplianceTeam.org
22
TMG Health, Inc.
Business Process Outsourcing (BPO)
J. Teig Boyle
Vice President, Sales & Marketing
455 S. Gulph Road, Suite 307
King of Prussia, PA 19406
P (610) 878-9111 ext 21223
F (610) 878-5525
ProfessionalSolutions @tmghealth.com
www.tmghealth.com
Top Tier Consulting
Management Consulting
Brad Armstrong
Principal & Co-Founder
21550 Oxnard Street, Third Floor
Woodland Hills, CA 91367
P (818) 338-2121
F (818) 338-2141
brad.armstrong @t2c.com
www.t2c.com
Total Transit
Transportation Benefit Services
James Rea
National Business Development Manager
4600 W Camelback Road
Glendale, AZ 85301
P (602) 200-5501 x1719
jrea @totaltransit.com
www.totaltransit.com
US Script, Inc.
Pharmacy Benefit Manager
Pete Clagett
President and CEO
2425 W Shaw Ave
Fresno, CA 93711
P (559) 244-3700
F (559) 244-3793
pclagett @ usscript.com
www.usscript.com
Associate Members
VITAS Healthcare Corporation
Hospice Care
Wolters Kluwer Health/
Health Language
Sue Malter
IT Software/Health Management Services
Regional Director of Market Development
16830 Ventura Boulevard, Suite 315
Encino, CA 91436
P (818) 971-3448
C (818) 599-1006
F (818) 971-3497
[email protected]
www.vitas.com
Brian Diaz
Director of Marketing
4600 South Syracuse Street, Suite 1200
Denver, CO 80237
P (720) 940-2900
F (720) 940-2913
brian.diaz @wolterskluwer.com
www.healthlanguage.com
Windsor Healthcare
The Word & Brown Companies
Skilled Nursing
Small Group, Individual and Medicare
Marketing & Enrollment
Linda M. Moore
Senior Director Managed Care
9200 Sunset Boulevard, 7th Floor
West Hollywood, CA 90069
P (310) 385-1009
F (310) 595-3790
lmoore @ snfmgt.com
www.snfmgt.com
David Duker
Chief Strategic Officer
721 South Parker
Orange, CA 92868
P (800) 869-6989
[email protected]
www.wordandbrown.com
23
B Y C AT E G O R Y
Associate Members
Accreditation
Continence Care
IT/Software
AAAHC
The Compliance Team
Medline Industries
Availity, LLC
CAQH
Dell
Emdeon
Essette, Inc.
FlexTech, Inc.
HealthEdge
HealthPlan Services
Healthx, Inc.
Intel—GE Care Innovations
Lynk Software, Inc.
Time Warner Cable
Business Class
The Word & Brown Companies (Quotit)
Health Language
Fraud Detection
Associations/Organizations LexisNexis
CalPACE
CAPG, The Voice of Accountable
Physician Groups
Health Management
Services
Loca l Health Plans of
California (LHPC) Billing/Claims Processing
Emdeon
HealthEdge
HMS
iHealth Technologies
Optum
APS Healthcare
Beacon Health Options
Health Integrated
HealthPlan Services
Krames Staywell MedSolutions
Optum
The Word & Brown Companies
Health Language
Business Process
Outsourcing (BPO)
Calibrated Healthcare
Network LLC
Emdeon
Firstsource Solutions USA, Inc.
iHealth Technologies
Optum
TMG Health, Inc.
Re-Solutions
Intermediaries, LLC
Summit Reinsurance
Services, Inc.
Munich Health North America
Marketing & Enrollment
Word & Brown (CA Choice and
Word & Brown General Agency)
Medical Equipment
Ramat Medical
Medical Supplies
Healthcare Technology
Arkray USA, Inc.
Medline Industries, Inc.
Genomic Health
CAQH
Intel—GE Care Innovations
Optum
Pay-Plus Solutions
Compliance
Home Infusion Therapy
Nutritional Support Services
Clearwater Compliance LLC
AxelaCare Health Solutions, LLC
Coram CVS/
Specialty Infusion Services
Clinical/Medical Diagnostics
Consulting
BluePeak Advisors
Excelsior Solutions, LLC
FlexTech, Inc.
Moss Adams LLP
Optum
Top Tier Consulting
Hospice Care
VITAS Healthcare Corporation
Member
Communications
KP LLC
Pharmaceutical
Acorda Therapeutics, Inc.
Amarin Corporation
Amgen
ARIAD Pharmaceuticals Inc.
Avanir Pharmaceuticals Inc.
Bristol-Myers Squibb
Celgene Corporation
Daiichi Sankyo
Eisai Inc
GlaxoSmithKline
Health Integrated
Lilly USA
Medivation
Novo Nordisk, Inc.
Sunovion, Inc.
24
B Y C AT E G O R Y
Pharmacy Benefit
Management (PBM)
Associate Members
Specialty Pharmacy
Telecommunications
Time Warner Cable Business Class
Catamaran
EnvisionRx
MedImpact Healthcare
Systems, Inc.
Navitus Health Solutions
PerformRx & Perform Specialty
ProCare Rx
Amber Pharmacy
ARIAD Pharmaceuticals, Inc.
Centene Corporation
Coram CVS/
Specialty Infusion Services
Diplomat Specialty Pharmacy
HealthPlan Services
Mission Road Pharmacy
US Script, Inc.
PerformRx and PerformSpecialty
Skilled Nursing
Staffing/Recruiting
Rockport Healthcare Services
Windsor Healthcare
HealthCare Scouts, Inc.
Telemedicine
Teladoc
Transportation Benefit Services
LogistiCare Solutions
Medical Transportation
Management, Inc. (MTM)
Total Transit
Utilization & Safety
Management
HealthHelp
sults
Negotiating the best
coverage wins clients.
Becoming a trusted
advisor keeps them.
CO N TACT
Chuck Newton
804.647.8360
[email protected]
Matt Smith
206.359.0465
[email protected]
Partner Members
Barger & Wolen LLP
Law Offices of Jinny R. Yang
John M. LeBlanc
Jinny Yang
Partner
633 West Fifth Street, 47th Floor
P (213) 680-2800
F (213) 614-7399
jleblanc @ bargerwolen.com
www.BargerWolen.com
Attorney
PO Box 8239
Northridge, CA 91327
P (310) 701-9106
jylaw@ jinnyyang.com
www.JinnyYang.com
Brownstein Hyatt Farber Schreck, LLC
Michael Zablocki Edward A. Stumpp
Jonathan C. Sandler Shareholder
2049 Century Park East, Suite 3550
P (310) 500-4600
F (310) 500-4602
EStumpp @ BHFS.com
JSandler@ BHFS.com
www.BHFS.com
Crowell & Moring LLP
William A. Helvestine
Andrew Hefty
Partner
275 Battery Street, 23 rd Floor
P (415) 986-2800
P (415) 365-7261
F (415) 986-2827
whelvestine @ crowell.com
ahefty@ crowell.com
www.crowell.com Katrina Pelto Consulting
Law Office of Michael Zablocki
Attorney
21250 Hawthorne Boulevard, Suite 500
Torrance, California 90503
P (310) 316-0968
mzablocki @ socal.rr.com
Locke Lord LLP
Karen R. Palmersheim
Partner
300 S. Grand Avenue, Suite 2600
P (213) 687-6742
F (213) 341-6742
kpalmersheim @ lockelord.com
www.lockelord.com
Manatt, Phelps & Phillips, LLP
John LeBlanc
Partner
11355 West Olympic Boulevard
P (310) 312-4000
F (310) 312-4224
jleblanc @ manatt.com
www.manatt.com
Katrina Pelto
Consultant
8172 Bushwick Drive
Huntington Beach, CA 92646
P (714) 536-6799
F (714) 960-3260
kpelto @ socal.rr.com
Kennaday, Leavitt & Daponde
Michael Daponde
Curtis Leavitt
Partner
500 Capitol Mall, Suite 2260
P (916) 431-7755
F (916) 431-7756
mdaponde @ kldlawgroup.com
cleavitt @ kldlawgroup.com
www.kldlawgroup.com
Nossaman LLP
Richard Spohn
Gregory Cochran
Partner
50 California Street, 34th Floor
P (415) 398-3600
F (415) 398-2438
rspohn @ nossaman.com
gcochran @ nossaman.com
www.nossaman.com
Nossaman LLP
Mary Antoine
Healthcare Practice Group Lead
621 Capitol Mall, 25th Floor
P (916) 442-8888
F (916) 442-0382
mantoine @ nossaman.com
www.nossaman.com
27
Partner Members
Sedgwick LLP
Tin Kin Lee Law Offices
David M. Humiston
Dennis Rolstad
Tin Kin Lee
Partner
801 S. Figueroa Street, 19th Floor
Los Angeles, CA 90017-5556
P (213) 426-6900
F (213) 426-6921
david.humiston @ sedgwicklaw.com
dennis.rolstad @ sedgwicklaw.com
www.sedgwicklaw.com
Attorney
55 South Lake Avenue, Suite 705
Pasadena, CA 91101
P (626) 229-9828
F (626) 229-9820
tlee @tinkinlee.com
www.tinkinlee.com
Wilke, Fleury, Hoffelt,
Gould & Birney, LLP
Daniel L. Baxter
Anthony R. Eaton
Michael G. Polis
Partner
400 Capitol Mall, 22nd Floor
P (916) 441-2430
F (916) 442-6664
[email protected]
aeaton @wilkefleury.com
mpolis @wilkefleury.com
www.wilkefleury.com
Plan it. Solve it. Deliver it.
Nossaman’s healthcare team is making it happen.
Nossaman is a long-standing partner with the managed
care industry. Our team of 30 healthcare attorneys and
policy advisors has the legal expertise, industry insight,
and business acumen to navigate the ever-shifting
maze of challenges clients face.
Nossaman LLP — quality results for more than 70 years.
LOS ANGELES
SAN FRANCISCO
ORANGE COUNTY
SACRAMENTO
WASHINGTON, DC
AUSTIN
ARLINGTON
28
nossaman.com/healthcare
Health Group Members
Delta Dental of California
Magellan Health, Inc.
Jeff Album
Jason Vega
Vice President, Public and Government Affairs
100 First Street
P (415) 972-8418
F (415) 227-0972
jalbum @ delta.org
www.deltadentalins.com
Vice President, State Affairs
980 9th Street, 16th Floor, Suite 7
P (916) 402-4153
F (916) 446-7104
jsvega @ magellanhealth.com
www.magellanhealth.com
DentaQuest
MESVision
Brian Watts
Aspasia Shappet
Sales Director, Western Region
23291 Mill Creek Drive #100
Laguna Hills, CA 92653
P (619) 884-4470
Brian.Watts @ dentaquest.com
www.dentaquest.com
President & CEO
345 Baker Street
Costa Mesa, CA 92626
P (714) 619-4660
F (714) 619-4667
www.mesvision.com
FirstSight Vision Services OptumHealth Behavioral Solutions of California
Robert K. Patton
Eileen Innecken
President & CEO
1202 Monte Vista Ave., Suite #17
Upland, CA 91786
P (909) 920-5008
F (626) 609-2391
Robert.Patton @firstsightvision.net
www.firstsightvision.net
Sr. Director, Regulatory Affairs & Compliance
3111 Camino del Rio North, #600
San Diego, CA 92108
P (619) 641-6907
F (619) 641-6916
eileen.innecken @ optum.com
www.optum.com
Gold Coast Health Plan
ValueOptions of California, Inc.
Guillermo Gonzalez
Steven Rockowitz, Psy.D.
Director of Government Affairs
711 East Daily Drive, Suite 106
Camarillo, CA 93010
P (805) 437-5533
F (805) 512-8721
ggonzalez @ goldchp.org
www.goldcoasthealthplan.org President
PO Box 6065
Cypress, CA 90630-2504
P (714) 763-2427
F (714) 763-2504
steven.rockowitz @valueoptions.com
www.valueoptions.com
LIBERTY Dental Plan of California
Dave Meadows
SVP Government Programs
340 Commerce, Suite 100
Irvine, CA 92602
P (949) 933-5327
F (949) 825-8216
dmeadows @ libertydentalplan.com
www.libertydentalplan.com
29
•
•
•
•
•
•
•
•
WHAT MAKES A LEADER
IN HEALTHCARE COST MANAGEMENT?
PRODUCT
PERFORMANCE
PARTNERSHIP
At PHX, we offer a comprehensive solution that is
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can add value to your business, or visit us online
at www.PHX-online.com
Copyright 2014 Premier Healthcare Exchange, Inc. All Rights Reserved.
What does Dell know about Healthcare?
Dell is an end-to-end
service provider of IT and business solutions for
more than 100 health plans, including several Blues and Medi-Cal plans.
Our level of service differentiates us from other companies with a business
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We are equipped to partner with health plans, enabling payers to
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Dell’s portfolio of solutions include:
•
•
•
•
Applications Modernization
Analytics & Business Intelligence
Billing & Enrollment
Business Process Outsourcing
• Consumerism Solutions
• Fraud/Waste/Abuse &
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• Staff Augmentation
For more information, please visit Dell.com/payers
or contact your Dell representative:
Marybeth Anderson
[email protected] | 303.923.3046
Pavan Bhatnagar
[email protected] | 925.522.9458
What is it?
I N N O V A T I O N
T R A N S F O R M E D
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I N N O V A T I O N
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For more information, visit us at PPSonline.com
©2014 Pay-Plus® Solutions, Inc. All Rights Reserved. CAQH CORE®, the CORE-certification/Endorser Seals and logo are
registered trademarks of CAQH® Copyright 2010, Council For Affordable Quality Healthcare®. All rights reserved.
CAQH CORE®, the CORE-certification/Endorser Seals and logo are registered trademarks of CAQH®
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Health Plan Members
Health Plan Members
Humana
AIDS Healthcare Foundation
Anthem Blue Cross
Kaiser Permanente
CalOptima
CalViva Health
Care1st Health Plan
On Lok Lifeways
CenCal Health
SCAN Health Plan
Seaside Health Plan
Sharp Health Plan
SIMNSA Health Plan
Sutter Health Plus
Valley Health Plan
Anthem Blue Cross
n
n
n
n
n
n
n
n
n
8
n
n
n
n
n
n
BUTTE
6
n
n
n
n
n
n
CALAVERAS
6
n
n
n
n
n
n
COLUSA
8
n
n
n
n
n
n
CONTRA COSTA
9
n
n
n
n
n
n
n
n
n
n
n
n
n
38
ALAMEDA
11
n
ALPINE
6
AMADOR
DEL NORTE
6
n
EL DORADO
10
n
n
n
FRESNO
10
n
n
n
n
n
INYO
6
n
KERN
11
n
n
n
KINGS
8
n
n
n
LAKE
6
n
n
n
LASSEN
6
n
n
n
LOS ANGELES
17
n
n
n
MADERA
8
n
n
n
MARIN
10
n
n
n
n
n
MARIPOSA
7
n
MENDOCINO
7
n
n
n
MERCED
7
n
n
n
MODOC
6
n
n
n
MONO
6
n
n
n
MONTEREY
6
n
n
n
NAPA
8
n
n
n
NEVADA
7
n
n
n
n
n
n
n
n
n
n
n
n
n
GLENN
6
n
HUMBOLDT
6
n
n
n
IMPERIAL
10
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
Valley Health Plan
Sutter Health Plus
SIMNSA Health Plan
Sharp Health Plan
Seaside Health Plan
SCAN Health Plan
On Lok Lifeways
Kaiser Permanente
Central Health Plan of California
CenCal Health
Care1st Health Plan
CalViva Health
CalOptima
Number of plans present in 2015
2015 Plan Enrollment by County
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
SAN BENITO
5
n
SAN BERNARDINO
15
n
n
n
n
SAN DIEGO
14
n
n
n
n
SAN FRANCISCO
12
n
n
n
n
SAN JOAQUIN
12
n
n
n
n
SAN LUIS OBISPO
9
n
n
n
SAN MATEO
9
n
n
n
SANTA BARBARA
8
n
n
n
SANTA CLARA
13
n
n
n
SANTA CRUZ
8
n
n
n
SHASTA
7
n
n
n
SIERRA
6
n
n
n
SISKIYOU
6
n
n
SOLANO
9
n
n
SONOMA
9
n
STANISLAUS
11
15
n
n
n
SACRAMENTO
10
n
n
n
n
n
n
n
n
n
Number of plans present in 2015
15
n
n
n
PLACER
10
n
n
n
n
n
n
n
n
n
n
n
SUTTER
8
n
TEHAMA
6
n
n
n
n
n
TRINITY
6
n
n
n
n
n
TULARE
8
n
n
n
n
n
TUOLUMNE
6
n
n
n
VENTURA
11
n
n
n
n
YOLO
10
n
n
n
n
n
n
YUBA
7
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
Valley Health Plan
Sutter Health Plus
SIMNSA Health Plan
Sharp Health Plan
Seaside Health Plan
SCAN Health Plan
On Lok Lifeways
Kaiser Permanente
n
Central Health Plan of California
CenCal Health
Care1st Health Plan
CalViva Health
CalOptima
6
RIVERSIDE
Anthem Blue Cross
PLUMAS
n
ORANGE
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
39
2625 Shadelands Drive • Walnut Creek, CA 94898
Ph: (925) 948-4700 • Fax: (925) 948-4264 • www.aetna.com
CALIFORNIA OFFICE
LOCATIONS
Fresno
Los Angeles
Rancho Cucamonga
Sacramento
San Diego
San Francisco
Santa Ana
Thousand Oaks
Walnut Creek
Woodland Hills
EXECUTIVE OFFICERS
Mark Bertolini
Chairman, CEO
and President
Shawn Guertin
Senior Executive Vice
President and Chief
Financial Officer
Meg McCarthy
Executive Vice President,
Operations and
Technology
Brian Ternan
President, West Region
EXECUTIVE STAFF
Gina Conflitti, M.D.
Regional Medical Director
Mary V. Anderson
Chief Legal Counsel
Greg Stevens
Region Head of
Network Operations and
Medical Economics
PRIMARY CONTACTS
Shannon Butler
Government Relations
(916) 374-4950
Anjie Coplin
Public Relations
(214) 200-8056
40
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . . .
Recent mergers or acquisitions within California . . . . . . .
Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of employees. . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Plan Enrollment. . . . . . . . . . . . . . . . . . . . . . . . . .
Aetna, Inc.
None
1956
1956
For profit
2,100 full time
14,854,143 National
(medical, dental and pharmacy)
1,565,218 California
PLAN-PROVIDER ARRANGEMENTS
Model types (ranked in descending order). . . . . . . . . . . . .
Number of medical groups/IPAs. . . . . . . . . . . . . . . . . . . .
Number of hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of physicians. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of other licensed clinicians. . . . . . . . . . . . . . . . .
Number of provider offices. . . . . . . . . . . . . . . . . . . . . . . .
Network of Medical Groups and IPAs,
Direct Contracts with Physicians
0 owned, 93 contracted
0 owned, 341 contracted (Short-Term Acute,
Long-Term Acute, and Children’s Hospitals only)
0 owned, 60,542 contracted
(all providers types other than physicians)
COMPENSATION METHODS
Physicians – primary care (ranked by method) . . . . . . . . .
Physicians – specialty (ranked by method). . . . . . . . . . . . .
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . .
All Markets: Capitation,
Negotiated Fee Schedule
All Markets: Capitation,
Negotiated Fee Schedule
All Markets: Per Diem, Capitation,
Discount off Charges
PLAN PRODUCTS
PRODUCTS CURRENTLY OFFERED
Small group (2 – 50 employees). . . . . . . . . . . . . . . . . . . .
Large group (50+ employees). . . . . . . . . . . . . . . . . . . . .
Medicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medi-Cal Managed Care. . . . . . . . . . . . . . . . . . . . . . . . .
Medigap (Supplemental Insurance). . . . . . . . . . . . . . . . .
Special Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .
Medicare Part D stand-alone. . . . . . . . . . . . . . . . . . . . . .
Access for Infants and Mothers. . . . . . . . . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Major Risk Medical Insurance/GIP. . . . . . . . . . . . . . . . . .
Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO, POS, PPO, and Indemnity
EPO, HMO, PPO, POS, HRA, HAS, Other
Yes
No
Yes
No
Yes
No
No
No
Indemnity: HMO, PPO, POS, Other
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Chiropractic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Accidental Death & Dismemberment. . . . . . . . . . . . . . . . Yes
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Durable Medical Equipment. . . . . . . . . . . . . . . . . . . . . . . Yes
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . No
1240 South Loop Road • Alameda, CA 94502
Ph: (877) 371-2222 • Fax: (510) 747- 4508 • www.alamedaalliance.org
CALIFORNIA OFFICE
LOCATIONS
Ed Roberts Campus
3075 Adeline Street,
Suite 160,
Berkeley, CA 94703
(510) 225-7200
EXECUTIVE OFFICERS
Mark Abernathy
Interim CEO
Frank Stevens
Interim COO
Lily Boris, MD
CMO
Neal Jarecki
CFO
Matthew Levin
Interim Compliance Officer
PRIMARY CONTACT
Matthew Levin
Interim Compliance Officer
(510) 373-5647
PLAN ORGANIZATION
Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Alameda Alliance Joint Powers Authority
None
1995
1995
Non profit
205 full time, 5 temporary
237,382
Model types (ranked in descending order). . . . . . . . . . . .
Number of hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of physicians. . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of provider offices . . . . . . . . . . . . . . . . . . . . . . .
Network of Medical Groups and IPAs;
Direct Contracting with Physicians
(Note: Excludes behavioral health)
Physicians – primary care (ranked by method). . . . . . . . . .
Fee-For-Service, Group Capitation,
Individual Capitation
Fee-For-Service, Group Capitation
Diagnosis-Related Group, Per Diem, Capitation
PLAN PRODUCTS
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medicare Advantage. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Special Needs Plans (SNPs). . . . . . . . . . . . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other: Alliance Group Care. . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
HMO
None
None
None
None
HMO
None
None
In-Home Supportive Services
Workers in Alameda County: HMO
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Accidental Death & Dismemberment. . . . . . . . . . . . . . . . None
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Durable Medical Equipment. . . . . . . . . . . . . . . . . . . . . . . HMO
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . None
41
Anthem Blue Cross
21555 Oxnard Street • Woodland Hills, CA 91367
Ph: (818) 234-2345 • Fax: (805) 713-7736 (for providers) • www.anthem.com/ca or www.wellpoint.com
CALIFORNIA
OFFICE LOCATIONS
Costa Mesa
Fresno
Glendale
Los Angeles
Newbury Park
North Hollywood
Pomona
Rancho Cordova
Riverside
Sacramento (2 offices)
San Diego (2 offices)
San Francisco
Santa Barbara
Thousand Oaks
(2 offices)
Visalia
Walnut Creek
Woodland Hills
EXECUTIVE OFFICERS
Joseph R. Swedish
CEO of WellPoint, Inc.
Mark Morgan
California President
of Anthem Blue Cross
Steve Melody
President of Anthem Blue
Cross Medicaid Health Plan
Wayne DeVeydt
CFO
EXECUTIVE STAFF
Dr. Sylvia Gates Carlisle
Medical Director,
Anthem Blue Cross
Craig Laidig
Legal Counsel
Darrel Ng
Public Relations
Michael Arvesen
Pharmacy Director
Steve Scott
Provider Solutions, Acting
PRIMARY CONTACTS
Mike Prosio
(916) 403-0527
Darrel Ng
Public Relations
(916) 403-0528
42
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Anthem, Inc.
Life and Health
Merged with Anthem, Inc. in November 2004
1937
1993
For profit
8,000 full time
36 million members WellPoint
8.5 million members California
Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . .
191 contracted
378 contracted
55,945 contracted
None
Other (Fee Schedule), Group Capitation,
Individual Capitation
Other (Fee Schedule), Group Capitation
Per Diem, Capitation, Case Rates,
Discounted Charges
PLAN PRODUCTS
Covered California (Individual Market). . . . . . . . . . . . . . .
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other (California Kids, Interim High Risk). . . . . . . . . . . . .
PPO, EPO, HMO
HMO, PPO, Other
HMO, PPO
HMO, PPO, POS, Other
HMO, PPO
PPO
No
PPO
HMO, PPO
Other
No
PPO
PPO
ANCILLARY CARE
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . No
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Accidental Death & Dismemberment. . . . . . . . . . . . . . . . No
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Durable Medical Equipment. . . . . . . . . . . . . . . . . . . . . . . None
Workers’ Compensation. . . . . . . . . . . . . . . . . . . . . . . . . . PPO
CALIFORNIA
OFFICE LOCATIONS
Costa Mesa, El Dorado
Hills (2 offices), El Segundo,
Fresno, Lodi, Ontario, Redding,
Sacramento (2 offices), San Diego,
San Francisco (2 offices),
San Jose, Valencia, Walnut Creek,
Woodland Hills
Evelyn Johnston
Vice President, Total Rewards
EXECUTIVE OFFICERS
Tina Kibler
Vice President,
Internal Audit Services
Paul Markovich
President and
Juan Davila
Executive Vice President, Health
Care Quality and Affordability
Kirsten Gorsuch
External Affairs
Seth A. Jacobs, Esq.
Senior Vice President, General
Counsel and Corporate Secretary
Michael Mathias
Senior Vice President and
Chief Information Officer
Michael Murray
Chief Financial Officer
Mary O’Hara
Chief Human Resources Officer
Michelle Simpson
Enterprise Sales and Service
Marcus Thygeson, M.D.
Chief Health Officer
Todd Walthall
Customer Experience
Janet Widmann
Executive Vice President, Markets
Ken Wood
Consumer and Senior Markets
Peter Long
President and CEO, Blue Shield
of California Foundation
Simon Jones
Vice President,
Health Information
Technology Product Strategy
Aaron Kaufman
Vice President and
Chief Technology Officer
Edward Lui
Vice President, Underwriting
Lou Lombardo
Vice President,
Markets Performance
Robert Losier
Vice President,
Infrastructure Services
Tom McCaffery
Vice President,
California State Partnerships
Jessica McCarthy
Vice President,
Integrated Marketing
and Client Experience
William McQueen
Vice President,
Premier Accounts
Kristen Miranda
Vice President, Strategic
Partnerships and Innovation
Mary Muller
Vice President, Core Accounts
Lisa Nunes
Vice President,
Organizational Effectiveness
Michael O’Neil
Vice President, Product and
Market Alignment
Arminé Papouchian
Vice President,
Provider Contracting
Daniel Prettyman
Vice President,
Finance, Markets
EXECUTIVE STAFF
Michael Sheils
Vice President,
Business Intelligence
Christopher Bellamy
Vice President,
Corporate Development
Steve Shivinsky
Vice President, Corporate
Communications
Tom Brophy
Vice President, Finance
and Treasury Services
Jeff Smith
Vice President, Individual
and Family Plans
Bill Brown
Vice President and
Executive Driver, Shield
Advance Business Readiness
Neil Solomon, MD, FACP
Vice President, Quality and
Care System Transformation
Cathy Campbell
Vice President, Senior Markets
Michael Dahlem
Vice President, IT Shared Services
Kenny Deng
Vice President, Provider
Relations, Operations
and Analytics
Nancy Stalker, PharmD
Vice President,
Pharmacy Services
Charles Sweeris, Esq.
Vice President,
Deputy General Counsel
Jon Tholen
Vice President, Customer Service
Edward A. Diver
Vice President,
Applications Development
K.C. Turan
Vice President,
Chief Risk Officer & Chief
Compliance Officer
Jim Elliott
Vice President, Producer and
Channel Partner Relations
Anjali Vichare
Vice President,
Organizational Development
Tom Epstein
Vice President, Public Affairs
Melissa Welch, MD, MPH
Vice President, Healthcare
Market Innovations and Support
Darrin Wells
Vice President, Network
and Trend Analytics
Bryce Williams
Vice President, Wellness
Amy Yao
Vice President and Chief Actuary
Shirley Fierstadt
Vice President, Claims and
Contracted Operations
Amanda Flaum
Vice President,
Medical Management
Brent Hitchings
Vice President, Small Business
Jennifer Hobart
Vice President,
Medical Informatics
PRIMARY CONTACT
Tom Epstein
Vice President, Public Affairs
50 Beale Street • San Francisco, CA 94105
Ph: (415) 229-5000 • www.blueshieldca.com
PLAN ORGANIZATION
Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . California Physicians’ Service dba Blue Shield of California
Recent mergers or acquisitions within California. . . . None
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1939
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1939
Tax status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Not-for-profit
Number of employees . . . . . . . . . . . . . . . . . . . . ~ 5,000
Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . 1,065,278 (HMO); 2,293,722 (PPO); 3,359,000 (Total)
Model types (ranked in descending order). . . . . . . . . HMO – Direct contracting with Network of Medical Groups
and IPAs; PPO – Direct Contracting with Physicians
Number of medical groups/IPAs . . . . . . . . . . . . . . . . 0 owned, 336 contracted medical groups/IPAs (HMO)
Number of hospitals. . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 321 contracted hospitals (HMO);
0 owned, 378 contracted hospitals (PPO)
Number of physicians . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 12,988 PCPs (HMO), 22,666 PCPs (PPO)
Number of other licensed clinicians . . . . . . . . . . . . . 0 owned, 28,406 specialists (HMO);
51,116 contracted specialists (PPO)
Number of provider offices . . . . . . . . . . . . . . . . . . . . 0 owned, 49,800 Provider Offices (HMO);
81,137 Provider Offices (PPO)
Physicians – primary care (ranked by method) . . . . . . Fee Schedule (PPO), Capitation (HMO)
Physicians – specialty (ranked by method). . . . . . . . . Fee Schedule (PPO), Capitation (HMO)
Hospitals (ranked by payment type). . . . . . . . . . . . . . Per Diem, Discount off Charges,
Fee Schedule, Case Rates, Capitation
PLAN PRODUCTS
Covered California. . . . . . . . . . . . . . . . . . . . . . . . . .For individual and family plans (IFP), Small Group plans
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO
Small group (2– 50 employees). . . . . . . . . . . . . . . . HMO, PPO, POS
Large group (50+ employees). . . . . . . . . . . . . . . . . HMO, PPO, POS
Medicare Advantage. . . . . . . . . . . . . . . . . . . . . . . . HMO
Medigap (Supplemental Insurance). . . . . . . . . . . . . Offered for individuals
Special Needs Plans (SNPs). . . . . . . . . . . . . . . . . . . None
Medicare Part D stand-alone. . . . . . . . . . . . . . . . . . For individual and group plans
Access for Infants and Mothers. . . . . . . . . . . . . . . . None
Medi-Cal Managed Care. . . . . . . . . . . . . . . . . . . . . None
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Major Risk Medical Insurance/GIP. . . . . . . . . . . . . . For individual and family plans (IFP)
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Shared Advantage
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PPO
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Available as a discounted service: HMO, PPO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .HMO, PPO
Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . Not available as a stand-alone product
Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . No
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Offered
Accidental Death & Dismemberment. . . . . . . . . . . . Offered in conjunction with our Life Insurance
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Available as a discounted service: HMO; PPO
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . Not available as a stand-alone product
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . Available as a discounted service rather than
as an Ancillary Product
Durable Medical Equipment. . . . . . . . . . . . . . . . . . . Not available as an Ancillary Product
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Not available as an Ancillary Product
Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . No
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Not applicable
43
1740 Creekside Oaks Drive, Suite 200 • Sacramento, CA 95833
Ph: (916) 246-3600 • Fax: (877) 502-7255 • www.CAHealthWellness.com
CALIFORNIA OFFICE
LOCATIONS
Headquarters
1740 Creekside Oaks Drive,
Suite 200
Butte
901 Bruce Road,
Suite 150
Chico, CA 95928
Imperial
1699 W. Main Street,
Suite B
El Centro, CA 92243
El Dorado
550 Main Street, Suite B2
Placerville, CA 95667
EXECUTIVE STAFF
Gregory S. Buchert,
MD, MPH
CEO & Plan President
Jeff Grahling, MBA
Kathryn Kaestner,
RN, MHA, CCM
Vice President,
Medical Management
Kathleen Lang, DPA
Executive Director
Garrett Leaf
Vice President, Finance
Brianna Lierman, Esq.
Vice President,
Government Affairs
Samrina Marshall,
MD, MPH
Chief Medical Director
PRIMARY CONTACT
Brianna Lierman, Esq.
Vice President,
Government Affairs
(916) 246-3753
44
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . . . Centene Corporation
Recent mergers or acquisitions within California . . . . . . . None
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2013
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2013
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For Profit
Number of employees . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 165,700
Model types (ranked in descending order) . . . . . . . . . . . .
Number of Medical Groups/IPAs . . . . . . . . . . . . . . . . . . .
Direct Contracting with Physicians,
Single Medical Group, Network of
Medical Groups & IPAs
Physicians – primary care (ranked by method) . . . . . . . . . Fee-for-Service, Group Capitation
Physicians – specialty (ranked by method). . . . . . . . . . . . Fee-for-Service
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Per Diem, Diagnosis-Related Group, Case Rates
PLAN PRODUCTS
Small group (2– 50 employees) . . . . . . . . . . . . . . . . . . .
Medicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
HMO
None
None
None
None
None
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other
Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . POS
Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . None
Workers’ Compensation. . . . . . . . . . . . . . . . . . . . . . . . . . None
Other (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . Disease Management, Behavioral Health,
Correctional Health
CalOptima (Orange County Health Authority)
505 City Parkway West • Orange, CA 92868
Ph: (714) 246-8400 • Fax: (714) 246-8492 • www.caloptima.org
EXECUTIVE OFFICERS
Michael Schrader
Gary Crockett
Chief Counsel
Dr. Richard Helmer
Chief Medical Officer
Bill Jones
Chet Uma
Len Rosignoli
Michael Ruane
Chief of Strategy
and Public Affairs
Javier Sanchez
Chief Network Officer
EXECUTIVE STAFF
Dr. Richard Bock
Deputy Chief Medical Officer
Candice Gomez
Executive Director of
Program Implementation
Ladan Khamseh
Executive Director
of Operations
Sun Janicek
Executive Director
of Compliance (Interim)
Ron Santos
Executive Director of HR
Terrie Stanley
Executive Director
of Clinical Operations
PLAN ORGANIZATION
Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . None
Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1995
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non Profit
Number of employees. . . . . . . . . . . . . . . . . . . . . . . . . . . 811 full time, 4 part time, 8 as needed
Health Plan Enrollment. . . . . . . . . . . . . . . . . . . . . . . . . . 664,122
Medical groups/IPAs and HMOs
Group Capitation, Fee-For-Service
Group Capitation, Fee-For-Service
Per Diem, Case Rates,
Diagnosis-Related Group, Capitation
PLAN PRODUCTS
Individual market. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Program of All-Inclusive Care for the Elderly (PACE). . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
See SNP
None
HMO
None
None
HMO
None
None
HMO
None
ANCILLARY PRODUCTS
PRIMARY CONTACTS
Julie Bomgren
Senior Manager,
Government Affairs
(714) 246-8836
Michael German
Senior Policy Analyst,
Government Affairs
(714) 796-6176
Arif Shaikh
Manager,
Government Affairs
(714) 246-8418
Phil Tsunoda
Director, Public Policy,
Government and
Community Affairs
(714) 246-8632
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . None
Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . None
Other (please specify). . . . . . . . . . . . . . . . . . . . . . . . . . . . None
45
CalViva Health (Fresno-Kings-Madera Regional Health Authority)
1315 Van Ness Avenue • Fresno, CA 93721
Ph: (559) 445-8735 • www.calvivahealth.org
CALIFORNIA
OFFICE LOCATIONS
1315 Van Ness Avenue
Fresno, CA 93721
7485 N. Palm Avenue, #101
Fresno, CA 93711-5764
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of employees . . . . . . . . . . . . . . . . . . . . . . . . . .
Fresno Kings Madera Regional Health Authority No recent mergers or acquisitions
2009 2010 Not-for-profit 14 Staff, subcontracted for administrative services 299,412
EXECUTIVE OFFICERS
Gregory Hund
CEO
William Gregor
CFO
Patrick Marabella, M.D.
CMO
Mary Beth Corrado
CCO
PRIMARY CONTACT
Cheryl Hurley
Office Manager/
Administrative Coordinator
All direct contracts with physician providers 2 IPAs
12 Hospitals, Contracted
2,299 contracted Physicians
250
Physicians – primary care. . . . . . . . . . . . . . . . . . . . . . . . . FFS percent of Medi-Cal Rates and Capitation
Physicians – specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . FFS percent of Medi-Cal Rates
Hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Percent of Medi-Cal Rates
PLAN PRODUCTS
Medi-Cal Managed Care. . . . . . . . . . . . . . . . . . . . . . . . . Yes
Special Needs Plans (SPD). . . . . . . . . . . . . . . . . . . . . . . . Yes
MSO Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No
ANCILLARY PRODUCTS
46
Care1st Health Plan
601 Potrero Grande Drive • Monterey Park, CA 91755
Ph: (323) 889-6638 • Fax: (323) 889-6270 • www.care1st.com
CALIFORNIA
OFFICE LOCATIONS
601 Potrero Grande Drive
Monterey Park, CA 91755
3131 Camino Del Rio, #350
San Diego, CA 92108
100 N. Winchester Blvd, #290
Santa Clara, CA 95050
2609 E. Hammer Lane
Stockton, CA 95210
833 Auto Center Drive, #D
Palmdale, CA 93551
44426 10th Street West
Lancaster, CA 93534
EXECUTIVE OFFICERS
Maureen B. Tyson
Chair
Anna Tran
CEO
Jorge Weingarten, MD
CMO
Janet Jan
CFO
Brooks Jones
CCO
EXECUTIVE STAFF
Alan Bloom
Legal and Regulatory
Steven Chin
Provider Network Operations
Tracie Howell
Member Services
Beverly Gibbs, RN
Utilization Management
Dr. Daryl Leong
Quality Management
PRIMARY CONTACT
Walter L. Gray, VP
Government Affairs/
Public Affairs
(323) 889-6638, ext. 6270
PLAN ORGANIZATION
Recent mergers or acquisitions within California. . . . . . . . 2006
Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1994
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1995
Tax status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profit
Number of employees. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,000
Health Plan Enrollment. . . . . . . . . . . . . . . . . . . . . . . . . . . 352,000
Model types (ranked in descending order). . . . . . . . . . . . Staff; Network of Medical Groups and Independent
Practice Associations (IPAs); Direct Contracting
with Physicians; Direct Contracting with Federally Qualified Health Centers
Number of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 110
Number of hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,500
Number of other licensed clinicians . . . . . . . . . . . . . . . . . 0
Number of provider offices . . . . . . . . . . . . . . . . . . . . . . . . 23,800
Physicians – primary care (ranked by method) . . . . . . . . . .
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . .
Group Capitation, FQHC capitation
Under Group Capitation, Fee-For-Service
Per Diem, Capitation, Discounted Charges,
Diagnosis-Related Group, Case Rates
PLAN PRODUCTS
Small group (2 – 50 employees). . . . . . . . . . . . . . . . . . . . .
Large group (50+ employees). . . . . . . . . . . . . . . . . . . . . .
Medicare Advantage. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medigap (Supplemental Insurance). . . . . . . . . . . . . . . . . .
Special Needs Plans (SNPs). . . . . . . . . . . . . . . . . . . . . . . .
Medicare Part D stand-alone. . . . . . . . . . . . . . . . . . . . . . .
Access for Infants and Mothers. . . . . . . . . . . . . . . . . . . . .
Medi-Cal Managed Care. . . . . . . . . . . . . . . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Major Risk Medical Insurance/GIP. . . . . . . . . . . . . . . . . . .
Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
HMO
None
HMO
None
None
HMO
None
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .
Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Accidental Death & Dismemberment . . . . . . . . . . . . . . . .
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Workers’ Compensation. . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
None
HMO
HMO
None
None
None
None
HMO
None
HMO
HMO
None
47
CenCal Health
4050 Calle Real • Santa Barbara, CA 93110
Ph: (805) 685-9525 • Fax: (805) 685-8292 • www.cencalhealth.org
CALIFORNIA
OFFICE LOCATIONS
Santa Barbara, CA
San Luis Obispo, CA
EXECUTIVE OFFICERS
Robert Freeman
CEO
David Ambrose
CFO/Treasurer
Paul Jaconette
COO
Mark Maddox, MD
CMO
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . . . Santa Barbara/San Luis Obispo
Regional Health Authority
Recent mergers or acquisitions within California . . . . . . . CenCal Health is a public entity
Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1983
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profit
Number of employees. . . . . . . . . . . . . . . . . . . . . . . . . . . 160 full time
EXECUTIVE STAFF
Caitlin Larsen, JD
Director of Legal Affairs
Dave Siebel
IT Director
Jeffrey Januska, PharmD
Pharmacy Director
Marina Gordon
Provider Services Director/
Program Development
Donna Slimak
Member Services Director
Carlos Hernandez
Director of Health
Services/Quality
Karyn Fish
Human Resources Director
Allen Freymuth
Director of Claims
Lulu Von Alvensleben
Associate Claims Director
PRIMARY CONTACTS
Robert Freeman
CEO
(805) 685-9525, ext. 1011
Michael Harris
(805) 685-9525, ext. 1012
Robert Freeman
Public Affairs
(805) 685-9525, ext. 1011
48
Individual and Group Capitation, Fee-For-Service,
Withhold and Pay for Performance
Per Diem/DRG (Inpatient), Percent of Charges
(Inpatient and Outpatient), Fee-For-Service (Outpatient)
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
None
None
None
HMO
HMO
HMO
None
In-Home Supportive Services Workers: HMO
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Chiropractic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
(Santa Cruz-Monterey-Merced Managed Medical Care Commission)
1600 Green Hills Road, Suite 101 • Scotts Valley, CA 95066
Ph: (831) 430-5500 • Fax: (831) 430-5882 • www.ccah-alliance.org
CALIFORNIA
OFFICE LOCATIONS
Scotts Valley (Main office)
Salinas and Merced
(Regional offices)
EXECUTIVE OFFICERS
Alan McKay
Dale Bishop, MD
Brendan Dowling
Scott Fortner
Chief Administrative Officer
Kathy Neal
Chief Health Services Officer
Barry Staton
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . . . None
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1996
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000
Number of employees. . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Physicians – primary care (ranked by method). . . . . . . . . . Fee-For-Service, Incentive Program
Physicians – specialty (ranked by method) . . . . . . . . . . . . Fee-For-Service, Incentive Program
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Per Diem, Case Rates, Discounted Charges
EXECUTIVE STAFF
Eva Balint, MD
Medical Director
Danita Carlson
Government Relations Director
Lilia Chagolla
Regional Operations
Director – Monterey
Anne Chai, PharmD
Pharmacy Director
Kathleen McCarthy
Provider Services Director
Jennifer Mockus
Regional Operations
Director – Merced
Julio Porro, MD
Medical Director
Stephanie Sonnenshine
Compliance Director
Jan Wolf
Member Services Director
PRIMARY CONTACTS
Danita Carlson
(831) 430-5603
Scott Fortner
Public Affairs
(831) 430-5630
PLAN PRODUCTS
Medi-Cal Access Program . . . . . . . . . . . . . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
County Organized Health System
None
None
None
HMO
HMO
None
In-Home Supportive Services: HMO
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . COHS, HMO
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . COHS, HMO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO: Healthy Kids
Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . COHS, HMO
Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . COHS
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . COHS, HMO
Durable Medical Equipment. . . . . . . . . . . . . . . . . . . . . . . COHS, HMO
Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
49
1540 Bridgegate Drive • Diamond Bar, CA 91765
Ph: (626) 388-2390 • Fax: (626) 388-2361 • www.centralhealthplan.com
EXECUTIVE OFFICERS
Lee Suyenaga
An Pang Chieng, M.D.
EXECUTIVE STAFF
Wan Yeap, M.D.
Medical Director
PRIMARY CONTACT
Annie Hsu Shieh
Senior Compliance Counsel
(626) 388-2390, ext. 2885
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . .
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
AHMC Central Health LLC
Acquired on 11/18/2011
2004
2004
For profit
90 full time
26,595 (as of 2/1/15)
IPAs, Direct Contracting with Physicians
38
62
5,965
888
11,444
Physicians – primary care (ranked by method). . . . . . . . . . Capitation, Fee-For-Service
Physicians – specialty (ranked by method). . . . . . . . . . . . . Fee-For-Service
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Diagnosis-Related Group, Per Diem
PLAN PRODUCTS
Medicare Advantage. . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Special Needs Plans (SNPs). . . . . . . . . . . . . . . . . . . . . . . HMO
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
50
445 Grant Ave • San Francisco, CA 94108
Ph: (415) 955-8800 • Fax: (415) 955-8818 • www.CCHPhmo.com
EXECUTIVE OFFICER
Brenda Yee
CEO
EXECUTIVE STAFF
Richard Garcia, MD
Medical Director
Amy Tsui
CFO
Larry Loo
CIO
Carmen Dobry
Director, Regulatory
Affairs and Corporate
Compliance Officer
PRIMARY CONTACT
Carmen Dobry
Director, Regulatory
Affairs and Corporate
Compliance Officer
(415) 955-8800
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . . . Chinese Hospital Association
Tax Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profit
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1984
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1985
Model Types (ranked in descending order). . . . . . . . . . . . . Network of Medical Groups and
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Independent Practice Associations (IPAs)
Number of medical groups/IPAs. . . . . . . . . . . . . . . . . . . . 1 contracted
Number of hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 contracted
Number of physicians. . . . . . . . . . . . . . . . . . . . . . . . . . . 449 contracted
Number of other licensed clinicians. . . . . . . . . . . . . . . . . 8 contracted
Fee-For-Service
Fee-For-Service
Capitation, Per Diem, Discounted Charges,
Differential by Service Type, Case Rates
PLAN PRODUCTS
Covered California (SHOP). . . . . . . . . . . . . . . . . . . . . . . .
Active Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
HMO
HMO
HMO
HMO
HMO
HMO
PPO
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Durable Medical Equipment. . . . . . . . . . . . . . . . . . . . . . .
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
HMO
HMO
HMO
51
400 N. Brand Boulevard, #400 • Glendale, CA 91203
Ph: (818) 500-6262 • Fax: (818) 500-6365 • www.cigna.com/healthcare
CALIFORNIA
OFFICE LOCATIONS
Glendale
Irvine
San Francisco
San Diego
Visalia
Walnut Creek
EXECUTIVE OFFICERS
Peter B. Welch
President, Northern CA
Gene Rapisardi
President, Southern CA
Anand Raghavan
CFO
Jennifer Gutzmore
Regional Medical
Executive
Maricel Del Rosario, R.N.
Director of Health Services
Valerie James
Quality Management
and Credentialing
Michelle Demonteverde
Regional Vice President,
Provider Contracting/
Services
Scott Hamilton
Services, Northern
California
Teri Lauenstein
Services, Southern
California
Karen Baker
Claims Manager
Kathy O’Neal
Customer Service
Manager
William S. Jameson
Chief Counsel
PRIMARY CONTACTS
Crystal Jack
(818) 500-6467
Amy Szable
Public Affairs
(440) 934-5385
52
PLAN ORGANIZATION
Parent Company/Affiliates. . . . . . . . . . . . . . . . . . . . . . . .
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HealthSource, Inc./Cigna Dental Health of CA, Inc.,
Cigna Behavioral Health of CA, Inc. (CBH),
Connecticut General Life Insurance Company (CGLIC)
None
1929
1979
For profit
116 full time
995,515 total members
188,645 California HMO and Open Access
806,870 California PPO and Open Access Plus
(offered by CGLIC)
Physicians – primary care (ranked by method). . . . . . . . . . Group Capitation, Fee-For-Service
Physicians – specialty (ranked by method). . . . . . . . . . . . . Group Capitation, Fee-For-Service
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Per Diem, Capitation, Case Rates, Discounted Charges
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
OAP, POS
HMO, POS, OA, OAP, PPO
HMO, POS, OA, OAP, PPO
None
None
None
Medicare Part D
None
None
None
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OA, OAP, PPO
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OAP, PPO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cigna Dental HMO & PPO
Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OAP, PPO
Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . CGLIC
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CGLIC
Accidental Death & Dismemberment. . . . . . . . . . . . . . . . CGLIC
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OAP, PPO
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CBH
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OAP, PPO
Durable Medical Equipment. . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OAP, PPO
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OAP, PPO
Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . CGLIC
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . International
2420 Fenton Street, Suite 100 • Chula Vista, CA 91914
Ph: (619) 422-0422 • Fax: (619) 422-5930 • www.chgsd.com
EXECUTIVE OFFICERS
Norma Diaz
Scott Carroll
Jonathan Tamayo
Edward D. Hutt, M.D., M.B.A.
Ann Warren
Chief Regulatory &
Human Resources Officer
EXECUTIVE STAFF
Richard Rifenbark, Esq.
Chief Legal Counsel
Noreen Koizumi, Pharm.D.
Director of Pharmacy
Nora Pintado
Director of Claims
David Ritchie
Director of Contract
Administration
PRIMARY CONTACT
Ann Warren
(619) 498-6516
PLAN ORGANIZATION
Recent mergers or acquisitions within California. . . . . . . . None
Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1982
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1985
Number of employees (full time/part time). . . . . . . . . . . . 192 full time, 5 part time
Direct Contracts with Physicians
0 owned, 556 contracted (pcp)
Fee-For-Service, Individual Capitation,
Group Capitation
Per Diem, Discounted Charges, DRG
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
None
None
None
None
HMO
None
None
Cal MediConnect
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . None
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
53
Contra Costa Health Plan (Contra Costa County Medical Services)
595 Center Avenue, Suite 100 • Martinez, CA 94553
Ph: (925) 313-6000 • Fax: (925) 313-6002 • www.contracostahealthplan.org
EXECUTIVE OFFICERS
Patricia Tanquary, MPH, Ph.D.
CEO
Patrick Godley
CFO
David J. Runt
CIO
EXECUTIVE STAFF
James Tysell, M.D.
Medical Director
Frank Lee, J.D.
Chief Legal Counsel
Wendy Mailer
Marketing, Sales and
Outreach Manager
Luke Lim, R.Ph
Pharmacy Director
Judi Louro
Member Services Manager
Terri Lieder
Provider Relations Manager
Kevin Drury
Director of
Quality Management
PRIMARY CONTACTS
Frank Lee, J.D.
(925) 313-6082
Judi Louro
Public Affairs
(925) 313-6000
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . . . Division of Contra Costa County Health Services Dept.
Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1973
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1973
Number of employees. . . . . . . . . . . . . . . . . . . . . . . . . . . 164 full time, 30 part time
Staff, Direct Contracting with Physicians
Physicians – primary care (ranked by method). . . . . . . . . . Fee-For-Service, Salary
Physicians – specialty (ranked by method). . . . . . . . . . . . . Fee-For-Service, Salary
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Per Diem, Diagnosis-Related Group
PLAN PRODUCTS
Covered California (Individual Market . . . . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
HMO
None
None
None
None
None
HMO
None
None
Commercial: In-Home Support Service Workers: HMO
Public: Basic Health Care – County Indigent Program,
plus Pharmacy-Only Program, Medicare Cost Plan
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
54
10803 Hope St. • Suite B • Cypress CA 90630
Ph: (866) 999-3945 • Fax: (877) 999-3945 • www.easychoicehealthplan.com
EXECUTIVE OFFICERS
Margaret Anderson
State President
Richard Nguyen, MD
Medical Director
EXECUTIVE STAFF
Rick Desai
VP Field Network
Management
Rachael Rudd
Sr. Director State Operations
Karen VanDyke
Sr. Director Human
Resources
Sara Dersch
Director of Finance
Karen Driskill
Sr. Director Field
Health Services
Emmalou Torres-Cabrera
Director Quality
Improvement
Elizabeth Gianini
Director State
Government Affairs
Ron McGinnis
Director Regulatory
Compliance
Koh Kerdsri
VP I.T., QA, & Compliance
PRIMARY CONTACTS
Ron McGinnis
Directory Regulatory
Compliance
(714) 226-2550
Elizabeth Gianini
Director State
Government Affairs
(714) 269-5190
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . . . WellCare Health Plans, Inc.
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2006
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2007
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profit
Number of Medical Groups/IPAs. . . . . . . . . . . . . . . . . . .
Delegated IPA
69 contracted
131 contracted
14,774 contracted
845 contracted
14,498 contracted
Physicians – specialty (ranked by method). . . . . . . . . . . .
4,842 Capitated
10,369 Fee-For-Service
131 Fee-For-Service contracts;
7 Capitated
PLAN PRODUCTS
Small group (2 – 50 employees) . . . . . . . . . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
Yes
None
None
Yes
No
None
None
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Accidental Death & Dismemberment . . . . . . . . . . . . . . . . None
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Other (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . Transportation
55
4550 California Avenue, Suite 100, Bakersfield, CA 93309
Ph: (661) 716-8800 • Fax: (661) 716-4820 • www.gemcarehealthplan.com
CALIFORNIA
OFFICE LOCATIONS
Corporate Office
4550 California Ave., Ste. 100,
Bakersfield, CA 93309
San Luis Obispo
EXECUTIVE OFFICER
Ken Wood
President and CEO
PRIMARY CONTACT
Michael Myers
Chief Operations
Administrator
(661) 716-8820
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .
California Physicians’ Service,
dba Blue Shield of California
None
2006
2006
For profit
35 full time
21,364 (20,962 HMO, 402 PPO)
Single Medicare Group IPA, Ancillary, Hospital
PLAN PRODUCTS
Individual market. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
N/A
HMO Commercial, PPO Commercial
HMO Commercial; PPO Commercial
HMO
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .
Other (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Gold Coast Health Plan (Ventura County Medi-Cal Managed Care Commission)
711 Daily Drive • Suite 106 • Camarillo, CA 93010
Ph: (888) 301-1228 • Fax: (805) 437-5132 • www.goldcoasthealthplan.org
EXECUTIVE OFFICER
Albert Reeves, M.D.
Ruth Watson
Interim CEO &
Chief Operations Officer
EXECUTIVE STAFF
Guillermo Gonzalez
Director of
PRIMARY CONTACT
Guillermo Gonzalez
Director of
(805) 437-5533
Public Affairs
see Primary Contact
PLAN ORGANIZATION
Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None None
July 1, 2011
Non profit
148 full time, 1 part time
178,984 PLAN-PROVIDER ARRANGEMENTS
Model types (ranked in descending order)
Number of Medical Groups/IPAs . . . . . . . . . . . . . . . . . . . 3 contracted Number of hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Number of physicians. . . . . . . . . . . . . . . . . . . . . . . . . . . 585 Number of other licensed clinicians. . . . . . . . . . . . . . . . . 189 COMPENSATION METHODS
Physicians – primary care (ranked by method). . . . . . . . . CAP/FFS
Physicians – specialty (ranked by method). . . . . . . . . . . . FFS/CAP
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Per Diem
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None Yes
None
None
None
None
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Denti-Cal
Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . Yes Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Carve Out
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Behavioral Health
57
CALIFORNIA
OFFICE LOCATIONS
Bakersfield, Chatsworth,
Fresno, Huntington Beach,
Modesto, Oakland,
Pasadena, Rancho Cordova,
San Bernardino, San Diego,
San Jose, San Rafael,
Stockton, Woodland Hills
NATIONAL
EXECUTIVE OFFICERS
Jay M. Gellert
National President and CEO
Steven Tough
President,
Government Programs
James E. Woys
Executive Vice President,
COO and CFO
Patricia Clarey
State Health Programs and
Regulatory Relations Officer
Angelee Fox Bouchard
Senior VP and
General Counsel/Secretary
Karin Mayhew
Senior VP of
Organization Effectiveness
Scott Law
Health Care Services Officer
Juanell Hefner
Chief Compliance and
Administration Officer
Patricia Buss, M.D.
Medical and Health Care
Services Officer
Dan Lieberman
Chief Marketing Officer
CALIFORNIA
EXECUTIVE OFFICERS
Steven Sell
President, Western Region
Health Plan and President,
Scott St. Clair
VP, Sales
Larry Tallman
VP, Sales
Eric Hause
VP, Strategy and
Business Development
EXECUTIVE STAFF
Douglas Schur
VP and Deputy General Counsel
PRIMARY CONTACTS
Dan Chick
(916) 552-5285
Brad Kieffer
Communications
(818) 676-6833
58
21281 Burbank Blvd. • Woodland Hills, CA 91367
Ph: (818) 676-6775 • Fax: (818) 676-6992 • www.healthnet.com
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . . . Health Net, Inc.
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1979
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1979
Number of employees. . . . . . . . . . . . . . . . . . . . . . . . . . . 8,000
Health Plan Enrollment. . . . . . . . . . . . . . . . . . . . . . . . . . 2,700,000 California
6,000,000 National
Network of Medical Groups or IPAs,
0 owned,171 contracted
Physicians – primary care (ranked by method). . . . . . . . . . Group Capitation, Other (RBRVS)
Physicians – specialty (ranked by method). . . . . . . . . . . . . Group Capitation, Other (RBRVS)
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Per Diem, Capitation, Discounted Charges
PLAN PRODUCTS
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO, EPO, HSP
HMO, PPO, EPO, HSP
PPO
HMO, PPO
HMO, PPO, POS, EPO, Indemnity, ASO
HMO, PPO
Medicare Supplement
HMO
HMO
None
Salud Con Health Net: HMO
ANCILLARY PRODUCTS
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, ASO, EPO, Medicare HMO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS, EPO, Indemnity
Accidental Death & Dismemberment. . . . . . . . . . . . . . . . HMO, PPO, POS, EPO, Indemnity
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, ASO, EPO, Medicare HMO
Durable Medical Equipment. . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Health Plan of San Joaquin (San Joaquin County Health Commission)
7751 S. Manthey Road • French Camp, CA 95231
1012 10th Street • Modesto, CA 95354
Ph: (209) 942-6300 • Fax: (209) 942-6305 • www.hpsj.com
EXECUTIVE STAFF
Amy Y. Shin
Jennifer Dinwoodie
Lakshmi Dhanvanthari, MD
Vacant
Cheron Vail
David Hurst
Vice President,
External Affairs
Alejandra Clyde
Compliance Officer
Victoria Hazen
Vice President,
Human Resources
PRIMARY CONTACTS
Alejandra Clyde
(209) 461-2265
David Hurst
Public Affairs
(209) 461-2241
PLAN ORGANIZATION
Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . None
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1995
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1996
Tax status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profit
Number of employees. . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 full time
Health Plan Enrollment. . . . . . . . . . . . . . . . . . . . . . . . . . . 270,535
Network of Medical Groups and IPAs
Individual Capitation, Group Capitation
Fee-For-Service including Withhold or Bonus,
Group Capitation
Per Diem – APR – DRG
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
None
None
None
HMO
HMO
None
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Durable Medical Equipment. . . . . . . . . . . . . . . . . . . . . . None
59
Health Plan of San Mateo (San Mateo Health Commission)
701 Gateway Boulevard, Suite 400 • So. San Francisco, CA 94080
Ph: (650) 616-0050 • Fax: (650) 616-0060 • www.hpsm.org
EXECUTIVE OFFICER
Maya Altman
EXECUTIVE STAFF
Ron Robinson
Director of Finance and
Administrative Services
Chris Baughman
Director of Compliance
and Regulatory Affairs
Chris Esguerra, M.D.
Interim Medical Director
Joy Sarraga
Director of Health Services
Edward Ortiz
Director of Provider
Network Development
and Services
Carolyn Thon
Director of Member
Services and Outreach
Eben Yong
Director of MIS
Chris Baughman
Director of System
Improvement
Cindy Lem
Director of Human
Resources
Khoa Nguyen
Manager of Governmental
Affairs and Business
Development
PRIMARY CONTACT
Chris Baughman
Director of Compliance
and Regulatory Affairs
(650) 616-0050
60
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1986
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1987
Physicians–primary care (ranked by method). . . . . . . . . .
Fee-For-Service and Capitation,
depending on line of business
Fee-For-Service
DRG, APC, Per Diem, and Fee-For-Service,
depending on hospital and line of business
PLAN PRODUCTS
Medicare-Medicaid Plan. . . . . . . . . . . . . . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
None
HMO
HMO
None
None
HMO
HMO
None
Public: In-Home Supportive Service
Workers in San Mateo: HMO
Third Party Administrator for County Indigent Programs
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Long-term Health Care. . . . . . . . . . . . . . . . . . . . . . . . . .
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Accidental Death & Dismemberment. . . . . . . . . . . . . . . .
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Workers’ Compensation. . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
HMO
HMO
HMO
HMO
None
None
HMO
HMO
None
HMO
HMO
None
None
8510 Balboa Boulevard, Suite 285 • Northridge, CA 91325
Ph: (818) 654-3461 • Fax: (818) 654-3460 • www.heritageprovidernetwork.com
EXECUTIVE OFFICERS
Richard N. Merkin, M.D.
President
S. Ian Drew, M.D.
Medical Director
Jaya Kurian
CFO
Rich Lipeles
COO
EXECUTIVE STAFF
Scott Bae
Information Technology
PRIMARY CONTACTS
Jaya Kurian
(818) 654-3461
Ann Wymer
(310) 823-5250
Rich Lipeles
Public Affairs
(714) 908-5613
PLAN ORGANIZATION
Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . .
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
0
1996
1997
For profit
3,162 full time
N/A
Number of medical groups . . . . . . . . . . . . . . . . . . . . . . .
Number of IPAs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of PCP, Specialists . . . . . . . . . . . . . . . . . . . . . . .
112 contracted
3,369 PCPs, 8,791 Specialists
433 owned (salaried)
71 contracted
Physicians-primary care (ranked by method). . . . . . . . . . .
Physicians-specialty (ranked by method) . . . . . . . . . . . . .
Other (Fee schedule), Group Capitation,
Individual Capitation, Salary
Other (Fee schedule), Group Capitation
Per Diem, Case Rates, Discount Charges
PLAN PRODUCTS
PRODUCTS CURRENTLY SERVED
Small group (2 – 50 employees) enrollment. . . . . . . . . . . .
Large group (50+ employees) enrollment . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO, PPO
HMO
HMO, POS
HMO, Supplemental, FFS
HMO, FFS
None
HMO
None
None
HMO
PPO, FFS
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
None
None
None
None
None
None
None
None
FFS Contract
Industrial Physical, Champus
61
10801 Sixth Street, Suite 120 • Rancho Cucamonga, CA 91730
Ph: (909) 890-2000 • Fax: (909) 890-2019 • www.iehp.org
EXECUTIVE OFFICER
PLAN ORGANIZATION
Rohan Reid
Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Susan Arcidiacono
Chief Marketing Officer
Bradley P. Gilbert, M.D., M.P.P.
EXECUTIVE STAFF
Kurt Hubler
Chief Network Officer
Laura Holden
William Henning, D.O.
Marcia Anderson,
BSN, RN, CCM, CDMS
Chief of Medical Services
Michael Deering
Steve Sohn, Esq.
Legal Counsel
PRIMARY CONTACT
Bradley P. Gilbert, M.D., M.P.P.
Government Relations/
Public Affairs
(909) 890-2010
Model types (ranked in descending order). . . . . . . . . . . . .
None
None
1994
1996
Not-for-profit
1,157 full time
1,018,642
Network of IPAs and Direct Physician Contracting
18 contracted
35 contracted
3,426 contracted
1,720 contracted
8,240 contracted
Physicians – primary care (ranked by method). . . . . . . . . . Individual Capitation, Fee-For-Service
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Per Diem, Diagnosis-Related Group
PLAN PRODUCTS
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Small group (2 – 50 employees). . . . . . . . . . . . . . . . . . . . None
Large group (50+ employees). . . . . . . . . . . . . . . . . . . . . None
Medicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Medigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . None
Special Needs Plans (SNPs). . . . . . . . . . . . . . . . . . . . . . . HMO
Medicare Part D stand-alone. . . . . . . . . . . . . . . . . . . . . . None
Access for Infants and Mothers. . . . . . . . . . . . . . . . . . . . None
Medi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . HMO
Healthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Major Risk Medical Insurance/GIP. . . . . . . . . . . . . . . . . . None
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Massage Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
62
None
None
None
None
None
None
None
None
None
None
None
None
None
None
300 South Park Avenue • Pomona, CA 91769-6002
Ph: (909) 623-6333 • Fax: (909) 397-9039 • www.ivhp.com
EXECUTIVE OFFICERS
Ronald H. Bolding
CEO
Bob Peters
CFO
EXECUTIVE STAFF
Susan Tenorio, R.N.
Vice President
Health Operations
Ken Smith, M.D.
Cyndie O’Brien
Vice President
Sales and Marketing
Larry Baca
Sales Director
Michelle Hageman
Provider Relations
Judy Johnson
Member Relations
Bill Chen
IT Director
PRIMARY CONTACTS
Gail Blacklock
(909) 623-6333
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
1979
1979
Non profit
110 full time
21,000 (Medicare Only)
Model types (ranked in descending order). . . . . . . . . . . . Network of Medical Groups and IPAs
Number of medical groups/IPAs. . . . . . . . . . . . . . . . . . . . 0 owned, 14 contracted
Number of hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 50 contracted
Physicians – primary care (ranked by method). . . . . . . . . . Group Capitation
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Capitation, Per Diem
PLAN PRODUCTS
Medicare Advantage. . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Cyndie O’Brien
Public Affairs
(909) 623-6333
63
CALIFORNIA
OFFICE LOCATIONS
See website for most updated list
of all office locations. www.kp.org
EXECUTIVE OFFICERS
Bernard J. Tyson
Chairman and National CEO
Gregory A. Adams
Group President and Regional
President, Northern California
Benjamin K. Chu, M.D.
Group President and Regional
President, Southern California
Daniel P. Garcia
Chief Compliance Officer
Wade Overgaard
California Health Plan Operations
Kathryn Lancaster
Executive Vice President and
National Chief Financial Officer
Michael D. Rowe
Chief Financial Officer and
Senior Vice President of Finance,
Northern California
George A. Disalvo
Senior Vice President and Chief
Financial Officer, Southern California
Richard Daniels
Senior Vice President and Interim
Charles E. Columbus
Chief Human Resources Officer
Paul M. Swenson
Chief Strategy Officer
Robert M. Pearl, M.D.
Executive Medical Director and CEO,
Northern California
Edward M. Ellison, M.D.
Executive Medical Director and Chairman
of the Board, Southern California
Sandra Golze
VP and Regional Counsel,
Northern California
John Yamamoto
Vice President and Assistant General
Counsel, Southern California
Christine Paige
Marketing and Internet Services
Alan T. Kiyohara, Pharm.D.
VP Pharmacy Operations and Services,
Southern California
Suzanne B. Shea
VP Pharmacy Operations and Services,
Northern California
PRIMARY CONTACTS
John Garcia
Vice President Legal and Government
Relations, Northern California
(916) 448-3209
Yvette Radford
Vice President External and Community
Affairs, Northern California
(510) 987-4190
Diana Halper
Vice President, Communications and
Media Services, Southern California
(626) 405-5890
Debby Cunningham
SVP Strategy and Business
Development, Northern California
(510) 987-3995
Deborah Espinal
Executive Director of Policy,
Health Plan Regulatory Services
(510) 393-6574
64
Lisa Koltun
Vice President, Health Plan
Regulatory Services
(510) 625-7028
Kaiser Permanente (Kaiser Foundation Health Plan, Inc.)
Northern California Region • 1950 Franklin Street, 20th Floor • Oakland, CA 94612
Ph: (510) 987-1000 • Fax: (510) 987-4303
Southern California Region • 393 East Walnut Street • Pasadena, CA 91188
Ph: (626) 405-5000 • Fax: (626) 405-2583
www.kaiserpermanente.org
PLAN ORGANIZATION
Parent Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1945
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1977
Number of employees. . . . . . . . . . . . . . . . . . . . . . . . . . . .174,569 total (108,871 full-time; 65,698 part-time)
Health Plan Enrollment. . . . . . . . . . . . . . . . . . . . . . . . . . 9,528,467 Nationally
3,600,080 Northern California
3,783,555 Southern California
Number of physicians. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Group Model HMO
0 owned, 2 exclusive contracts (TPMG, SCPMG)
35 owned, 11 Plan contracted
16,945 TPMG & SCPMG, 2,644 contracted
5,564 TPMG & SCPMG, 471 contracted
12,687 offices
Physicians – specialty (ranked by method). . . . . . . . . . . . . Group Capitation
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Cost Reimbursement (Kaiser)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Discounted Charges, Per Diem, Case Rates (non-Kaiser)
PLAN PRODUCTS
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
HMO, Other
HMO, Other
HMO, PPO, Other
HMO, POS, PPO, Other
HMO (with and without Part D)
HMO
HMO
HMO
HMO
HMO
ANCILLARY PRODUCTS
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, Other
Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Durable Medical Equipment. . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS
Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . Injury Care and Occupational Health and Safety Services
Kern Family Health Care (Kern Health Systems)
9700 Stockdale Highway • Bakersfield, CA 93311
Ph: (661) 664-5000 • Fax: (661) 664-5178 • www.kernfamilyhealthcare.com
EXECUTIVE OFFICERS
Douglas A. Hayward
President and CEO
Robert Landis
Alan Avery
Richard Pruitt
Chandrakala Gowda,
M.D., M.B.A.
EXECUTIVE STAFF
Beverly Dolberg, M.D.
Medical Director
Irwin Harris, M.D.
Associate Medical Director
Deborah Murr, R.N.
Administrative Director
of Health Services
Louis Iturriria
Director of Marketing and
Member Services
Bruce Wearda, Pharm. D.
Director of Pharmacy
Anita Martin
Director of Human Resources
Carl R. Breining, CHC
Director of Compliance and
Regulatory Affairs
Emily Silva
Director of Provider Relations
PRIMARY CONTACTS
Jeremy McGuire
Louis Iturriria
Public Affairs
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
1994
1996
Non profit
270 full time
175,857 (Medi-Cal)
Physicians – primary care (ranked by method). . . . . . . . . . Fee-For-Service
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Fee-For-Service
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
None
None
None
None
HMO
None
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
None
None
None
None
None
None
None
None
None
None
65
L.A. Care Health Plan (Local Initiative Health Authority for Los Angeles County)
1055 W 7th Street, 10th Floor • Los Angeles, CA 90017
Ph: (213) 694-1250 • Fax: (213) 694-1246 • www.lacare.org
EXECUTIVE OFFICERS
John Baackes
John R. Wallace
Trudi Carter, M.D.
Tim Reilly
Jonathan Freedman
Chief of Strategy,
Regulatory and
External Affairs
Augustavia Haydel, Esq.
General Counsel
Robert Turner
Chief of Human Resources
PRIMARY CONTACTS
Cherie Fields
(916) 930-0043
Francisco Oaxaca
Public Affairs
(213) 694-1250
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
1994
1997
Not-for-profit
1,400
1,500,000
Network of Medical Groups and IPA’s Plan
Partner/Delegated; Direct Contracting
with Physicians
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Per Diem, Diagnosis Related Groups, Capitation,
Case Rates, Discount Charges,
Differential by Service Type
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
None
None
None
None
None
None
None
HMO
HMO
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
66
200 Oceangate, Suite 100 • Long Beach, CA 90802
Ph: (562) 499-6191 • Fax: (562) 499-6170 • www.molinahealthcare.com
CALIFORNIA
OFFICE LOCATIONS
Sacramento
2180 Harvard St., Suite 500
Inland Empire
887 E 2nd Street
2nd Floor
Pomona, CA 91766-2009
San Diego
9275 Sky Park Court,
Suite 400
San Diego, CA 92123
El Centro
1607 W. Main Street
El Centro, CA 92243-2212
EXECUTIVE OFFICERS
Richard Chambers
President
James Novello
Plan Chief Operations Officer
Rajeev Narula
VP Finance & Analytics
James Cruz, MD
CMO
EXECUTIVE STAFF
Deborah Miller
VP Health Care Services
Yunkyung Kim
AVP Government Contracts
Carl Gardner, Esq.
Legal Counsel
Michelle Espinoza
VP Network Management
PRIMARY CONTACTS
Yunkyung Kim
AVP Government Contracts
(562) 491-7004
Cameron Smyth
AVP State Affairs
(661) 505-2269
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Molina Healthcare, Inc.
None
1980
1994
For profit
682 full time
2,546,572 National
528,980 California
Direct Contracting with Physicians, Staff
2 exclusive, 82 contracted
1 affiliated, 90 contracted
13,792 contracted
2,272 contracted
19 exclusive, 12,399 contracted
Group Capitation, Individual Capitation,
Salary, Fee-For-Service
Fee-For-Service, Capitation
Per Diem, Capitation
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
None
None
None
HMO
None
HMO
None
HMO
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
67
11 Technology Drive • Irvine, CA 92618
Ph: (949) 923-3350 • Fax: (949) 923-3585 • www.monarchhealthplan.com
EXECUTIVE OFFICERS
Nancy Boerner, MD
CEO
Jay Cohen, MD
Executive Chairman,
Board of Directors
EXECUTIVE STAFF
Karen Goldstein
General Manager
PRIMARY CONTACT
Karen Goldstein
General Manager
(949) 923-3350
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Monarch Healthcare, A Medical Group, Inc.
None
2007
2007
Profit
16 FTE’s
MHP takes global risk for other
Health Plans’ members
Network of Medical Groups and
Independent Practice Associations (IPAs)
1 contracted
15 contracted
None
None
None
Physicians – primary care (ranked by method). . . . . . . . . None
Physicians – specialty (ranked by method). . . . . . . . . . . . None
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Diagnosis Related Group
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
None
None
None
None
None
None
None
MHP takes global risk for other
Health Plans’ members
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Chiropractic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Other (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . None
68
On Lok Lifeways (On Lok Senior Health Services)
1333 Bush Street • San Francisco, CA 94109
Ph: (415) 292-8888 • Fax: (415) 292-8745 • www.OnLok.org
EXECUTIVE OFFICERS
Robert E. Edmondson
CEO
Kelly Walsh
CFO
Jay Luxenberg, MD
Grace Li
Eileen Kunz
Chief of Government
Affairs and Compliance
PRIMARY CONTACTS
Eileen Kunz
(415) 292-8722
Robert Novelli
Public Affairs
(415) 292-8711
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
On Lok, Inc.
None
1971
1999
Non profit
1,337
Staff Model
20 employed, 350 contracted
Physicians – primary care (ranked by method). . . . . . . . . . Employed
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
None
None
None
None
None
None
None
PACE: HMO
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Durable Medical Equipment. . . . . . . . . . . . . . . . . . . . . . None
Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
69
4665 Business Center Drive • Fairfield, CA 94534
Ph: (707) 863-4100 • Fax: (707) 863-4117 • www.partnershiphp.org
CALIFORNIA
OFFICE LOCATIONS
Headquarters
4665 Business Center Drive
Fairfield, CA 94534
Santa Rosa Office
495 Tesconi Circle
Santa Rosa, CA 95401
Redding Office
3688 Avtech Parkway
Redding, CA 96002
Eureka Office
1036 5th Street, Suite E
Eureka, CA 95501
EXECUTIVE OFFICERS
Jack Horn
Executive Director/
Elizabeth Gibboney
Deputy Executive Director/
Patti McFarland
Robert Moore, MD, MPH
Kirt Kemp
Margaret Kisliuk
Executive Director,
Northern Region
Robert Layne
Director of Government
and Public Affairs
Amy Turnipseed
Director of Policy and
Program Development
PRIMARY CONTACT
Robert Layne
Director of Government
and Public Affairs
(707) 420-7690
70
PLAN ORGANIZATION
Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
1994
2005
Non profit
611
502,500
Individual and Group Capitation, Fee-For-Service
Fee-For-Service, Individual Capitation,
Group Capitation
Per Diem, Capitation, Diagnosis-Related Group
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
None
HMO
None
None
HMO
HMO
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
San Francisco Health Plan (San Francisco Health Authority)
201 Third Street, 7th Floor • San Francisco, CA 94103
Ph: (415) 547-7818 • Fax: (415) 615-6435 • www.sfhp.org
EXECUTIVE OFFICERS
John F. Grgurina, Jr.
CEO
EXECUTIVE STAFF
Sunny Cooper
CIO
John Gregoire
CFO
Deena Louie
Nina Maruyama
Officer, Regulatory
(includes Community
Relations and Marketing)
James Glauber, MD, MPH
Sumi Sousa
Officer, Policy Development
and Coverage Programs
PRIMARY CONTACTS
Sumi Sousa
Officer, Policy Development
and Coverage Programs
(415) 615-5121
Nina Maruyama
Officer, Regulatory
(includes Community
Relations and Marketing)
(415) 615-4217
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1997
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1996
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profit/Public Agency
Staff (Kaiser)
0 owned, 2,508 contracted (PCP & Specialists)
0 owned, 287 contracted (Mid-Level providers)
0 owned, 136 contracted (PCP sites)
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Capitation, Fee-For-Service
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
HMO
None
None
None
None
HMO
None
Healthy Workers: HMO
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
None
HMO
HMO
None
None
None
HMO
HMO
None
HMO
HMO
None
None
71
Santa Clara Family Health Plan (Santa Clara County Health Authority)
210 E. Hacienda Avenue • Campbell, CA 95008
Ph: (408) 376-2000 • Fax: (408) 376-2191 • www.scfhp.com
CALIFORNIA
OFFICE LOCATIONS
Ancillary Office
San Jose, CA
(877) 688-7234
Corporate Office
Campbell, CA
(408) 376-2000
Fax: (408) 376-2191
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
1995
1997
Non profit
154,246
EXECUTIVE OFFICERS
Elizabeth Darrow
Dave Cameron
Anthony Solem
Chief Medicare Officer
Jeff Robertson, MD
EXECUTIVE STAFF
Pat McClelland
VP, Member and
Medical Operations
Gary Kaplan
VP of Information
Technology
Jennifer Clements
Director, Provider
Operations
Diane Brown
Sr. Director of Medical
Management and
Quality Improvement
Johanna Liu
Director, Pharmacy
Beth Paige
Compliance and
Privacy Officer
PRIMARY CONTACT
Elizabeth Darrow
Public Affairs
(408) 376-2000
72
Medical Group Capitation, PCP Capitated,
Fee-For-Service including risk sharing
Fee-For-Service, Medical Group Capitation
Per Diem, Capitation, Diagnosis-Related Group
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
None
HMO
None
None
None
None
HMO
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
SCAN Health Plan
®
3800 Kilroy Airport Way, Suite 100 • Long Beach, CA 90806
Ph: (562) 989-5100 • Fax: (562) 989-5200 • www.scanhealthplan.com
EXECUTIVE OFFICERS
Chris Wing
Vinod Mohan
Romilla Batra, M.D.
Vice President,
Corporate Medical Director
Raymond Chan, M.D.
Vice President,
Corporate Medical Director
Nancy Monk
Chief Risk Officer
William Roth
Josh Goode
Chief Technology Officer
Cathy Batteer
and General Manager,
All SCAN Markets
David Milligan
National Sales
Sherry Stanislaw
and General Manager,
Southern California
Peter Begans
Public and
Government Affairs
EXECUTIVE STAFF
Andrew Whitelock
Vice President and
Compliance Officer
Karen Sugano
Vice President and
General Manager,
Northern California
Riaz Ali
Chief Marketing Executive
Sharon Bakshi
Pharmacy Vice President
Kim McBeath
Director, Customer Services
(Member Relations)
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . . . SCAN Group
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1977
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1985
Model types (ranked in descending order). . . . . . . . . . . . Network of Medical Groups and IPAs
Number of medical groups/IPAs. . . . . . . . . . . . . . . . . . . . 0 owned, 67 contracted
Number of hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 121 contracted
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Per Diem, Diagnosis-Related Group, Capitation
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
HMO
None
HMO
None
None
HMO
None
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
PRIMARY CONTACTS
Peter Begans
(202) 756-2279
Sherry Stanislaw
Public Affairs
(562) 989-5216
73
Seaside Health Plan
2840 Long Beach Blvd., Suite 120 • Long Beach, CA 90806
Ph: (562) 933-0950 • Fax: (562) 424-1486 • www.SeasideHealthPlan.org
EXECUTIVE OFFICERS
Wendy Dorchester
CAO
Jay Davis
Barry C. Smith, MD
CMO
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . . . MemorialCare Health System
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2013
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2013
Tax Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non-Profit
Number of employees . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Health Plan Enrollment. . . . . . . . . . . . . . . . . . . . . . . . . . 23,071, CA HMO
PRIMARY CONTACTS
Peter Mackler
(714) 377-2946
Rhoda Weiss
Public Affairs
(562) 933-1622
Network of Medical Group,
IPA’s, and Direct Contracting
0 owned, 326 PCP + 1310 SPC contracted
Physicians – primary care (ranked by method) . . . . . . . . . Group Capitation, Individual Capitation, FFS
Physicians – specialty (ranked by method). . . . . . . . . . . . Group Capitation, Individual Capitation, FFS
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Capitation, Case Rate, DRG, Per Diem
PLAN PRODUCTS
Small group (2 – 50 employees) . . . . . . . . . . . . . . . . . . .
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Plan to Plan
Plan to Plan
Plan to Plan, Direct 100+ Employees
Plan to Plan
Plan to Plan
None
Plan to Plan
None
None
None
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Large Group
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Large Group
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Large Group
Other (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . None
74
Sharp Health Plan
8520 Tech Way, Suite 200 • San Diego, CA 92123
Ph: (858) 499-8377 • Fax: (858) 499-8244 • www.sharphealthplan.com
EXECUTIVE OFFICERS
Melissa Hayden Cook
President and Chief
Executive Officer
Rita Datko
Leslie Pels-Beck
Lori Stone, MD
EXECUTIVE STAFF
Michael Byrd
Business Development
Officer
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . . Sharp HealthCare
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1992
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1992
Physician practices (including specialists). . . . . . . . . . . . .
Network of Medical Groups, IPAs,
Individual Practices, Physician Practices
PRIMARY CONTACTS
Stacy Baker
(858) 499-8237
Leslie Pels-Beck
Public Affairs
(858) 499-8327
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Capitation, Discounted Charges, Per Diem
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
HSA HMO, HMO-1, HMO-2
HMO
HMO, POS
None
None
None
None
None
None
None
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO/Other
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO/PPO
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO/Other
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
75
SIMNSA Health Plan
333 H Street, Suite 6040 • Chula Vista, CA 91910
Ph: (619) 407-4082 • www.simnsa.com
EXECUTIVE OFFICERS
Frank Carrillo
Christina Suggett
Claudia Da Costa
EXECUTIVE STAFF
Elizabeth B. Daniels
Chief Legal Counsel
PRIMARY CONTACT
Elizabeth B. Daniels
Chief Legal Counsel
Government Relations/
Public Affairs
(619) 407-4082, ext. 121
PLAN ORGANIZATION
Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sistemas Medicos Nacionales, SA de CV
None
1980
2000
For profit
250 full time
38,374
Network, Direct Contracts and Staff
3 owned
3 owned groups, 300 contracted
20 contracted
200
Physicians – primary care (ranked by method). . . . . . . . . . Individual Capitation
PLAN PRODUCTS
Small group (2 – 50 employees). . . . . . . . . . . . . . . . . . . . HMO
Large group (50+ employees). . . . . . . . . . . . . . . . . . . . . HMO
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . HMO
76
Sutter Health Plus
2880 Gateway Oaks Drive, Suite 150 • Sacramento, CA 95833
Ph: (855) 325-5200 • Fax: (916) 614-2487 • www.sutterhealthplus.org
EXECUTIVE OFFICERS
Steve Nolte
Robert Caione
Jennifer Schirmer
VP, Operations
Monica Majors
VP, Strategic Sales
& Marketing
Robert Carnaroli
VP, Commercial Sales
Jennifer Nuovo, MD
EXECUTIVE STAFF
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sutter Health
N/A
2012
2013
Non profit
58 fulltime FTE
13,500
Network of Medical Groups and IPAs 4 contracted
9 contracted
1,800 contracted
Not tracked – N/A
Not tracked – N/A COMPENSATION METHODS
Michael Poole
Compliance Officer
Physicians – primary care (ranked by method). . . . . . . . . Group Capitation Physicians – specialty (ranked by method). . . . . . . . . . . . Group Capitation
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Capitation; Per diem PRIMARY CONTACT
PLAN PRODUCTS
Sy Neilsen
Communications
(916) 292-0666
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
HMO and HSA eligible HMO
HMO and HSA eligible HMO
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
HMO
HMO
HMO
N/A
N/A
N/A
HMO
HMO
Individual and Small Group HMO
HMO
HMO
N/A
N/A
77
5995 Plaza Drive • Cypress, CA 92630
Ph: (714) 952-1121 • Fax: (866) 383-0428 • www.uhcwest.com or www.securehorizons.com
EXECUTIVE OFFICERS
Brandon Cuevas
President and CEO
John Wolterbeek
Jeffrey Mason, MD
Medical Director
Claire Hannan
VP Operations
Joy Higa
VP Regulatory Affairs
Alexander Uhm
PRIMARY CONTACT
Elizabeth Hays
Regulatory Affairs
(714) 226-3106
PLAN ORGANIZATION
Parent Company/Affiliate. . . . . . . . . . . . . . . . . . . . . . . . . UnitedHealth Group
Ultimate Parent Company. . . . . . . . . . . . . . . . . . . . . . . . UnitedHealth Group
Health plan products and services are offered by UnitedHealthcare of California,
Indemnity insurance products (including PPO, medical, dental, life/AD&D and short term
disability products) are underwritten by UnitedHealthcare Insurance Company.
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1975
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1978
Number of employees. . . . . . . . . . . . . . . . . . . . . . . . . . . 5,000+ UHG employees
44,343 contracted
27,512 contracted
Physicians – primary care (ranked by method). . . . . . . . . Depends on IPA/PMG subcontracts
Physicians – specialty (ranked by method). . . . . . . . . . . . Depends on IPA/PMG subcontracts
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Capitation, Per Diem
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
HMO
HMO
None
by affiliate
None
by affiliate
None
None
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PPO
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO
Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other
Accidental Death & Dismemberment. . . . . . . . . . . . . . . . Other
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO
Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO
Durable Medical Equipment. . . . . . . . . . . . . . . . . . . . . . . HMO, PPO
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Infertility: HMO, PPO
78
Valley Health Plan (Santa Clara County)
2480 North 1st Street, Suite 200 • San Jose, CA 95131
Ph: (408) 885-4080 • Fax: (408) 885-5921 • www.valleyhealthplan.org
EXECUTIVE OFFICERS
(ACTING)
Pat Cox, RN
CEO
Vacant
COO
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Santa Clara County
N/A
1985
1985
Non profit
100 FTE
120,583
EXECUTIVE STAFF
Dolly Goel, MD
Medical Director
PRIMARY CONTACTS
Georgette Cook
Regulatory Affairs
(408) 885-5606
Joy Alexiou
Public Affairs
(408) 885-4164
Two-Plan Model
5 contracted
5 contracted
839 staff/contracted
400 contracted
COMPENSATION METHOD
Physicians – primary care (ranked by method). . . . . . . . . . Fee-For-Service, Capitation, Salary
Physicians – specialty (ranked by method). . . . . . . . . . . . . Fee-For-Service, Salary
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Capitation, Per Diem, Percentage of Billed
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO
None
HMO
HMO
None
None
None
None
None
HMO
HMO
None
COBRA: HMO
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
79
2220 E. Gonzales Rd., Suite 210B • Oxnard, CA 93036
Ph: (805) 981-5050 • Fax: (805) 981-5026 • www.vchealthcareplan.org
EXECUTIVE OFFICERS
County Board
of Supervisors
EXECUTIVE STAFF
Barry Fisher, MPPA
Health Care
Agency Director
Narcisa Reyes-Egan
Interim Chief
Financial Officer
Dr. Catherine Rajala Sanders
PLAN ORGANIZATION
Year founded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County of Ventura
None
1993
1996
Non profit
52
15,000
Number of medical groups/IPAs . . . . . . . . . . . . . . . . . . .
Number of other (NPs/PAs) . . . . . . . . . . . . . . . . . . . . . . .
Number of provider offices (all specialties) . . . . . . . . . . .
Direct Contract
None
2 County operated, 6 contracted
0 owned, 134 contracted, 55 PCPs
PRIMARY CONTACTS
Dee Pupa
Plan Administrator
(805) 981-5006
Sharon Clack
Fiscal Manager
(805) 981-5002
Physicians – primary care (ranked by method) . . . . . . . . . FFS
Physicians – specialty (ranked by method). . . . . . . . . . . . FFS
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Per Diem, Case Rates, % Charges
PLAN PRODUCTS
HMO
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ANCILLARY PRODUCTS
No
Yes
Yes
No
No
No
No
No
Yes
No
No
No
HMO
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No
Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No
Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . No
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No
Accidental Death & Dismemberment . . . . . . . . . . . . . . . . No
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No
Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . No
Other (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . No
80
2349 Gateway Oaks Drive, Suite 100 • Sacramento, CA 95833
Ph: (916) 563-3180 • Fax: (916) 563-3182 • www.westernhealth.com
EXECUTIVE OFFICERS
Garry Maisel
President and CEO
Rita Ruecker
EXECUTIVE STAFF
Donald Hufford, M.D.
Glenn Hamburg
Chief Client
Services Officer
Bill Figenshu
Chief Sales Officer
Rebecca Downing
Chief Legal Officer
Rick Heron
Chief Marketing and
Brand Officer
Ali Darugar
PRIMARY CONTACTS
Rebecca Downing
(916) 563-3183
Rick Heron
Public Affairs
(916) 614-6009
PLAN ORGANIZATION
Subsidiaries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Year licensed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
None
None
None
1995
1997
Non exempt
108,599
Number of medical groups . . . . . . . . . . . . . . . . . . . . . . .
Number of IPAs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hospitals (ranked by payment type). . . . . . . . . . . . . . . . . Capitation, Discount Charges
PLAN PRODUCTS
Healthy Kids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO, HSA HMO
HMO, HSA HMO
HMO, HSA HMO
HMO, HSA HMO
HMO, HSA HMO, PPO
None
None
None
None
None
None
None
None
None
ANCILLARY PRODUCTS
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO/PPO
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO/PPO
Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health coaching
International travel assistance services
81
Helping people get the services that support
an improved quality of life where they live
NURSE
TRIAGE
TELEPHONIC
URGENT
CARE
POST
DISCHARGE
TRANSITIONAL
SUPPORT
TELEMEDICINE
SUPPORT
CHRONIC
DISEASE
MANAGEMENT
SUPPORT
TRANSPORTATION
HEALTH RISK
ASSESSMENTS
INDEPENDENT
LIVING
SUPPORT
We coordinate delivery of
traditional and non-traditional
health related services
and solutions.
SUPPLY
CHAIN BENEFIT
COORDINATION
& DELIVERY
BIOMETRIC
MONITORING
ER COST
CONTAINMENT
PROGRAMS
MEMBER
ENGAGEMENT
PROGRAMS
Benefits you’ll receive when you choose LogistiCare:
•
•
•
•
•
•
Frees up key staff time
Single point of access for members and care providers
Consistent standards, quality and coordination
24 hour, 7 day per week access
Single Vendor Agreement
Fraud, waste and abuse protection
• Supports bending of cost curve
• Multiple reimbursement models
• Customizable programs
• White-labeled
• Works with existing supply networks
[email protected] | 886.246.5875 | www.logisticare.com
ADVANCING PHARMACY AND
HEALTH MANAGEMENT
Delivering the Most Appropriate Outcome
Argus Health offers modular to full service programs focused on lowering plan
cost, and improving patient and provider quality measures. Our innovative
Clinical Programs integrate pharmacy, medical, and lab data to help plans
address total cost of care. The insights from The Johns Hopkins ACG®
System’s predictive modeling and our proprietary advanced analytics stratify
risk in your member population with greater specificity and sensitivity to
improve the impact of intervention strategies.
Don Abramo
Vice President Sales Operations
[email protected]
724.816.5490
© 2015 Argus Health Systems, Inc.
SCALABLE SOLUTIONS FOCUSED ON
ADVANCING THE BUSINESS
OF HEALTHCARE
DST Health Solutions has a unique blend of industry experience, technological expertise,
and service excellence into their business solutions. Their technology is designed to be
flexible, understanding the need to balance your business and technology integration
needs. Our solutions include:
•
•
•
•
•
Enterprise payer platforms with modular architecture
Population health management with The Johns Hopkins ACG® System
predictive analytics
HCC revenue management
Business performance optimization with prescriptive analytics
Business process outsourcing
We support commercial, individual, and government-sponsored health plans, health
insurance marketplaces, and healthcare providers in achieving the goal of managing the
benefit and delivering the most appropriate care to their members.
Chris
Henry
Chief Revenue Officer
[email protected]
800.272.4799
© 2015 DST Health Solutions
AD CAHP FINAL 1 28 15.indd 1
1/28/15 9:22 AM
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In•de•pend•ent
(adj.) free from control in action or judgment
The specialty drug pipeline is overflowing. Is your PA program consistent,
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Formed in 1999, PerformRx, LLC, is a URAC-accredited, clinician-led pharmacy benefits manager
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We have the missing piece.
Amplifon Hearing Health Care, formerly HearPO,
a voluntary benefit with a difference.
Grow your member base and bottom line.
No cost to you, no member premiums.
More and more health insurance companies across the country are harnessing the power of a
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Learn more by visiting www.amplifonusa.com/cahp
©2015 Amplifon Hearing Health Care, Corp.
2580ROPA
In 1996, we opened our doors with 62,000
members, 600 providers and 40 employees.
Today’s IEHP is healthy, fit and growing fast.
In January 2015, we reached one million
members – with a provider network of more
than 4,000. And, a team of over 1,100.
We serve families with children, adults, seniors,
people with disabilities, and people with both
Medicare and Medi-Cal. They’re enrolled in
Medi-Cal, IEHP DualChoice Cal Medi-Connect
Plan, Medicare Special Needs Plan, and
Healthy Kids.
We’ve been providing quality, accessible
healthcare services to the community. And
doing it in a big way. Did you know that in the
Inland Empire…
•IEHPisthelargest health plan
•IEHPisoneofthelargest employers
•IEHPhasbeenvotedFavorite Overall
Company to work for, Favorite Training
Program, and Favorite Workplace Culture
(According to a 2014 survey by
LA News Group.)
©2015 Inland Empire Health Plan. All Rights Reserved. MK-15-02104
Together with our providers we’ll keep growing
and caring for our Members – now over one
million strong.
Strong Today.
Even Better Tomorrow.

2015 Membership Directory | CAHP

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