2015 membership directory | cahp
TRANSCRIPT
2015
Mem
bers
hip
Dir
ecto
ry
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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
■ 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
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
Letter from the President
We 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.
Our members include for-profit, not-for-profit,
and public full service licensed Knox-Keene
health plans. They serve commercial, Medi-Cal, Medicare, and
Covered California consumers.
The directory also highlights CAHP’s conference sponsors,
Associate and Partner Members, and Health Group Members.
All contribute to the success of CAHP in our representation
of managed health plans in California.
As health care coverage continues to expand, we are focused
on improving California’s Medicaid program and advancing
affordability for the over 22 million Californians receiving
coverage from CAHP’s member plans.
Throughout the year, CAHP hosts a series of issue-based
seminars and our annual conference in Palm Desert. For more
information please visit our website at www.calhealthplans.org.
You will also find a wide variety of resources and information.
Thank you for your interest in the California Association
of Health Plans.
Sincerely,
Charles Bacchi
President & CEO, California Association of Health Plans
Aetna Health of California, Inc .
AIDS Healthcare Foundation
Alameda Alliance for Health
Anthem Blue Cross
Blue Shield of California
California Health & Wellness
CalOptima
CalViva Health
Care1st Health Plan
CenCal Health
Central California Alliance for Health
Central Health Medicare Plan
Chinese Community Health Plan
Cigna HealthCare of California, Inc .
Community Health Group
Contra Costa Health Plan
Easy Choice, A WellCare Company
GEMCare Health Plan, Inc .
Health Net of California
Health Plan of San Joaquin
Health Plan of San Mateo
Heritage Provider Network
Humana
Inland Empire Health Plan
Inter Valley Health Plan
Kaiser Permanente
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
Santa Clara Family Health Plan
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
CAHP IS PROUD TO REPRESENT CALIFORNIA’S HEALTH PLANS, WHICH ENSURE ACCESS TO QUALITY HEALTH CARE FOR OVER 22 MILLION CALIFORNIANS.
2
October 19–21 | 2015
C A H P A N N U A L C O N F E R E N C E
J W M A R R I O T T D E S E R T S P R I N G S R E S O R T & S P A | P A L M D E S E R T
CHARTING THE PATH TO A HEALTHIER CALIFORNIA
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.
CAHP Conference 2014
O C T O B E R 2 0 – 2 2 , 2 0 1 4 | H Y A T T R E G E N C Y H U N T I N G T O N B E A C H
4
CAHP Seminar Series 2014
FEBRUARY 6 • BURBANK MARRIOTT
Making Medi-Cal Work: Quality Care on a Tight Budget
133 ATTENDEES
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:
• DST Health Solutions
• Health Language
• Healthx
• Optum
• Treo Solutions
APRIL 22 • BURBANK MARRIOTT
Advances in Analytics: Shaping Health Care Delivery through Data
120 ATTENDEES
SUPPORTED BY:
• DST Health 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
• DST Health Solutions
• 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:
• DST Health Solutions
• LogistiCare Solutions LLC
• Magellan Rx Management
• Monument Systems LLC
• PerformRx
• Philips Lifeline
• Teva Pharmaceuticals
• Total Transit
• VARIS LLC
5
Garry Maisel | CHAIRMAN OF THE BOARD
Western Health Advantage President & CEO
Peter Welch | VICE CHAIR Cigna HealthCare of California, Inc .President and General Manager
Mark Morgan | SECRETARY/TREASURER Anthem Blue CrossPresident, California
Mark ReynoldsAetna Health of California, Inc .President, Northern California Market
Paul Markovich Blue Shield of California President & CEO
Steven Sell Health Net of California President
Maya AltmanHealth Plan of San MateoExecutive Director
Bradley Gilbert, M.D.Inland Empire Health PlanCEO
Wade OvergaardKaiser Permanente Health PlanSenior Vice President, California Health Plan Operations
Richard ChambersMolina Healthcare of CaliforniaPresident
Jack HornPartnership HealthPlan of CaliforniaCEO
Chris WingSCAN Health PlanPresident & CEO
Melissa Hayden Cook Sharp Health Plan President & CEO
Alex UhmUnitedHealthcare of CaliforniaChief Operating Officer, California
CAHP Board of Directors
PA S T C H A I R P E R S O N S
Paul Markovich . . . . . . . . . . . . . . . . . . . . . . . 2013-2014
Jerry Fleming . . . . . . . . . . . . . . . . . . . . . . . . . 2011-2012
Howard Kahn . . . . . . . . . . . . . . . . . . . . . . . . . 2009-2010
Curtis Terry . . . . . . . . . . . . . . . . . . . . . . . . . . . 2007-2008
David Helwig . . . . . . . . . . . . . . . . . . . . . . . . . 2005-2006
Ken Wood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2002-2005
Mark G . Hyde . . . . . . . . . . . . . . . . . . . . . . . . . 2001-2002
Ron Williams . . . . . . . . . . . . . . . . . . . . . . . . . . 2000-2001
Bruce Bodaken . . . . . . . . . . . . . . . . . . . . . . . 1998-2000
Arthur M . Southam, M .D . . . . . . . . . . . . . 1995-1998
Kathleen Swenson . . . . . . . . . . . . . . . . . . . 1994-1995
R . Judd Jessup . . . . . . . . . . . . . . . . . . . . . . . 1992-1994
Stuart Byer . . . . . . . . . . . . . . . . . . . . . . . . . . . 1987-1992
Anthony Pescetti . . . . . . . . . . . . . . . . . . . . . 1985-1987
Maree Church . . . . . . . . . . . . . . . . . . . . . . . . . 1983-1985
6
Charles BacchiPresident & CEO
Nicole Kasabian EvansVice President, Communications
Nick LouizosVice President, Legislative Affairs
Athena ChapmanDirector, State Programs
Sunshine MooreSenior Policy Analyst
Geri O’NeilBusiness Development Manager
Marjorie PurscellMeeting and Events Manager
Connie FloresAdministrative Services Manager
Selena Coppi HornbackLegislative Assistant
CAHP Staff
7
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Ass
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Mem
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AAAHC Accreditation for Health Plans
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 youwith a set of resources and tools to help you maximize efficient, cost-effective delivery of servicesto your members.
As an approved accrediting body for Qualified Health Plans (QHPs), we stand ready to help youmeet 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].
©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 RY H E A LT H C A R E , I N C . 11
A. Members are treated with respect, consideration, and dignity and are afforded appropriate privacy.
B. Member disclosures and records are treated confidentially, and members are given the opportunity toapprove or refuse their release, except when release is required by law.
Review Guidelines
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 andconcerns are identified.
Scoring
Scoring
All elements of thereview guidelines arepresent.
4 of 5 elements arepresent.
3 or 4 of 5 elements arepresent.
2 of 5 elements arepresent.
1 or no element is present.
Fully Compliant SubstantiallyCompliant
Partially Compliant Minimally Compliant Non-Compliant
Review Guidelines
1. 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.
2. 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.
All elements of thereview guidelines arepresent.
3 of 4 elements arepresent.
2 of 4 elements arepresent.
1 of 4 elements ispresent.
No element is present.
Fully Compliant SubstantiallyCompliant
Partially Compliant Minimally Compliant Non-Compliant
Chapter 1
Member Rights, Responsibilities and ProtectionsAn accreditable organization recognizes the basic human rights of members. Such an organization hasthe following characteristics:
YES NO N/A
YES NO N/A
©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 RY H E A LT H C A R E , I N C . 12
C. Members (or a patient-designated person or legally authorized person) are provided information abouttheir health care and are provided the opportunity to participate in decisions related to their health care.
All elements of thereview guidelines arepresent.
5 of 6 elements arepresent.
3 or 4 of 6 elements are present.
2 of 6 elements arepresent.
1 or no element is present.
Fully Compliant SubstantiallyCompliant
Partially Compliant Minimally Compliant Non-Compliant
D. The organization establishes member rights and makes information available to members and networkprovider staff regarding services, fees, and other issues.
Chapter 1: Member Rights, Responsibilities and Protections
Review Guidelines
1. 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 guidelines1 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 inguidelines 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, progressnotes, etc.).
6. There is evidence of a process for the implementation of interventions to correct identifieddeficiencies.
YES NO N/A
Review Guidelines
Documentation exists for:
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. Payment policies.
7. 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.
YES NO N/A
Scoring
AccreditationHandbook
For Health Plans
A
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3M Health Information SystemsBilling/Claims Processing and IT/Software
David WethereltDirector, Business Development
125 Defreest AvenueTroy, NY 12180P (651) 261-2878dwetherelt@mmm .comwww .3mhis .com
AAAHCAccreditation
Carolyn KurtzVice President and General Counsel
5250 Old Orchard Road, Suite 200Skokie, IL 60077P (847) 853-6060F (847) 853-9028info@aaahc .orgwww .aaahc .org
Acorda Therapeutics, Inc.Biotech Manufacturer
Stephanie Roberts Account Director, West Region
420 Saw Mill River RoadArdsley, NY 10502P (520) 241-8559sroberts@acorda .comwww .acorda .com
Amarin CorporationPharmaceutical
Amy DelacluyseNational Director of Accounts1430 Route 206, Suite 200Bedminster, NJ 07921P (952) 484-5341amy .delacluyse@amarincorp .comwww .amarincorp .com
Amber PharmacySpecialty Pharmacy
Luis TorresVice President, Managed Care
10004 South 152nd StreetOmaha, NE 68138P (888) 703-3551C (407) 616-4626ltorres@amberpharmacy .comwww .amberpharmacy .com
AmgenBiotechnology
Joe GelinasCorporate Account Manager
1822 Calle BorregoThousand Oaks, CA 91360P (805) 313-8135F (805) 435-8174jgelinas@amgen .comwww .amgen .com
APS HealthcareCare Management
Julie FisherSenior Vice President, Development
44 S Broadway, Suite 1200White Plains, NY 10601P (800) 305-3720 ext . 3198F (866) 793-5578 jfisher@apshealthcare .com www .apshealthcare .com
ARIAD PharmaceuticalsPharmaceutical Company
Mike McDoleCorporate Account Director
26 Landsdowne StreetCambridge, MA 02139P (303) 548-8949F (855) 324-1880michael .mcdole@ariad .comwww .ariad .com
ArkrayUSA, Inc.Medical Supplies
Robert WernsmanVP Consumer Health Division
5198 West 76th StreetEdina, MN 55439P (210) 473-1919wernsmanr@arkrayusa .comwww .arkrayusa .com
Availity, LLCHealth Information Network
David FularczykHealth Plan Strategic
10752 Deerwood Park Blvd South, Suite 110Jacksonville, FL 32256P (414) 897-7598C (414) 344-8113 dfularczyk@availity .comwww .availity .com
Associate Members
15
Avanir Pharmaceuticals Inc.Pharmaceutical Manufacturer
Julie BrownAccount Manager
20 Enterprise, Suite 200Aliso Viejo, CA 92656P (425) 876-4760F (949) 362-6265jsbrown@avanir .comwww .avanir .com
AxelaCare Health Solutions, LLCHome Infusion Provider
Joseph ZavalishinEVP, Strategic Contracting & Payer Relations
15501 College BoulevardLenexa, KS 66219P (877) 342-9352jzavalishin@axelacare .comwww .axelacare .com
Beacon Health OptionsHealth Management Services
Mark HeitSVP, Strategy and Development
5665 Plaza Drive, 4th FloorCypress, CA 90603P (978) 270-0379mark .heit@beaconhealthoptions .comwww .beaconhealthoptions .com
BluePeak AdvisorsConsultant
Sherry PoundPrincipal
14648 Sunrise Canyon RoadPoway, CA 92064P (808) 478-3975spound@bluepeakadv .comwww .bluepeakadv .com
Bristol-Myers SquibbPharmaceutical
Sabrina AerySenior State Access Manager
2130 Mountain Boulevard #206Oakland, CA 94611P (510) 336-0807sabrina .aery@bms .comwww .bms .com
Byram HealthcareMedical Supplies
Janet RuehleRVP of Managed Care
120 Bloomingdale Road, Suite 301White Plains, NY 10605P (877) 902-9726jruehle@byramhealthcare .comwww .byramhealthcare .com
Calibrated Healthcare Network LLCBusiness Process Outsourcing
Jovita Montes De OcaCEO
1601 Monte Vista Ave ., Suite 250Claremont, CA 91711P (866) 955-0044F (909) 256-8903jovita@calibratedgroup .com www .calibratedhealthcarenetwork .com
CalPACEAssociation
Peter HanselChief Executive Officer
1315 I Street, Suite 100Sacramento, CA 95814P (916) 469-3368F (916) 428-4250phansel@calpace .orgwww .calpace .org
CAPG, The Voice of Accountable Physician GroupsPhysician Organization Trade Association
Donald H. CranePresident & CEO
915 Wilshire Blvd ., Suite 1620Los Angeles, CA 90017P (213) 624-CAPG (2274)F (213) 683-0032dcrane@capg .orgwww .capg .org
CatamaranPharmacy Benefit Management
Jason PaaschMarketing Specialist
11900 West Lake Park DriveMilwaukee, WI 53224P (414) 760-4722F (630) 577-3101jason .paasch@catamaranRx .comwww .catamaranrx .com
Associate Members
16
CAQHHealthcare Technology & IT Software
Ann BriskDirector, Business Development
1900 K Street NW, Suite 650Washington, DC 20006P (801) 355-6158F (202) 517-0397abrisk@caqh .orgwww .caqh .org
Celgene CorporationBiopharmaceutical
Chris WoolseyNational Account Manager
3433 Raben WayCameron Park, CA 95682P (530) 558-5150F (530) 672-2823cwoolsey@celgene .comwww .celgene .com
Clearwater Compliance LLCCompliance
Bob ChaputCEO
106 Windward Pt . Hendersonville, TN 37075-5108P (800) 704-3394F (966) 734-1181bob .chaput@clearwatercompliance .comwww .clearwatercompliance .com
Coram CVS/Specialty Infusion ServicesHome Infusion Therapy
Jim SepedaStrategic Account Executive
3160 Corporate PlaceHayward, CA 94545P (510) 732-8315F (949) 462-8846Jim .Sepeda@coramhc .comwww .coramhc .com
Daiichi SankyoPharmaceutical Company
Teri Ross, RN Account Manager
2 Hilton Court Parsippany, NJ 07054P (949) 294-1509F (949) 721-8793tross@dsi .comwww .dsi .com
DellIT Services
Pavan BhatnagarServices Account Executive
Marybeth AndersonServices Account Executive
2300 West Plano ParkwayPlano, TX 75075P (925) 522-9458pavan_bhatnagar@dell .commarybeth_anderson@dell .comwww .dell .com/payers
Diplomat Specialty PharmacySpecialty Pharmacy
Dennis BradleySpecialist, Key Accounts
4100 S . Saginaw StreetFlint, MI 48507P (616) 733-0243dbradley@diplomat .iswww .diplomat .is
DST Health Solutions, LLCBPO, IT/Software, Billing/Claims
Jill SingletarySenior Sales Executive
2500 Corporate DriveBirmingham, AL 35242P (214) 695-8372jjsingletary@dsthealthsolutions .comwww .dsthealthsolutions .com
Eisai Inc Pharmaceutical Company
Olaf Reinwald Regional Account Manager
8969 Covey Court Elk Grove, CA 95624 P (916) 417-9580 olaf_reinwald@eisai .com www .eisai .com
EmdeonHealthcare IT Vendor
Pete SarnataroRVP, Payer Sales
P (720) 837-3498psarnataro@emdeon .comwww .emdeon .com
Associate Members
17
EnvisionRxPharmacy Benefit Management
Jason JohnsonSVP, Market Leader Managed Care
531 Santa AnaNewport Beach, CA 92663P (949) 887-0863jajohnson@envisionrx .comwww .envisionrx .com
Essette, Inc.IT–Software
Marc LawrenceSVP Business Development
636 Coffman Street, Suite 300Longmont, CO 80501P (800) 403-8220 ext 134P (303) 500-6933info@essette .comwww .essette .com
Excelsior SolutionsPharmacy Consulting
Ken DowellChairman, Pharmacy Analytics Board
7401 Metro Blvd, Suite 210Edina, MN 55439P (952) 562-5540F (952) 562-5558kdowell@excelsiorsolutions .comwww .excelsiorsolutions .com
Firstsource Solutions USA, Inc.Business Process Management
Nancy MazeSVP Client Relations
4500 Campbell DriveFort Scott, KS 66701P (620) 223-8217F (620) 223-8216nancy .maze@na .firstsource .comwww .na .firstsource .com
FlexTech, Inc.IT Consulting & Services
Craig PfentFounder, President & CEO
445 Butternut DriveHolland, MI 49424P (616) 392-9726F (616) 392-5384cpfent@flextech .comwww .flextech .com
Genomic Health Inc.Medical Diagnostics
Matt MegaAssociate Director, Managed Care Marketing
301 Penobscot DriveRedwood City, CA 94063P (804) 305-7343mmega@genomichealth .comwww .genomichealth .com
GlaxoSmithKlinePharmaceutical Manufacturer
Julie WadeField VP, Regional Accounts West
231 Market Place, Suite 377San Ramon, CA 94583P (925) 855-1300F (925) 855-1311julie .h .wade@gsk .comwww .gsk .com
HealthCare Scouts, Inc.Staffing/Recruiting
CJ RodriguezPresident
2699 Lee RoadWinter Park, FL 32789P (800) 708-0605info@healthcarescouts .comwww .healthcarescouts .com
HealthEdgeIT/Software
Ray DesrochersExecutive VP, Sales & Marketing
30 Corporate DriveBurlington, MA 01803P (781) 285-1300F (781) 419-6183info@healthedge .comwww .healthedge .com
HealthHelpUtilization & Safety Management
Cherrill FarnsworthPresident & CEO
650 North Sam Houston Parkway, Suite 250Houston, TX 77069P (281) 447-7000 ext . 1707F (281) 447-0606farnsworthc@healthhelp .comwww .healthhelp .com
Associate Members
18
Health IntegratedHealth Management Services
Alycia Sepe, RN, BSNVP, Business Development
10008 North Dale Mabry HighwayTampa, FL 33618P (804) 241-9604asepe@healthintegrated .comwww .healthintegrated .com
HealthPlan ServicesHealth Management Services & IT
Jennifer NeedleSenior Account Manager
3501 East Frontage RoadTampa, FL 33607P (813) 289-1000 ext 7003242jneedle@healthplan .comwww .healthplan .com
Healthx, Inc.Software (Portal Development)
Chuck RolfsenChief Revenue Officer
9339 Priority Way, West Dr ., Suite 150Indianapolis, IN 46240P (877) 492-3633crolfsen@healthx .com www .healthx .com
HMSClaims Processing
Carrie CunninghamVice President, Business Development
401 Park Avenue SouthNew York, NY 10016P (916) 405-6780ccunningham@hms .comwww .hms .com
iHealth TechnologiesBusiness Process & Claims
Richard KrichbaumVice President, Sales
100 Ashford Center North, Suite 400Atlanta, GA 30338P (770) 379-2812F (770) 379-2850rick .krichbaum@ihealthtechnologies .comwww .ihealthtechnologies .com
Independent Living SystemsHealthcare Management Services
Laura A. StineSales Manager
5200 Blue Lagoon Drive, Suite 500Miami, FL 33126P (305) 262-1292 ext 7019F (305) 397-1869lstine@ilshealth .comwww .ilshealth .com
Intel-GE Care InnovationsIT Software
Kerry ArmstrongSenior Account Executive
3721 Douglas Blvd, Suite 100Roseville, CA 95661P (800) 450-0970karmstrong@careinnovations .comwww .careinnovations .com
KP LLCMember Communications
Cindy SonnenbergVice President, California Sales
13951 Washington AvenueSan Leandro, CA 94578P (510) 435-7862F (510) 588-4808csonnenberg@kpcorp .comwww .kpcorp .com
Krames StaywellHealth Management Services
Staci KupersmitMarketing Director, Payer Channel
136 East South Temple, Suite 900Salt Lake City, UT 84111P (267) 685-2548skupersmit@kramesstaywell .comwww .kramesstaywell .com
LexisNexis Risk SolutionsFraud Detection
Carin Whitaker Director of Sales
1000 Alderman DriveAlpharetta, GA 30005P (866) 396-7703healthcare@lexisnexis .comwww .lexisnexis .com/risk/healthcare .aspx
Lilly USA, LLCPharmaceutical Company
Helen P. LiaoSenior Account Manager
Lilly Corporate CenterIndianapolis, IN 46285P (925) 577-0511hpliao@lilly .comwww .lilly .com
Associate Members
19
Local Health Plans of CaliforniaPolicy and Legislative Association
Jennifer KentExecutive Director
1225 Eighth Street, Suite 440Sacramento, CA 95814P (916) 448-8292jkent@lhpc .orgwww .lhpc .org
LogistiCare SolutionsCare Coordination Solutions & Transportation Benefit Management
Bill WalterVice President, Business Development
400 South Farrell Drive, Suite 209Palm Springs, CA 92262P (866) 246-5875F (866) 245-8142billw@logisticare .comwww .logisticare .com
Lynk Software, Inc.IT
Ron KingsleyProject Manager-Healthcare Specialist
P .O . Box 5498Scottsdale, AZ 85261P (877) 998-1933F (480) 998-4979ron@lynksoftware .comwww .lynksoftware .com
Medical Transportation Management, Inc. (MTM)Transportation and Home & Community Based Services
Rhonda HollingsworthDirector, Business Development Operations
16 Hawk Ridge DriveLake Saint Louis, MO 63367P (636) 695-5563F (636) 561-2962rhollingsworth@mtm-inc .netwww .mtm-inc .net
MedImpact Healthcare Systems, Inc.Pharmacy Benefit Management
Janeen McBride Vice President Business Development
10181 Scripps Gateway CourtSan Diego, CA 92131P (858) 790-6365F (858) 790-6053Janeen .mcbride@medimpact .com www .medimpact .com
Medivation, Inc.Pharmaceutical Manufacturer
Kerri Miller, PharmDNational Account Director
6402 South Zeno CourtAurora, CO 80016P (303) 954-0230kerri .miller@medivation .comwww .medivation .com
Medline Industries & Continence CareMedical Supplies
Jake MeadVP Payer Solutions
1 Medline PlaceMundelein, IL 60060P (310) 780-5038F (866) 726-9865jmead@medline .comwww .medline .com
MedSolutionsHealth Management Services
Brittany DaltonMarketing Specialist
730 Cool Springs Blvd, Suite 800Franklin, TN 37067P (615) 468-4365F (615) 468-4303brittany .dalton@medsolutions .comwww .medsolutions .com
Mission Road PharmacySpecialty Pharmacy
Ryan SkrableVP Managed Markets
1155 North Mission RoadLos Angeles, CA 90033P (323) 227-4646F (323) 227-8887rskrable@salveospecialty .comwww .mrpscripts .com
Moss Adams LLPFinancial & Business Consulting
Chris PritchardPartner, National Practice Leader for Health Plans
101 Second St ., 9th Floor San Francisco, CA 92614P (415) 677-8262healthcare@mossadams .comwww .mossadams .com
Associate Members
20
Munich Health North AmericaHealthcare Reinsurer
Michael ShevlinSenior Vice President
555 College Road EastPrinceton, NJ, 08543P (609) 577-2610F (609) [email protected]
Navitus Health SolutionsPharmacy Benefit Management
Byron MickleSenior Vice President, Sales & Marketing
2601 West Beltline Highway, Suite 600Madison, WI 53713P (608) 729-1543F (608) [email protected]
Novo Nordisk, Inc.Pharmaceutical Company
Sheree PaloutzianWest Director of Managed Markets
22481 Marquam Hill RoadBella Vista, CA 96008P (530) 515-9331F (530) [email protected]
OptumHealthcare Technology, Management & Services
Eric MurphyPresident, Payer Solutions
13625 Technology DriveEden Prairie, MN 55344P (800) 765-6817F (952) [email protected]
Pay-Plus Solutions, Inc.Billing/Claims, Healthcare Technology & Health Mgmt
Art HoathExecutive VP Sales
18167 US Highway 19 NorthClearwater, FL 33764P (877) [email protected]
Associate Members
PerformRx and PerformSpecialtyPBM and Specialty Pharmacy
John ButtsDirector, Market Development & Public Relations
200 Stevens Drive, 4th FloorPhiladelphia, PA 19113P (215) 937-8073F (215) [email protected]
Premier Healthcare ExchangeBilling/Claims, Healthcare Technology & Health Management
Clara PachomskiExecutive Assistant
2 Crossroads DriveBedminster, NJ 07921P (888) 311-3505F (908) [email protected]
ProCare RxPharmacy Benefit Management
Scott BurnsVice President of Sales
1267 Professional ParkwayGainesville, GA 30507P (678) [email protected]
Ramat MedicalDurable Medical Equipment, Rentals, Supplies, Nurse Consulting, Furniture & Case Goods
Denise WilsonChief Operating Officer
5812 West Pico BoulevardLos Angeles, CA 90019P (877) 726-2863F (323) [email protected]
Re-Solutions Intermediaries, LLC Reinsurance Intermediaries
Chuck NewtonSenior Vice President
10 South 5th Street, Suite 1108Minneapolis, MN 55402P (804) [email protected]
21
Time Warner Cable Business ClassIT/Telecommunications
Charles McLaurinMajor Account Executive
17777 N Center Court Drive, 8th FloorCerritos, CA 90703P (310) 863-9452F (704) 414-9088charles .mclaurin@twcable .comwww .business .twc .com
TMG Health, Inc.Business Process Outsourcing (BPO)
J. Teig BoyleVice President, Sales & Marketing
455 S . Gulph Road, Suite 307King of Prussia, PA 19406P (610) 878-9111 ext 21223F (610) 878-5525ProfessionalSolutions@tmghealth .comwww .tmghealth .com
Top Tier ConsultingManagement Consulting
Brad ArmstrongPrincipal & Co-Founder
21550 Oxnard Street, Third FloorWoodland Hills, CA 91367P (818) 338-2121F (818) 338-2141brad .armstrong@t2c .comwww .t2c .com
Total TransitTransportation Benefit Services
James ReaNational Business Development Manager
4600 W Camelback RoadGlendale, AZ 85301P (602) 200-5501 x1719jrea@totaltransit .comwww .totaltransit .com
US Script, Inc.Pharmacy Benefit Manager
Pete ClagettPresident and CEO
2425 W Shaw AveFresno, CA 93711P (559) 244-3700F (559) 244-3793pclagett@usscript .comwww .usscript .com
Rockport Healthcare ServicesSkilled Nursing
Ted ChigarosSenior VP Managed Care
5900 Wilshire Blvd, Suite 1600Los Angeles, CA 90036P (323) 326-6181tchigaros@rockporthc .com
Summit Reinsurance Services, Inc.Healthcare Reinsurer
Rob Wood, IIIRegional Vice President
7030 Pointe Inverness Way, Suite 350Fort Wayne, IN 46804P (260) 469-3005F (260) 469-3014rwood@summit-re .comwww .summit-re .com
Sunovion, Inc.Pharmaceutical Manufacturer
Marjorie OrmsbyAccount Director
84 Waterford DriveMarlboro, MA 01752P (508) 481-6700marjorie .ormsby@sunovion .comwww .sunovion .com
TeladocTelemedicine
Lon HechtVP of Payer and Provider Markets
4100 Spring Valley Road, Suite 515Dallas, TX 75244P (732) 539-6086lhecht@teladoc .comwww .teladoc .com
The Compliance TeamAccreditation Organization
Sandra C. Canally, RNPresident
PO Box 160 Spring House, PA 19477P (215) 654-9110F (215) 654-9068info@thecomplianceteam .orgwww .TheComplianceTeam .org
Associate Members
22
Associate Members
VITAS Healthcare CorporationHospice Care
Sue MalterRegional Director of Market Development
16830 Ventura Boulevard, Suite 315Encino, CA 91436P (818) 971-3448C (818) 599-1006F (818) 971-3497sue .malter@vitas .comwww .vitas .com
Windsor HealthcareSkilled Nursing
Linda M. MooreSenior Director Managed Care
9200 Sunset Boulevard, 7th FloorWest Hollywood, CA 90069P (310) 385-1009F (310) 595-3790lmoore@snfmgt .comwww .snfmgt .com
Wolters Kluwer Health/ Health LanguageIT Software/Health Management Services
Brian DiazDirector of Marketing
4600 South Syracuse Street, Suite 1200Denver, CO 80237P (720) 940-2900F (720) 940-2913brian .diaz@wolterskluwer .comwww .healthlanguage .com
The Word & Brown CompaniesSmall Group, Individual and Medicare Marketing & Enrollment
David DukerChief Strategic Officer
721 South Parker Orange, CA 92868 P (800) 869-6989dduker@wordandbrown .comwww .wordandbrown .com
23
Associate Members
AccreditationAAAHCThe Compliance Team
Associations/Organizations CalPACE CAPG, The Voice of Accountable Physician Groups
Local Health Plans of California (LHPC)
Billing/Claims Processing 3M Health Information SystemsDST Health Solutions, LLCEmdeonHealthEdge HMSiHealth Technologies OptumPay-Plus Solutions, Inc.Premier Healthcare Exchange
Business Process Outsourcing (BPO)Calibrated Healthcare Network LLCDST Health Solutions, LLCEmdeonFirstsource Solutions USA, Inc.iHealth Technologies OptumTMG Health, Inc.
Clinical/Medical DiagnosticsGenomic Health
ComplianceClearwater Compliance LLC
ConsultingBluePeak AdvisorsExcelsior Solutions, LLCFlexTech, Inc. Moss Adams LLPOptumTop Tier Consulting
Continence CareMedline Industries
Fraud DetectionLexisNexis
Health Management ServicesAPS HealthcareBeacon Health OptionsHealth IntegratedHealthPlan ServicesIndependent Living SystemsKrames Staywell MedSolutions Optum Pay-Plus Solutions, Inc.Premier Healthcare ExchangeThe Word & Brown CompaniesWolters Kluwer Health/ Health Language
Healthcare ReinsurerMunich Health North America
Re-Solutions Intermediaries, LLCSummit Reinsurance Services, Inc.
Healthcare TechnologyCAQH Intel—GE Care InnovationsOptumPay-Plus SolutionsPremier Healthcare Exchange
Home Infusion TherapyAxelaCare Health Solutions, LLCCoram CVS/ Specialty Infusion Services
Hospice CareVITAS Healthcare Corporation
IT/Software3M Health Information SystemsAvaility, LLCCAQHDellDST Health Solutions, LLCEmdeon Essette, Inc.FlexTech, Inc. HealthEdge HealthPlan Services Healthx, Inc.Intel—GE Care InnovationsLynk Software, Inc.Time Warner Cable Business ClassThe Word & Brown Companies (Quotit)Wolters Kluwer Health/ Health Language
Marketing & EnrollmentWord & Brown (CA Choice and Word & Brown General Agency)
Medical EquipmentRamat Medical
Medical SuppliesArkray USA, Inc.
Medline Industries, Inc.
Member CommunicationsKP LLC
Nutritional Support ServicesIndependent Living Systems
PharmaceuticalAcorda Therapeutics, Inc.Amarin CorporationAmgenARIAD Pharmaceuticals Inc. Avanir Pharmaceuticals Inc.Bristol-Myers Squibb Celgene CorporationDaiichi SankyoEisai IncGlaxoSmithKline Health IntegratedLilly USAMedivationNovo Nordisk, Inc.Sunovion, Inc.
B Y C AT E G O R Y
24
sultsNegotiating the best coverage wins clients.Becoming a trusted advisor keeps them.
CONTACT
Chuck Newton804.647.8360 [email protected]
Matt [email protected]
Associate Members
Pharmacy Benefit Management (PBM)CatamaranEnvisionRxMedImpact Healthcare Systems, Inc.Navitus Health SolutionsPerformRx & Perform SpecialtyProCare Rx
US Script, Inc.
Skilled NursingRockport Healthcare ServicesWindsor Healthcare
Specialty PharmacyAmber PharmacyARIAD Pharmaceuticals, Inc.Centene CorporationCoram CVS/ Specialty Infusion ServicesDiplomat Specialty PharmacyHealthPlan Services Mission Road Pharmacy
PerformRx and PerformSpecialty
Staffing/RecruitingHealthCare Scouts, Inc.
TelecommunicationsTime Warner Cable Business Class
TelemedicineTeladoc
Transportation Benefit ServicesLogistiCare SolutionsMedical Transportation Management, Inc. (MTM)
Total Transit
Utilization & Safety ManagementHealthHelp
B Y C AT E G O R Y
Barger & Wolen LLPJohn M. LeBlancPartner633 West Fifth Street, 47th FloorLos Angeles, CA 90071P (213) 680-2800F (213) 614-7399jleblanc@bargerwolen .comwww .BargerWolen .com
Brownstein Hyatt Farber Schreck, LLCEdward A. StumppJonathan C. Sandler Shareholder2049 Century Park East, Suite 3550Los Angeles, CA 90067P (310) 500-4600F (310) 500-4602EStumpp@BHFS .com JSandler@BHFS .comwww .BHFS .com
Crowell & Moring LLPWilliam A. HelvestineAndrew HeftyPartner275 Battery Street, 23rd FloorSan Francisco, CA 94111P (415) 986-2800P (415) 365-7261F (415) 986-2827whelvestine@crowell .comahefty@crowell .comwww .crowell .com
Katrina Pelto ConsultingKatrina PeltoConsultant
8172 Bushwick DriveHuntington Beach, CA 92646P (714) 536-6799F (714) 960-3260kpelto@socal .rr .com
Kennaday, Leavitt & DapondeMichael DapondeCurtis LeavittPartner
500 Capitol Mall, Suite 2260Sacramento, CA 95814P (916) 431-7755F (916) 431-7756mdaponde@kldlawgroup .comcleavitt@kldlawgroup .comwww .kldlawgroup .com
Law Offices of Jinny R. YangJinny YangAttorney
PO Box 8239Northridge, CA 91327P (310) 701-9106jylaw@jinnyyang .comwww .JinnyYang .com
Law Office of Michael ZablockiMichael Zablocki Attorney
21250 Hawthorne Boulevard, Suite 500Torrance, California 90503P (310) 316-0968mzablocki@socal .rr .com
Locke Lord LLPKaren R. PalmersheimPartner
300 S . Grand Avenue, Suite 2600Los Angeles, CA 90071P (213) 687-6742F (213) 341-6742kpalmersheim@lockelord .comwww .lockelord .com
Manatt, Phelps & Phillips, LLPJohn LeBlanc Partner11355 West Olympic BoulevardLos Angeles, CA 90064P (310) 312-4000F (310) 312-4224jleblanc@manatt .comwww .manatt .com
Nossaman LLPRichard Spohn Gregory CochranPartner
50 California Street, 34th FloorSan Francisco, CA 94111P (415) 398-3600F (415) 398-2438rspohn@nossaman .com gcochran@nossaman .comwww .nossaman .com
Nossaman LLPMary AntoineHealthcare Practice Group Lead
621 Capitol Mall, 25th Floor Sacramento, CA 95814P (916) 442-8888F (916) 442-0382mantoine@nossaman .comwww .nossaman .com
Partner Members
27
nossaman.com/healthcare
Plan it. Solve it. Deliver it.
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 ANGELESSAN FRANCISCOORANGE COUNTYSACRAMENTOWASHINGTON, DCAUSTINARLINGTON
Nossaman’s healthcare team is making it happen.
Partner Members
Sedgwick LLPDavid M. Humiston Dennis RolstadPartner
801 S . Figueroa Street, 19th Floor Los Angeles, CA 90017-5556P (213) 426-6900F (213) 426-6921david .humiston@sedgwicklaw .comdennis .rolstad@sedgwicklaw .comwww .sedgwicklaw .com
Tin Kin Lee Law OfficesTin Kin LeeAttorney
55 South Lake Avenue, Suite 705Pasadena, CA 91101P (626) 229-9828F (626) 229-9820tlee@tinkinlee .comwww .tinkinlee .com
Wilke, Fleury, Hoffelt, Gould & Birney, LLPDaniel L. Baxter Anthony R. EatonMichael G. PolisPartner
400 Capitol Mall, 22nd FloorSacramento, CA 95814P (916) 441-2430F (916) 442-6664dbaxter@wilkefleury .comaeaton@wilkefleury .commpolis@wilkefleury .comwww .wilkefleury .com
28
Delta Dental of CaliforniaJeff AlbumVice President, Public and Government Affairs
100 First StreetSan Francisco, CA 94105P (415) 972-8418F (415) 227-0972jalbum@delta .orgwww .deltadentalins .com
DentaQuestBrian WattsSales Director, Western Region
23291 Mill Creek Drive #100Laguna Hills, CA 92653P (619) 884-4470Brian .Watts@dentaquest .comwww .dentaquest .com
FirstSight Vision Services Robert K. PattonPresident & CEO
1202 Monte Vista Ave ., Suite #17Upland, CA 91786P (909) 920-5008F (626) 609-2391Robert .Patton@firstsightvision .netwww .firstsightvision .net
Gold Coast Health PlanGuillermo GonzalezDirector of Government Affairs
711 East Daily Drive, Suite 106Camarillo, CA 93010P (805) 437-5533F (805) 512-8721ggonzalez@goldchp .orgwww .goldcoasthealthplan .org
LIBERTY Dental Plan of CaliforniaDave MeadowsSVP Government Programs
340 Commerce, Suite 100Irvine, CA 92602P (949) 933-5327F (949) 825-8216dmeadows@libertydentalplan .comwww .libertydentalplan .com
Magellan Health, Inc.Jason VegaVice President, State Affairs
980 9th Street, 16th Floor, Suite 7Sacramento, CA 95814P (916) 402-4153F (916) 446-7104jsvega@magellanhealth .comwww .magellanhealth .com
MESVisionAspasia ShappetPresident & CEO
345 Baker StreetCosta Mesa, CA 92626P (714) 619-4660F (714) 619-4667www .mesvision .com
OptumHealth Behavioral Solutions of CaliforniaEileen InneckenSr . Director, Regulatory Affairs & Compliance
3111 Camino del Rio North, #600San Diego, CA 92108P (619) 641-6907F (619) 641-6916eileen .innecken@optum .comwww .optum .com
ValueOptions of California, Inc.Steven Rockowitz, Psy.D.President
PO Box 6065Cypress, CA 90630-2504P (714) 763-2427F (714) 763-2504steven .rockowitz@valueoptions .comwww .valueoptions .com
Health Group Members
29
• • • •
• • • •
WHAT MAKES A LEADERIN HEALTHCARE COST MANAGEMENT?
At PHX, we offer a comprehensive solution that is
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Contact us at (888) 311.3505 to find out how PHX
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Copyright 2014 Premier Healthcare Exchange, Inc. All Rights Reserved.
PHX_WMAL_Ad_8_5x11.indd 1 9/2/14 12:46 PM
For more information, please visit Dell.com/payers or contact your Dell representative:
Marybeth [email protected] | 303.923.3046
Pavan [email protected] | 925.522.9458
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.
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model that emphasizes listening to and engaging with our customers.
We are equipped to partner with health plans, enabling payers to
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organization while remaining competitive in the evolving market.
Dell’s portfolio of solutions include:
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t is
CAQH CORE®, the CORE-certification/Endorser Seals and logo are registered trademarks of CAQH® Copyright 2010-2014, Council For Affordable Quality Healthcare®. All rights reserved.
©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.
For more information, visit us at PPSonline.com
PPS_It_ad_SIIA.indd 1 11/25/14 4:19 PM
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Central California Alliance for Health
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ALAMEDA 11 n n n n n n n n n n n ORANGE 15 n n n n n n n n n n n n n n n
ALPINE 6 n n n n n n PLACER 10 n n n n n n n n n n
AMADOR 8 n n n n n n n n PLUMAS 6 n n n n n n
BUTTE 6 n n n n n n RIVERSIDE 15 n n n n n n n n n n n n n n n
CALAVERAS 6 n n n n n n SACRAMENTO 10 n n n n n n n n n n
COLUSA 8 n n n n n n n n SAN BENITO 5 n n n n n
CONTRA COSTA 9 n n n n n n n n n SAN BERNARDINO 15 n n n n n n n n n n n n n n n
DEL NORTE 6 n n n n n n SAN DIEGO 14 n n n n n n n n n n n n n n
EL DORADO 10 n n n n n n n n n n SAN FRANCISCO 12 n n n n n n n n n n n n
FRESNO 10 n n n n n n n n n n SAN JOAQUIN 12 n n n n n n n n n n n n
GLENN 6 n n n n n n SAN LUIS OBISPO 9 n n n n n n n n n
HUMBOLDT 6 n n n n n n SAN MATEO 9 n n n n n n n n n
IMPERIAL 10 n n n n n n n n n n SANTA BARBARA 8 n n n n n n n n
INYO 6 n n n n n n SANTA CLARA 13 n n n n n n n n n n n n n
KERN 11 n n n n n n n n n n n SANTA CRUZ 8 n n n n n n n n
KINGS 8 n n n n n n n n SHASTA 7 n n n n n n n
LAKE 6 n n n n n n SIERRA 6 n n n n n n
LASSEN 6 n n n n n n SISKIYOU 6 n n n n n n
LOS ANGELES 17 n n n n n n n n n n n n n n n n n SOLANO 9 n n n n n n n n n
MADERA 8 n n n n n n n n SONOMA 9 n n n n n n n n n
MARIN 10 n n n n n n n n n n STANISLAUS 11 n n n n n n n n n n n
MARIPOSA 7 n n n n n n n SUTTER 8 n n n n n n n n
MENDOCINO 7 n n n n n n n TEHAMA 6 n n n n n n
MERCED 7 n n n n n n n TRINITY 6 n n n n n n
MODOC 6 n n n n n n TULARE 8 n n n n n n n n
MONO 6 n n n n n n TUOLUMNE 6 n n n n n n
MONTEREY 6 n n n n n n VENTURA 11 n n n n n n n n n n n
NAPA 8 n n n n n n n n YOLO 10 n n n n n n n n n n
NEVADA 7 n n n n n n n YUBA 7 n n n n n n n
39
Num
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ALAMEDA 11 n n n n n n n n n n n ORANGE 15 n n n n n n n n n n n n n n n
ALPINE 6 n n n n n n PLACER 10 n n n n n n n n n n
AMADOR 8 n n n n n n n n PLUMAS 6 n n n n n n
BUTTE 6 n n n n n n RIVERSIDE 15 n n n n n n n n n n n n n n n
CALAVERAS 6 n n n n n n SACRAMENTO 10 n n n n n n n n n n
COLUSA 8 n n n n n n n n SAN BENITO 5 n n n n n
CONTRA COSTA 9 n n n n n n n n n SAN BERNARDINO 15 n n n n n n n n n n n n n n n
DEL NORTE 6 n n n n n n SAN DIEGO 14 n n n n n n n n n n n n n n
EL DORADO 10 n n n n n n n n n n SAN FRANCISCO 12 n n n n n n n n n n n n
FRESNO 10 n n n n n n n n n n SAN JOAQUIN 12 n n n n n n n n n n n n
GLENN 6 n n n n n n SAN LUIS OBISPO 9 n n n n n n n n n
HUMBOLDT 6 n n n n n n SAN MATEO 9 n n n n n n n n n
IMPERIAL 10 n n n n n n n n n n SANTA BARBARA 8 n n n n n n n n
INYO 6 n n n n n n SANTA CLARA 13 n n n n n n n n n n n n n
KERN 11 n n n n n n n n n n n SANTA CRUZ 8 n n n n n n n n
KINGS 8 n n n n n n n n SHASTA 7 n n n n n n n
LAKE 6 n n n n n n SIERRA 6 n n n n n n
LASSEN 6 n n n n n n SISKIYOU 6 n n n n n n
LOS ANGELES 17 n n n n n n n n n n n n n n n n n SOLANO 9 n n n n n n n n n
MADERA 8 n n n n n n n n SONOMA 9 n n n n n n n n n
MARIN 10 n n n n n n n n n n STANISLAUS 11 n n n n n n n n n n n
MARIPOSA 7 n n n n n n n SUTTER 8 n n n n n n n n
MENDOCINO 7 n n n n n n n TEHAMA 6 n n n n n n
MERCED 7 n n n n n n n TRINITY 6 n n n n n n
MODOC 6 n n n n n n TULARE 8 n n n n n n n n
MONO 6 n n n n n n TUOLUMNE 6 n n n n n n
MONTEREY 6 n n n n n n VENTURA 11 n n n n n n n n n n n
NAPA 8 n n n n n n n n YOLO 10 n n n n n n n n n n
NEVADA 7 n n n n n n n YUBA 7 n n n n n n n
40
Aetna Health of California, Inc.2625 Shadelands Drive • Walnut Creek, CA 94898 Ph: (925) 948-4700 • Fax: (925) 948-4264 • www.aetna.com
CALIFORNIA OFFICE LOCATIONS
FresnoLos Angeles
Rancho CucamongaSacramento
San DiegoSan Francisco
Santa AnaThousand Oaks
Walnut CreekWoodland Hills
EXECUTIVE OFFICERS
Mark BertoliniChairman, 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. AndersonChief Legal Counsel
Greg Stevens Region Head of
Network Operations and Medical Economics
PRIMARY CONTACTS
Shannon ButlerGovernment Relations
(916) 374-4950
Anjie CoplinPublic Relations(214) 200-8056
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . Aetna, Inc .Recent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1956Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1956Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,100 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .14,854,143 National (medical, dental and pharmacy) 1,565,218 California
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAs, Direct Contracts with PhysiciansNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 93 contracted Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 341 contracted (Short-Term Acute, Long-Term Acute, and Children’s Hospitals only) Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 60,542 contracted Number of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 28,366 contracted (all providers types other than physicians)Number of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 57,411 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . All Markets: Capitation, Negotiated Fee SchedulePhysicians– specialty (ranked by method) . . . . . . . . . . . . . All Markets: Capitation, Negotiated Fee ScheduleHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . All Markets: Per Diem, Capitation, Discount off Charges
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Small group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . HMO, POS, PPO, and Indemnity Large group (50+ employees) . . . . . . . . . . . . . . . . . . . . . EPO, HMO, PPO, POS, HRA, HAS, OtherMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . .YesMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . .NoMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . .YesSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .No Medicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .YesAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Indemnity: HMO, PPO, POS, Other
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YesDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YesPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .YesLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Yes Accidental Death & Dismemberment . . . . . . . . . . . . . . . .YesAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .YesRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .No
41
Alameda Alliance for Health 1240 South Loop Road • Alameda, CA 94502Ph: (877) 371-2222 • Fax: (510) 747- 4508 • www.alamedaalliance.org
CALIFORNIA OFFICE LOCATIONS
Ed Roberts Campus3075 Adeline Street,
Suite 160, Berkeley, CA 94703
(510) 225-7200
EXECUTIVE OFFICERS
Mark AbernathyInterim CEO
Frank StevensInterim COO
Lily Boris, MDCMO
Neal Jarecki CFO
Matthew LevinInterim Compliance Officer
PRIMARY CONTACT
Matthew LevinInterim Compliance Officer
(510) 373-5647
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . Alameda Alliance Joint Powers AuthorityRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1995Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1995Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 full time, 5 temporary Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 237,382
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAs; Direct Contracting with Physicians (Note: Excludes behavioral health)Number of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 6 contracted Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 15 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 1,373 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 308 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 422 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Fee-For-Service, Group Capitation, Individual CapitationPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-Service, Group CapitationHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Diagnosis-Related Group, Per Diem, Capitation
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther: Alliance Group Care . . . . . . . . . . . . . . . . . . . . . . . In-Home Supportive Services Workers in Alameda County: HMO
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .None
42
Anthem Blue Cross21555 Oxnard Street • Woodland Hills, CA 91367Ph: (818) 234-2345 • Fax: (805) 713-7736 (for providers) • www.anthem.com/ca or www.wellpoint.com
CALIFORNIA OFFICE LOCATIONS
Costa MesaFresno
GlendaleLos Angeles
Newbury ParkNorth Hollywood
PomonaRancho Cordova
RiversideSacramento (2 offices)
San Diego (2 offices)San FranciscoSanta Barbara
Thousand Oaks (2 offices)
VisaliaWalnut Creek
Woodland Hills
EXECUTIVE OFFICERS
Joseph R. SwedishCEO of WellPoint, Inc.
Mark MorganCalifornia President
of Anthem Blue Cross
Steve MelodyPresident of Anthem Blue
Cross Medicaid Health Plan
Wayne DeVeydtCFO
EXECUTIVE STAFF
Dr. Sylvia Gates Carlisle Medical Director,
Anthem Blue Cross
Craig LaidigLegal Counsel
Darrel NgPublic Relations
Michael ArvesenPharmacy Director
Steve ScottProvider Solutions, Acting
PRIMARY CONTACTS
Mike ProsioGovernment Relations
(916) 403-0527
Darrel NgPublic Relations(916) 403-0528
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . Anthem, Inc . Life and HealthRecent mergers or acquisitions within California . . . . . . . Merged with Anthem, Inc . in November 2004Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1937Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1993Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,000 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 36 million members WellPoint 8 .5 million members California
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAs, Direct Contracting with PhysiciansNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . .191 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 55,945 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . NoneNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 20,931 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Other (Fee Schedule), Group Capitation, Individual CapitationPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Other (Fee Schedule), Group CapitationHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Capitation, Case Rates, Discounted Charges
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Covered California (Individual Market) . . . . . . . . . . . . . . . PPO, EPO, HMO Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, OtherSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . HMO, PPOLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS, OtherMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPOMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . PPOSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . . PPOAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . . HMO, PPOMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . .OtherHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .No Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . PPOOther (California Kids, Interim High Risk) . . . . . . . . . . . . . PPO
ANCILLARY CARE
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . PPO
43
Blue Shield of California50 Beale Street • San Francisco, CA 94105Ph: (415) 229-5000 • www.blueshieldca.com
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . California Physicians’ Service dba Blue Shield of CaliforniaRecent mergers or acquisitions within California . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1939Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1939Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Not-for-profitNumber of employees . . . . . . . . . . . . . . . . . . . . ~ 5,000Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . 1,065,278 (HMO); 2,293,722 (PPO); 3,359,000 (Total)
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . HMO – Direct contracting with Network of Medical Groups and IPAs; PPO – Direct Contracting with PhysiciansNumber 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)
COMPENSATION METHODSPhysicians– 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 PRODUCTSPRODUCTS CURRENTLY OFFERED
Covered California . . . . . . . . . . . . . . . . . . . . . . . . . .For individual and family plans (IFP), Small Group plans Individual market . . . . . . . . . . . . . . . . . . . . . . . . . .HMO, PPOSmall group (2–50 employees) . . . . . . . . . . . . . . . .HMO, PPO, POSLarge group (50+ employees) . . . . . . . . . . . . . . . . .HMO, PPO, POSMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . .HMO Medigap (Supplemental Insurance) . . . . . . . . . . . . .Offered for individuals Special Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . .For individual and group plansAccess for Infants and Mothers . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Major Risk Medical Insurance/GIP . . . . . . . . . . . . . .For individual and family plans (IFP)Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Shared Advantage
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PPOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Available as a discounted service: HMO, PPODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .HMO, PPOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . .Not available as a stand-alone productLong Term Health Care . . . . . . . . . . . . . . . . . . . . . .NoLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OfferedAccidental Death & Dismemberment . . . . . . . . . . . .Offered in conjunction with our Life InsuranceAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Available as a discounted service: HMO; PPO Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . .Not available as a stand-alone productMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . .Available as a discounted service rather than as an Ancillary ProductDurable Medical Equipment . . . . . . . . . . . . . . . . . . .Not available as an Ancillary ProductRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Not available as an Ancillary ProductWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . .NoOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Not applicable
Evelyn JohnstonVice President, Total Rewards
Simon JonesVice President,
Health Information Technology Product Strategy
Aaron KaufmanVice President and
Chief Technology Officer
Tina KiblerVice President,
Internal Audit Services
Edward LuiVice President, Underwriting
Lou LombardoVice President,
Markets Performance
Robert LosierVice President,
Infrastructure Services
Tom McCafferyVice President,
California State Partnerships
Jessica McCarthyVice President,
Integrated Marketing and Client Experience
William McQueenVice President,
Premier Accounts
Kristen MirandaVice President, Strategic
Partnerships and Innovation
Mary MullerVice President, Core Accounts
Lisa NunesVice President,
Organizational Effectiveness
Michael O’NeilVice President, Product and
Market Alignment
Arminé PapouchianVice President,
Provider Contracting
Daniel PrettymanVice President,
Finance, Markets
Michael SheilsVice President,
Business Intelligence
Steve ShivinskyVice President, Corporate
Communications
Jeff SmithVice President, Individual
and Family Plans
Neil Solomon, MD, FACPVice President, Quality and
Care System Transformation
Nancy Stalker, PharmDVice President,
Pharmacy Services
Charles Sweeris, Esq.Vice President,
Deputy General Counsel
Jon TholenVice President, Customer Service
K.C. TuranVice President,
Chief Risk Officer & Chief Compliance Officer
Anjali VichareVice President,
Organizational Development
Melissa Welch, MD, MPHVice President, Healthcare
Market Innovations and Support
Darrin WellsVice President, Network
and Trend Analytics
Bryce WilliamsVice President, Wellness
Amy YaoVice President and Chief Actuary
PRIMARY CONTACT Tom Epstein
Vice President, Public Affairs
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
EXECUTIVE OFFICERSPaul Markovich
President and Chief Executive Officer
Juan DavilaExecutive Vice President, Health
Care Quality and Affordability
Kirsten GorsuchSenior Vice President,
External Affairs
Seth A. Jacobs, Esq.Senior Vice President, General
Counsel and Corporate Secretary
Michael MathiasSenior Vice President and Chief Information Officer
Michael MurraySenior Vice President and
Chief Financial Officer
Mary O’HaraSenior Vice President and
Chief Human Resources Officer
Michelle SimpsonSenior Vice President,
Enterprise Sales and Service
Marcus Thygeson, M.D.Senior Vice President, Chief Health Officer
Todd WalthallSenior Vice President, Customer Experience
Janet WidmannExecutive Vice President, Markets
Ken WoodSenior Vice President,
Consumer and Senior Markets
Peter LongPresident and CEO, Blue Shield
of California Foundation
EXECUTIVE STAFFChristopher Bellamy
Vice President, Corporate Development
Tom BrophyVice President, Finance
and Treasury Services
Bill BrownVice President and
Executive Driver, Shield Advance Business Readiness
Cathy CampbellVice President, Senior Markets
Michael DahlemVice President, IT Shared Services
Kenny DengVice President, Provider
Relations, Operations and Analytics
Edward A. DiverVice President,
Applications Development
Jim ElliottVice President, Producer and
Channel Partner Relations
Tom EpsteinVice President, Public Affairs
Shirley FierstadtVice President, Claims and
Contracted Operations
Amanda FlaumVice President,
Medical Management
Brent HitchingsVice President, Small Business
Jennifer HobartVice President,
Medical Informatics
44
California Health & Wellness 1740 Creekside Oaks Drive, Suite 200 • Sacramento, CA 95833Ph: (916) 246-3600 • Fax: (877) 502-7255 • www.CAHealthWellness.com
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . Centene Corporation Recent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2013Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2013Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For ProfitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . .160 Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .165,700
PLAN-PROVIDER ARRANGEMENTS Model types (ranked in descending order) . . . . . . . . . . . . Direct Contracting with Physicians, Single Medical Group, Network of Medical Groups & IPAsNumber of Medical Groups/IPAs . . . . . . . . . . . . . . . . . . . 0 owned, 547 contracted Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 43 contracted Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 2,719 contracted Number of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 683 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 990 contracted
COMPENSATION METHODS Physicians – primary care (ranked by method) . . . . . . . . . Fee-for-Service, Group CapitationPhysicians – specialty (ranked by method) . . . . . . . . . . . . Fee-for-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Diagnosis-Related Group, Case Rates
PLAN PRODUCTS PRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneSmall group (2– 50 employees) . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .None Medicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OtherLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . POSLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . Disease Management, Behavioral Health, Correctional Health
CALIFORNIA OFFICE LOCATIONS
Headquarters1740 Creekside Oaks Drive,
Suite 200 Sacramento, CA 95833
Butte 901 Bruce Road,
Suite 150 Chico, CA 95928
Imperial 1699 W. Main Street,
Suite B El Centro, CA 92243
El Dorado550 Main Street, Suite B2
Placerville, CA 95667
EXECUTIVE STAFF
Gregory S. Buchert, MD, MPH
CEO & Plan President
Jeff Grahling, MBAChief Operating Officer
Kathryn Kaestner, RN, MHA, CCM
Vice President, Medical Management
Kathleen Lang, DPAExecutive 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
45
CalOptima (Orange County Health Authority)
505 City Parkway West • Orange, CA 92868Ph: (714) 246-8400 • Fax: (714) 246-8492 • www.caloptima.org
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1995Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non ProfitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 811 full time, 4 part time, 8 as neededHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 664,122
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Medical groups/IPAs and HMOs Number of medical groups/IPAs . . . . . . . . . . . . . . . . . . . 0 owned, 15 contracted Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 32 contracted Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 6,777 contracted Number of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 857 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 2,228 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . Group Capitation, Fee-For-ServicePhysicians– specialty (ranked by method) . . . . . . . . . . . . . Group Capitation, Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Case Rates, Diagnosis-Related Group, Capitation
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . See SNPMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . HMOMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneProgram of All-Inclusive Care for the Elderly (PACE) . . . . . HMOOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . None Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
EXECUTIVE OFFICERS
Michael SchraderChief Executive Officer
Gary Crockett Chief Counsel
Dr. Richard HelmerChief Medical Officer
Bill JonesChief Operating Officer
Chet Uma Chief Financial Officer
Len RosignoliChief Information Officer
Michael RuaneChief of Strategy
and Public Affairs
Javier Sanchez Chief Network Officer
EXECUTIVE STAFF
Dr. Richard BockDeputy Chief Medical Officer
Candice GomezExecutive Director of
Program Implementation
Ladan KhamsehExecutive Director
of Operations
Sun JanicekExecutive Director
of Compliance (Interim)
Ron SantosExecutive Director of HR
Terrie StanleyExecutive Director
of Clinical Operations
PRIMARY CONTACTS
Julie BomgrenSenior Manager,
Government Affairs(714) 246-8836
Michael GermanSenior Policy Analyst,
Government Affairs(714) 796-6176
Arif ShaikhManager,
Government Affairs(714) 246-8418
Phil Tsunoda Director, Public Policy,
Government and Community Affairs
(714) 246-8632
46
CalViva Health (Fresno-Kings-Madera Regional Health Authority)
1315 Van Ness Avenue • Fresno, CA 93721Ph: (559) 445-8735 • www.calvivahealth.org
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . Fresno Kings Madera Regional Health Authority Recent mergers or acquisitions within California . . . . . . . No recent mergers or acquisitionsYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2009 Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2010 Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Not-for-profit Number of employees . . . . . . . . . . . . . . . . . . . . . . . . . .14 Staff, subcontracted for administrative services Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .299,412
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . All direct contracts with physician providers Number of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 2 IPAsNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Hospitals, Contracted Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,299 contracted PhysiciansNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 250
COMPENSATION METHODSPhysicians – 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 PRODUCTSPRODUCTS CURRENTLY OFFERED
Medi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . .Yes Special Needs Plans (SPD) . . . . . . . . . . . . . . . . . . . . . . . .Yes MSO Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No
ANCILLARY PRODUCTS
Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .Yes
CALIFORNIA OFFICE LOCATIONS
1315 Van Ness Avenue Fresno, CA 93721
7485 N. Palm Avenue, #101 Fresno, CA 93711-5764
EXECUTIVE OFFICERS
Gregory HundCEO
William GregorCFO
Patrick Marabella, M.D.CMO
Mary Beth CorradoCCO
PRIMARY CONTACT
Cheryl HurleyOffice Manager/
Administrative Coordinator
47
Care1st Health Plan 601 Potrero Grande Drive • Monterey Park, CA 91755Ph: (323) 889-6638 • Fax: (323) 889-6270 • www.care1st.com
PLAN ORGANIZATION Recent mergers or acquisitions within California . . . . . . . 2006Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1994Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1995Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,000Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 352,000
PLAN-PROVIDER ARRANGEMENTSModel 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 CentersNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . 110 Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,500 Number of other licensed clinicians . . . . . . . . . . . . . . . . 0 Number of provider offices . . . . . . . . . . . . . . . . . . . . . . . 23,800
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . Group Capitation, FQHC capitationPhysicians– specialty (ranked by method) . . . . . . . . . . . . Under Group Capitation, Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Capitation, Discounted Charges, Diagnosis-Related Group, Case Rates
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Small group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . HMOMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . . NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . . NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . None
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 TranCEO
Jorge Weingarten, MDCMO
Janet JanCFO
Brooks JonesCCO
EXECUTIVE STAFF
Alan BloomLegal and Regulatory
Steven ChinProvider Network Operations
Tracie HowellMember Services
Beverly Gibbs, RN Utilization Management
Dr. Daryl LeongQuality Management
PRIMARY CONTACT
Walter L. Gray, VPGovernment Affairs/
Public Affairs(323) 889-6638, ext. 6270
48
CenCal Health4050 Calle Real • Santa Barbara, CA 93110Ph: (805) 685-9525 • Fax: (805) 685-8292 • www.cencalhealth.org
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . Santa Barbara/San Luis Obispo Regional Health AuthorityRecent mergers or acquisitions within California . . . . . . . CenCal Health is a public entityYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1983Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .160 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .155,000
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Direct Contracting with PhysiciansNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 9 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 1,252 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 246 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Individual and Group Capitation, Fee-For-Service, Withhold and Pay for PerformancePhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-Service, Group CapitationHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem/DRG (Inpatient), Percent of Charges (Inpatient and Outpatient), Fee-For-Service (Outpatient)
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . . HMOMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . In-Home Supportive Services Workers: HMO
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .HMODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . None
CALIFORNIA OFFICE LOCATIONS
Santa Barbara, CASan Luis Obispo, CA
EXECUTIVE OFFICERS
Robert FreemanCEO
David AmbroseCFO/Treasurer
Paul JaconetteCOO
Mark Maddox, MDCMO
EXECUTIVE STAFF
Caitlin Larsen, JDDirector of Legal Affairs
Dave SiebelIT Director
Jeffrey Januska, PharmDPharmacy Director
Marina GordonProvider Services Director/
Program Development
Donna SlimakMember Services Director
Carlos HernandezDirector of Health
Services/Quality
Karyn FishHuman Resources Director
Allen FreymuthDirector of Claims
Lulu Von AlvenslebenAssociate Claims Director
PRIMARY CONTACTS
Robert FreemanCEO
(805) 685-9525, ext. 1011
Michael HarrisGovernment Relations
(805) 685-9525, ext. 1012
Robert FreemanPublic Affairs
(805) 685-9525, ext. 1011
49
Central California Alliance for Health (Santa Cruz-Monterey-Merced Managed Medical Care Commission)
1600 Green Hills Road, Suite 101 • Scotts Valley, CA 95066Ph: (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 McKayChief Executive Officer
Dale Bishop, MDChief Medical Officer
Brendan DowlingChief Information Officer
Scott FortnerChief Administrative Officer
Kathy NealChief Health Services Officer
Barry StatonChief Financial Officer
EXECUTIVE STAFF
Eva Balint, MDMedical Director
Danita CarlsonGovernment Relations Director
Lilia ChagollaRegional Operations Director – Monterey
Anne Chai, PharmDPharmacy Director
Kathleen McCarthyProvider Services Director
Jennifer MockusRegional Operations
Director – Merced
Julio Porro, MDMedical Director
Stephanie SonnenshineCompliance Director
Jan WolfMember Services Director
PRIMARY CONTACTS
Danita CarlsonGovernment Relations
(831) 430-5603
Scott FortnerPublic Affairs
(831) 430-5630
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1996Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 381Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 291,792
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Direct Contracting with PhysiciansNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 242 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 16 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 2,390 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 264 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 550 contracted
COMPENSATION METHODSPhysicians – primary care (ranked by method) . . . . . . . . . . Fee-For-Service, Incentive Program Physicians – specialty (ranked by method) . . . . . . . . . . . . Fee-For-Service, Incentive ProgramHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Case Rates, Discounted Charges
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . County Organized Health System Medigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Access Program . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . In-Home Supportive Services: HMO
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . COHS, HMOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . COHS, HMODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO: Healthy KidsPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . COHS, HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . COHSLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . COHS, HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . COHS, HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
50
Central Health Medicare Plan 1540 Bridgegate Drive • Diamond Bar, CA 91765Ph: (626) 388-2390 • Fax: (626) 388-2361 • www.centralhealthplan.com
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . .AHMC Central Health LLC Recent mergers or acquisitions within California . . . . . . . Acquired on 11/18/2011Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2004Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2004Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 26,595 (as of 2/1/15)
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . IPAs, Direct Contracting with PhysiciansNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 38Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,965Number of other licensed clinicians . . . . . . . . . . . . . . . . . 888Number of provider offices . . . . . . . . . . . . . . . . . . . . . . .11,444
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Capitation, Fee-For-ServicePhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Diagnosis-Related Group, Per Diem
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Medicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . HMO
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
EXECUTIVE OFFICERS
Lee SuyenagaChief Executive Officer
An Pang Chieng, M.D. Chief Medical Officer
EXECUTIVE STAFF
Wan Yeap, M.D. Medical Director
PRIMARY CONTACT
Annie Hsu ShiehSenior Compliance Counsel(626) 388-2390, ext. 2885
51
Chinese Community Health Plan445 Grant Ave • San Francisco, CA 94108Ph: (415) 955-8800 • Fax: (415) 955-8818 • www.CCHPhmo.com
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . Chinese Hospital AssociationTax Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1984 Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1985 Number of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .138Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 27,418
PLAN-PROVIDER ARRANGEMENTSModel Types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Independent Practice Associations (IPAs) Number of medical groups/IPAs . . . . . . . . . . . . . . . . . . . .1 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 449 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 8 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Fee-For-ServicePhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Capitation, Per Diem, Discounted Charges, Differential by Service Type, Case Rates
PLAN PRODUCTS PRODUCTS CURRENTLY OFFERED
Covered California (Individual Market) . . . . . . . . . . . . . . . HMO Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOCovered California (SHOP) . . . . . . . . . . . . . . . . . . . . . . . . HMO Small group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . HMOLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMOMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . HMOActive Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PPO
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
EXECUTIVE OFFICER
Brenda YeeCEO
EXECUTIVE STAFF
Richard Garcia, MDMedical Director
Amy TsuiCFO
Larry LooCIO
Carmen DobryDirector, Regulatory
Affairs and Corporate Compliance Officer
PRIMARY CONTACT
Carmen DobryDirector, Regulatory
Affairs and Corporate Compliance Officer
(415) 955-8800
52
Cigna HealthCare of California, Inc.400 N . Brand Boulevard, #400 • Glendale, CA 91203Ph: (818) 500-6262 • Fax: (818) 500-6365 • www.cigna.com/healthcare
PLAN ORGANIZATION Parent Company/Affiliates . . . . . . . . . . . . . . . . . . . . . . . . HealthSource, Inc ./Cigna Dental Health of CA, Inc ., Cigna Behavioral Health of CA, Inc . (CBH), Connecticut General Life Insurance Company (CGLIC)Recent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1929Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1979Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .116 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 995,515 total members 188,645 California HMO and Open Access 806,870 California PPO and Open Access Plus (offered by CGLIC)
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAs, Direct Contracting with PhysiciansNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 247 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 367 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 56,411 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Group Capitation, Fee-For-ServicePhysicians– specialty (ranked by method) . . . . . . . . . . . . . Group Capitation, Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Capitation, Case Rates, Discounted Charges
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OAP, POSSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . HMO, POS, OA, OAP, PPOLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMO, POS, OA, OAP, PPOMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .Medicare Part DAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OA, OAP, PPOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OAP, PPODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cigna Dental HMO & PPOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OAP, PPOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . CGLICLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CGLICAccidental Death & Dismemberment . . . . . . . . . . . . . . . . CGLICAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OAP, PPOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CBHMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OAP, PPODurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OAP, PPORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, OAP, PPOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . CGLICOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . International
CALIFORNIA OFFICE LOCATIONS
GlendaleIrvine
San FranciscoSan Diego
VisaliaWalnut Creek
EXECUTIVE OFFICERS
Peter B. WelchPresident, Northern CA
Gene RapisardiPresident, Southern CA
Anand RaghavanCFO
Jennifer GutzmoreRegional Medical
Executive
Maricel Del Rosario, R.N.Director of Health Services
Valerie JamesQuality Management
and Credentialing
Michelle DemonteverdeRegional Vice President,
Provider Contracting/Services
Scott HamiltonProvider Contracting/
Services, Northern California
Teri LauensteinProvider Contracting/
Services, Southern California
Karen BakerClaims Manager
Kathy O’NealCustomer Service
Manager
William S. JamesonChief Counsel
PRIMARY CONTACTS
Crystal Jack Government Relations
(818) 500-6467
Amy SzablePublic Affairs
(440) 934-5385
53
Community Health Group2420 Fenton Street, Suite 100 • Chula Vista, CA 91914Ph: (619) 422-0422 • Fax: (619) 422-5930 • www.chgsd.com
EXECUTIVE OFFICERS
Norma DiazChief Executive Officer
Scott Carroll Chief Financial Officer
Jonathan TamayoChief Information Officer
Edward D. Hutt, M.D., M.B.A.Chief Medical Officer
Ann WarrenChief Regulatory &
Human Resources Officer
EXECUTIVE STAFF
Richard Rifenbark, Esq.Chief Legal Counsel
Noreen Koizumi, Pharm.D.Director of Pharmacy
Nora PintadoDirector of Claims
David RitchieDirector of Contract
Administration
PRIMARY CONTACT
Ann Warren(619) 498-6516
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1982Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1985Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees (full time/part time) . . . . . . . . . . . .192 full time, 5 part timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 218,518
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAs, Direct Contracts with PhysiciansNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 23 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 19 contracted Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 3,421 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 1,090 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 556 contracted (pcp)
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Fee-For-Service, Individual Capitation, Group CapitationPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-Service, Group CapitationHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Discounted Charges, DRG
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cal MediConnect
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
54
Contra Costa Health Plan (Contra Costa County Medical Services)
595 Center Avenue, Suite 100 • Martinez, CA 94553Ph: (925) 313-6000 • Fax: (925) 313-6002 • www.contracostahealthplan.org
EXECUTIVE OFFICERS
Patricia Tanquary, MPH, Ph.D.CEO
Patrick GodleyCFO
David J. Runt CIO
EXECUTIVE STAFF
James Tysell, M.D.Medical Director
Frank Lee, J.D. Chief Legal Counsel
Wendy MailerMarketing, Sales and
Outreach Manager
Luke Lim, R.PhPharmacy Director
Judi LouroMember Services Manager
Terri Lieder Provider Relations Manager
Kevin DruryDirector of
Quality Management
PRIMARY CONTACTS
Frank Lee, J.D.Government Relations
(925) 313-6082
Judi Louro Public Affairs
(925) 313-6000
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . Division of Contra Costa County Health Services Dept .Recent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1973Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1973Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .164 full time, 30 part timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .150,433
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Staff, Direct Contracting with PhysiciansNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 owned, 8 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 1,479 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 498 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . .10 owned, 537 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Fee-For-Service, SalaryPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-Service, SalaryHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Diagnosis-Related Group
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Covered California (Individual Market . . . . . . . . . . . . . . . NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMOMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Commercial: In-Home Support Service Workers: HMO Public: Basic Health Care – County Indigent Program, plus Pharmacy-Only Program, Medicare Cost Plan
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . None Acupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
55
Easy Choice, A WellCare Company 10803 Hope St . • Suite B • Cypress CA 90630Ph: (866) 999-3945 • Fax: (877) 999-3945 • www.easychoicehealthplan.com
EXECUTIVE OFFICERS
Margaret AndersonState President
Richard Nguyen, MD Medical Director
EXECUTIVE STAFF
Rick DesaiVP Field Network
Management
Rachael RuddSr. Director State Operations
Karen VanDykeSr. Director Human
Resources
Sara DerschDirector of Finance
Karen DriskillSr. Director Field
Health Services
Emmalou Torres-CabreraDirector Quality
Improvement
Elizabeth GianiniDirector State
Government Affairs
Ron McGinnisDirector Regulatory
Compliance
Koh KerdsriVP I.T., QA, & Compliance
PRIMARY CONTACTS
Ron McGinnisDirectory Regulatory
Compliance (714) 226-2550
Elizabeth GianiniDirector State
Government Affairs(714) 269-5190
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . WellCare Health Plans, Inc .Recent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2006Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2007Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .156Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 33,892
PLAN-PROVIDER ARRANGEMENTS Model types (ranked in descending order) . . . . . . . . . . . . Delegated IPANumber of Medical Groups/IPAs . . . . . . . . . . . . . . . . . . .69 contracted Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . .131 contracted Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . .14,774 contracted Number of other licensed clinicians . . . . . . . . . . . . . . . . . 845 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . .14,498 contracted
COMPENSATION METHODS Physicians – primary care (ranked by method) . . . . . . . . .4,842 CapitatedPhysicians – specialty (ranked by method) . . . . . . . . . . . .10,369 Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . .131 Fee-For-Service contracts; 7 Capitated
PLAN PRODUCTS PRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .YesMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . .NoAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . .NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . .Transportation
56
GEMCare Health Plan, Inc.4550 California Avenue, Suite 100, Bakersfield, CA 93309Ph: (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 WoodPresident and CEO
PRIMARY CONTACT
Michael MyersChief Operations
Administrator(661) 716-8820
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . California Physicians’ Service, dba Blue Shield of California Recent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2006Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2006Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . 35 full time Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 21,364 (20,962 HMO, 402 PPO)
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Single Medicare Group IPA, Ancillary, HospitalNumber of Medical Groups/IPAs . . . . . . . . . . . . . . . . . . . 0 owned, 7 contracted Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 20 contracted Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 876 contracted Number of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 145 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 614 contracted
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/ASmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . HMO Commercial, PPO CommercialLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMO Commercial; PPO CommercialMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO Medi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . .N/AMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . N/ASpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .N/A Medicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .N/AAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .N/AHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/AMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . N/AOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .N/A Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A Accidental Death & Dismemberment . . . . . . . . . . . . . . . .N/A Acupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .N/A Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .N/A Other (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A
57
Gold Coast Health Plan (Ventura County Medi-Cal Managed Care Commission)
711 Daily Drive • Suite 106 • Camarillo, CA 93010Ph: (888) 301-1228 • Fax: (805) 437-5132 • www.goldcoasthealthplan.org
EXECUTIVE OFFICER
Albert Reeves, M.D.Chief Medical Officer
Ruth WatsonInterim CEO &
Chief Operations Officer
EXECUTIVE STAFF
Guillermo GonzalezDirector of
Government Relations
PRIMARY CONTACT
Guillermo GonzalezDirector of
Government Relations(805) 437-5533
Public Affairssee Primary Contact
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .None Recent mergers or acquisitions within California . . . . . . . None Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . July 1, 2011 Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profit Number of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .148 full time, 1 part time Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .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 PRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .None Large group (50+ employees) . . . . . . . . . . . . . . . . . . . . .None Medicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Medi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . .Yes Medigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . None Special Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .None Medicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .None Access for Infants and Mothers . . . . . . . . . . . . . . . . . . . .None Healthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Yes Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Denti-Cal Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Yes Long Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .Yes Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Accidental Death & Dismemberment . . . . . . . . . . . . . . . . None Acupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Carve Out Massage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .Yes Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Yes Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Behavioral Health
58
Health Net of California21281 Burbank Blvd . • Woodland Hills, CA 91367Ph: (818) 676-6775 • Fax: (818) 676-6992 • www.healthnet.com
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. GellertNational President and CEO
Steven ToughPresident,
Government Programs
James E. WoysExecutive Vice President,
COO and CFO
Patricia ClareyState Health Programs and
Regulatory Relations Officer
Angelee Fox BouchardSenior VP and
General Counsel/Secretary
Karin MayhewSenior VP of
Organization Effectiveness
Scott LawHealth Care Services Officer
Juanell HefnerChief Compliance and Administration Officer
Patricia Buss, M.D.Medical and Health Care
Services Officer
Dan LiebermanChief Marketing Officer
CALIFORNIA EXECUTIVE OFFICERS
Steven SellPresident, Western Region Health Plan and President,
Health Net of California
Scott St. ClairVP, Sales
Larry TallmanVP, Sales
Eric HauseVP, Strategy and
Business Development
EXECUTIVE STAFF
Douglas SchurVP and Deputy General Counsel
PRIMARY CONTACTS
Dan ChickGovernment Relations
(916) 552-5285
Brad KiefferCommunications
(818) 676-6833
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . Health Net, Inc .Recent mergers or acquisitions within California . . . . . . . None Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1979Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1979Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,000Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 2,700,000 California 6,000,000 National
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups or IPAs, Direct Contracting with PhysiciansNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned,171 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 315 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 77,000 contracted
COMPENSATION METHODSPhysicians– 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 PRODUCTS CURRENTLY OFFERED
Covered California (Individual Market) . . . . . . . . . . . . . . . HMO, EPO, HSP Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, EPO, HSPCovered California (SHOP) . . . . . . . . . . . . . . . . . . . . . . . . PPO Small group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . HMO, PPOLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS, EPO, Indemnity, ASO Medicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPOMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . Medicare SupplementSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . HMOMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Salud Con Health Net: HMO
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, ASO, EPO, Medicare HMODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS, EPO, IndemnityAccidental Death & Dismemberment . . . . . . . . . . . . . . . . HMO, PPO, POS, EPO, IndemnityAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, POS, ASO, EPO, Medicare HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .None
59
Health Plan of San Joaquin (San Joaquin County Health Commission)
7751 S . Manthey Road • French Camp, CA 952311012 10th Street • Modesto, CA 95354 Ph: (209) 942-6300 • Fax: (209) 942-6305 • www.hpsj.com
EXECUTIVE STAFF
Amy Y. ShinChief Executive Officer
Jennifer DinwoodieChief Financial Officer
Lakshmi Dhanvanthari, MDChief Medical Officer
VacantChief Operating Officer
Cheron VailChief Information Officer
David HurstVice President,
External Affairs
Alejandra ClydeCompliance Officer
Victoria HazenVice President,
Human Resources
PRIMARY CONTACTS
Alejandra ClydeGovernment Relations
(209) 461-2265
David HurstPublic Affairs
(209) 461-2241
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1995Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1996Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 270,535
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Direct Contracting with Physicians, Network of Medical Groups and IPAsNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 272 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 20 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 3,915 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 511 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 1,037 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Individual Capitation, Group CapitationPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-Service including Withhold or Bonus, Group CapitationHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem – APR – DRG
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . . HMOMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . .NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .None
60
Health Plan of San Mateo (San Mateo Health Commission)
701 Gateway Boulevard, Suite 400 • So . San Francisco, CA 94080Ph: (650) 616-0050 • Fax: (650) 616-0060 • www.hpsm.org
EXECUTIVE OFFICER
Maya AltmanChief Executive Officer
EXECUTIVE STAFF
Ron RobinsonDirector of Finance and Administrative Services
Chris BaughmanDirector of Compliance and Regulatory Affairs
Chris Esguerra, M.D.Interim Medical Director
Joy SarragaDirector of Health Services
Edward OrtizDirector of Provider
Network Development and Services
Carolyn ThonDirector of Member
Services and Outreach
Eben YongDirector of MIS
Chris BaughmanDirector of System
Improvement
Cindy LemDirector of Human
Resources
Khoa NguyenManager of Governmental
Affairs and Business Development
PRIMARY CONTACT
Chris BaughmanDirector of Compliance and Regulatory Affairs
(650) 616-0050
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1986Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1987Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 full time, 9 part timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .137,216
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAs, Direct Contracting with PhysiciansNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 14 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 3,610 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 273 contracted
COMPENSATION METHODSPhysicians–primary care (ranked by method) . . . . . . . . . . Fee-For-Service and Capitation, depending on line of businessPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . DRG, APC, Per Diem, and Fee-For-Service, depending on hospital and line of business
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneMedicare-Medicaid Plan . . . . . . . . . . . . . . . . . . . . . . . . . HMOSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . HMOMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Public: In-Home Supportive Service Workers in San Mateo: HMO Third Party Administrator for County Indigent Programs
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong-term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
61
Heritage Provider Network8510 Balboa Boulevard, Suite 285 • Northridge, CA 91325Ph: (818) 654-3461 • Fax: (818) 654-3460 • www.heritageprovidernetwork.com
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . NoneRecent mergers or acquisitions within California . . . . . . . 0 Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1996Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1997Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,162 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . N/A
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAs, Direct Contracting with PhysiciansNumber of medical groups . . . . . . . . . . . . . . . . . . . . . . . 9 owned, 0 contractedNumber of IPAs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 owned, 2 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . .112 contractedNumber of PCP, Specialists . . . . . . . . . . . . . . . . . . . . . . . 3,369 PCPs, 8,791 SpecialistsNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 433 owned (salaried)Number of provider offices . . . . . . . . . . . . . . . . . . . . . . . 71 contracted
COMPENSATION METHODSPhysicians-primary care (ranked by method) . . . . . . . . . . . Other (Fee schedule), Group Capitation, Individual Capitation, SalaryPhysicians-specialty (ranked by method) . . . . . . . . . . . . . Other (Fee schedule), Group CapitationHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Case Rates, Discount Charges
PLAN PRODUCTSPRODUCTS CURRENTLY SERVED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPOSmall group (2 –50 employees) enrollment . . . . . . . . . . . . HMOLarge group (50+ employees) enrollment . . . . . . . . . . . . HMO, POSMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, Supplemental, FFSMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMO, FFSMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . HMO Medicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . PPO, FFSOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . .NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . FFS ContractOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Industrial Physical, Champus
EXECUTIVE OFFICERS
Richard N. Merkin, M.D.President
S. Ian Drew, M.D.Medical Director
Jaya KurianCFO
Rich LipelesCOO
EXECUTIVE STAFF
Scott BaeInformation Technology
PRIMARY CONTACTS
Jaya KurianGovernment Relations
(818) 654-3461
Ann Wymer(310) 823-5250
Rich LipelesPublic Affairs
(714) 908-5613
62
Inland Empire Health Plan10801 Sixth Street, Suite 120 • Rancho Cucamonga, CA 91730Ph: (909) 890-2000 • Fax: (909) 890-2019 • www.iehp.org
EXECUTIVE OFFICER
Bradley P. Gilbert, M.D., M.P.P.Chief Executive Officer
EXECUTIVE STAFF
Rohan ReidChief Operations Officer
Susan ArcidiaconoChief Marketing Officer
Kurt HublerChief Network Officer
Laura HoldenChief Financial Officer
William Henning, D.O.Chief Medical Officer
Marcia Anderson, BSN, RN, CCM, CDMSChief of Medical Services
Michael DeeringChief Information Officer
Steve Sohn, Esq.Legal Counsel
PRIMARY CONTACT
Bradley P. Gilbert, M.D., M.P.P.Government Relations/
Public Affairs(909) 890-2010
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1994Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1996Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Not-for-profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .1,157 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .1,018,642
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . . Network of IPAs and Direct Physician ContractingNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . .18 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,426 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 1,720 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . . 8,240 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Individual Capitation, Fee-For-ServicePhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Diagnosis-Related Group
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . HMOMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . . NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . . NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
63
Inter Valley Health Plan300 South Park Avenue • Pomona, CA 91769-6002Ph: (909) 623-6333 • Fax: (909) 397-9039 • www.ivhp.com
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1979Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1979Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .110 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 21,000 (Medicare Only)
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAsNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 14 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 50 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Group Capitation Hospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Capitation, Per Diem
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Medicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .YesRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Yes
EXECUTIVE OFFICERS
Ronald H. Bolding CEO
Bob Peters CFO
EXECUTIVE STAFF
Susan Tenorio, R.N.Vice President
Health Operations
Ken Smith, M.D. Chief Medical Officer
Cyndie O’Brien Vice President
Sales and Marketing
Larry BacaSales Director
Michelle HagemanProvider Relations
Judy JohnsonMember Relations
Bill Chen IT Director
PRIMARY CONTACTS
Gail BlacklockGovernment Relations
(909) 623-6333
Cyndie O’BrienPublic Affairs
(909) 623-6333
64
PLAN ORGANIZATION Parent Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1945Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1977Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber 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
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Group Model HMONumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 2 exclusive contracts (TPMG, SCPMG)Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 owned, 11 Plan contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . .16,945 TPMG & SCPMG, 2,644 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 5,564 TPMG & SCPMG, 471 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . .12,687 offices
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Group CapitationPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Group CapitationHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Cost Reimbursement (Kaiser) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Discounted Charges, Per Diem, Case Rates (non-Kaiser)
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Covered California (Individual Market) . . . . . . . . . . . . . . . HMO Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, OtherCovered California (SHOP) . . . . . . . . . . . . . . . . . . . . . . . . HMO, Other Small group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . HMO, PPO, OtherLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMO, POS, PPO, OtherMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO (with and without Part D)Special Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . HMO Access for Infants and Mothers . . . . . . . . . . . . . . . . . . . . HMOMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . HMOOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, OtherPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POS Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPO, POSWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . Injury Care and Occupational Health and Safety Services
Kaiser Permanente (Kaiser Foundation Health Plan, Inc .)
Northern California Region • 1950 Franklin Street, 20th Floor • Oakland, CA 94612Ph: (510) 987-1000 • Fax: (510) 987-4303Southern California Region • 393 East Walnut Street • Pasadena, CA 91188Ph: (626) 405-5000 • Fax: (626) 405-2583www.kaiserpermanente.org
CALIFORNIA OFFICE LOCATIONS
See website for most updated list of all office locations. www.kp.org
EXECUTIVE OFFICERSBernard J. Tyson
Chairman and National CEO
Gregory A. AdamsGroup President and Regional President, Northern California
Benjamin K. Chu, M.D.Group President and Regional President, Southern California
Daniel P. GarciaSenior Vice President,
Chief Compliance Officer
Wade OvergaardSenior Vice President,
California Health Plan Operations
Kathryn LancasterExecutive Vice President and
National Chief Financial Officer
Michael D. RoweChief Financial Officer and
Senior Vice President of Finance, Northern California
George A. DisalvoSenior Vice President and Chief
Financial Officer, Southern California
Richard DanielsSenior Vice President and Interim
Chief Information Officer
Charles E. ColumbusSenior Vice President
Chief Human Resources Officer
Paul M. SwensonSenior Vice PresidentChief 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 PaigeSenior Vice President,
Marketing and Internet Services
Alan T. Kiyohara, Pharm.D.VP Pharmacy Operations and Services,
Southern California
Suzanne B. SheaVP Pharmacy Operations and Services,
Northern California
PRIMARY CONTACTSJohn 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 CunninghamSVP Strategy and Business
Development, Northern California(510) 987-3995
Deborah EspinalExecutive Director of Policy,
Health Plan Regulatory Services (510) 393-6574
Lisa Koltun Vice President, Health Plan
Regulatory Services (510) 625-7028
65
Kern Family Health Care (Kern Health Systems)
9700 Stockdale Highway • Bakersfield, CA 93311Ph: (661) 664-5000 • Fax: (661) 664-5178 • www.kernfamilyhealthcare.com
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1994Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1996Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .175,857 (Medi-Cal)
PLAN-PROVIDER ARRANGEMENTSNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 15 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 725 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 195 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 320 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Fee-For-ServicePhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Fee-For-Service
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
EXECUTIVE OFFICERS
Douglas A. HaywardPresident and CEO
Robert Landis Chief Financial Officer
Alan AveryChief Operating Officer
Richard PruittChief Information Officer
Chandrakala Gowda, M.D., M.B.A.
Chief Medical Officer
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 IturririaDirector of Marketing and
Member Services
Bruce Wearda, Pharm. D.Director of Pharmacy
Anita MartinDirector of Human Resources
Carl R. Breining, CHCDirector of Compliance and
Regulatory Affairs
Emily SilvaDirector of Provider Relations
PRIMARY CONTACTS
Jeremy McGuireGovernment Relations
Louis IturririaPublic Affairs
66
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 BaackesChief Executive Officer
John R. WallaceChief Operating Officer
Trudi Carter, M.D.Chief Medical Officer
Tim ReillyChief Financial Officer
Jonathan FreedmanChief of Strategy, Regulatory and
External Affairs
Augustavia Haydel, Esq.General Counsel
Robert TurnerChief of Human Resources
PRIMARY CONTACTS
Cherie FieldsGovernment Relations
(916) 930-0043
Francisco OaxacaPublic Affairs
(213) 694-1250
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1994Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1997Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Not-for-profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .1,400Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .1,500,000
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPA’s Plan Partner/Delegated; Direct Contracting with PhysiciansNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 126 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 83 contracted Number of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 2,577 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 12,043 contracted Number of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 5,691 contracted
COMPENSATION METHODSPhysicians – primary care (ranked by method) . . . . . . . . . . Group Capitation, Fee-For-Service Physicians– specialty (ranked by method) . . . . . . . . . . . . . Group Capitation, Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Diagnosis Related Groups, Capitation, Case Rates, Discount Charges, Differential by Service Type
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Covered California (Individual Market) . . . . . . . . . . . . . . . HMO Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
67
Molina Healthcare of California200 Oceangate, Suite 100 • Long Beach, CA 90802Ph: (562) 499-6191 • Fax: (562) 499-6170 • www.molinahealthcare.com
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .Molina Healthcare, Inc .Recent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1980Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1994Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 682 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 2,546,572 National 528,980 California
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAs, Direct Contracting with Physicians, Staff Number of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 2 exclusive, 82 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 affiliated, 90 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . .13,792 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 2,272 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . .19 exclusive, 12,399 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Group Capitation, Individual Capitation, Salary, Fee-For-ServicePhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-Service, CapitationHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Capitation
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Covered California (Individual Market) . . . . . . . . . . . . . . . HMO Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . HMOMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .None
CALIFORNIA OFFICE LOCATIONS
Sacramento2180 Harvard St., Suite 500
Sacramento, CA 95815
Inland Empire887 E 2nd Street
2nd FloorPomona, CA 91766-2009
San Diego9275 Sky Park Court,
Suite 400San Diego, CA 92123
El Centro1607 W. Main Street
El Centro, CA 92243-2212
EXECUTIVE OFFICERS
Richard ChambersPresident
James NovelloPlan Chief Operations Officer
Rajeev NarulaVP Finance & Analytics
James Cruz, MDCMO
EXECUTIVE STAFF
Deborah MillerVP Health Care Services
Yunkyung KimAVP Government Contracts
Carl Gardner, Esq. Legal Counsel
Michelle EspinozaVP Network Management
PRIMARY CONTACTS
Yunkyung Kim AVP Government Contracts
(562) 491-7004
Cameron Smyth AVP State Affairs
(661) 505-2269
68
Monarch Health Plan, Inc.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 ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .Monarch Healthcare, A Medical Group, Inc . Recent mergers or acquisitions within California . . . . . . .NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2007Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2007Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ProfitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .16 FTE’s Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .MHP takes global risk for other Health Plans’ members
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and Independent Practice Associations (IPAs)Number of medical groups/IPAs . . . . . . . . . . . . . . . . . . . .1 contracted Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . None Number of other licensed clinicians . . . . . . . . . . . . . . . . . NoneNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . None
COMPENSATION METHODSPhysicians – primary care (ranked by method) . . . . . . . . . NonePhysicians – specialty (ranked by method) . . . . . . . . . . . . None Hospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Diagnosis Related Group
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .None Medicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .MHP takes global risk for other Health Plans’ members
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . .NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . .None
69
On Lok Lifeways (On Lok Senior Health Services)
1333 Bush Street • San Francisco, CA 94109Ph: (415) 292-8888 • Fax: (415) 292-8745 • www.OnLok.org
EXECUTIVE OFFICERS
Robert E. EdmondsonCEO
Kelly WalshCFO
Jay Luxenberg, MDChief Medical Officer
Grace LiChief Operating Officer
Eileen KunzChief of Government
Affairs and Compliance
PRIMARY CONTACTS
Eileen KunzGovernment Relations
(415) 292-8722
Robert NovelliPublic Affairs
(415) 292-8711
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . On Lok, Inc .Recent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1971Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1999Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 450 full time, 250 part timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .1,337
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Staff ModelNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 55 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 15 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 employed, 350 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 55 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 9 owned, 175 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . EmployedPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Fee-For-Service
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PACE: HMO
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . .NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
70
Partnership HealthPlan of California4665 Business Center Drive • Fairfield, CA 94534Ph: (707) 863-4100 • Fax: (707) 863-4117 • www.partnershiphp.org
CALIFORNIA OFFICE LOCATIONS
Headquarters4665 Business Center Drive
Fairfield, CA 94534
Santa Rosa Office495 Tesconi Circle
Santa Rosa, CA 95401
Redding Office3688 Avtech Parkway Redding, CA 96002
Eureka Office1036 5th Street, Suite E
Eureka, CA 95501
EXECUTIVE OFFICERS
Jack Horn Executive Director/
Chief Executive Officer
Elizabeth GibboneyDeputy Executive Director/
Chief Operating Officer
Patti McFarlandChief Financial Officer
Robert Moore, MD, MPHChief Medical Officer
Kirt KempChief Information Officer
Margaret KisliukExecutive Director,
Northern Region
Robert LayneDirector of Government
and Public Affairs
Amy TurnipseedDirector of Policy and
Program Development
PRIMARY CONTACT
Robert LayneDirector of Government
and Public Affairs(707) 420-7690
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1994 Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2005 Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profit Number of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 611Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 502,500
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Direct Contracting with Physicians, Network of Medical Groups and IPAsNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 6 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 59 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 6,017 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 756 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 916 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Individual and Group Capitation, Fee-For-ServicePhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-Service, Individual Capitation, Group CapitationHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Capitation, Diagnosis-Related Group
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . HMOMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
71
San Francisco Health Plan (San Francisco Health Authority)
201 Third Street, 7th Floor • San Francisco, CA 94103Ph: (415) 547-7818 • Fax: (415) 615-6435 • www.sfhp.org
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1997Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1996Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profit/Public AgencyNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .127,407
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAs, Staff (Kaiser)Number of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 7 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 8 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 2,508 contracted (PCP & Specialists)Number of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 287 contracted (Mid-Level providers)Number of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 136 contracted (PCP sites)
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Group Capitation, Fee-For-ServicePhysicians– specialty (ranked by method) . . . . . . . . . . . . . Group Capitation, Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Capitation, Fee-For-Service
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Healthy Workers: HMO
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .HMOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
EXECUTIVE OFFICERS
John F. Grgurina, Jr.CEO
EXECUTIVE STAFF
Sunny CooperCIO
John GregoireCFO
Deena LouieChief Operations Officer
Nina MaruyamaOfficer, Regulatory
Affairs and Compliance (includes Community
Relations and Marketing)
James Glauber, MD, MPHChief Medical Officer
Sumi SousaOfficer, Policy Development
and Coverage Programs
PRIMARY CONTACTS
Sumi SousaOfficer, Policy Development
and Coverage Programs(415) 615-5121
Nina MaruyamaOfficer, Regulatory
Affairs and Compliance (includes Community
Relations and Marketing)(415) 615-4217
72
Santa Clara Family Health Plan (Santa Clara County Health Authority)
210 E . Hacienda Avenue • Campbell, CA 95008Ph: (408) 376-2000 • Fax: (408) 376-2191 • www.scfhp.com
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1995Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1997Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .117 full time, 1 part timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .154,246
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAs, Direct Contracting with PhysiciansNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 8 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 8 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 4,144 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Medical Group Capitation, PCP Capitated, Fee-For-Service including risk sharingPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-Service, Medical Group CapitationHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Capitation, Diagnosis-Related Group
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . .NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
CALIFORNIA OFFICE LOCATIONS
Ancillary OfficeSan Jose, CA
(877) 688-7234
Corporate OfficeCampbell, CA
(408) 376-2000Fax: (408) 376-2191
EXECUTIVE OFFICERS
Elizabeth DarrowChief Executive Officer
Dave CameronChief Financial Officer
Anthony SolemChief Medicare Officer
Jeff Robertson, MDChief Medical Officer
EXECUTIVE STAFF
Pat McClellandVP, Member and
Medical Operations
Gary KaplanVP of Information
Technology
Jennifer ClementsDirector, Provider
Operations
Diane BrownSr. Director of Medical
Management and Quality Improvement
Johanna LiuDirector, Pharmacy
Beth PaigeCompliance and
Privacy Officer
PRIMARY CONTACT
Elizabeth DarrowPublic Affairs
(408) 376-2000
73
SCAN Health Plan®
3800 Kilroy Airport Way, Suite 100 • Long Beach, CA 90806Ph: (562) 989-5100 • Fax: (562) 989-5200 • www.scanhealthplan.com
EXECUTIVE OFFICERS
Chris WingChief Executive Officer
Vinod MohanChief Financial Officer
Romilla Batra, M.D.Vice President,
Corporate Medical Director
Raymond Chan, M.D.Vice President,
Corporate Medical Director
Nancy MonkChief Risk Officer
William RothChief Operating Officer
Josh GoodeChief Technology Officer
Cathy BatteerSenior Vice President and General Manager,
All SCAN Markets
David MilliganSenior Vice President,
National Sales
Sherry StanislawSenior Vice President and General Manager,
Southern California
Peter BegansSenior Vice President,
Public and Government Affairs
EXECUTIVE STAFF
Andrew WhitelockVice President and Compliance Officer
Karen SuganoVice President and General Manager,
Northern California
Riaz AliChief Marketing Executive
Sharon BakshiPharmacy Vice President
Kim McBeathDirector, Customer Services
(Member Relations)
PRIMARY CONTACTS
Peter BegansGovernment Relations
(202) 756-2279
Sherry StanislawPublic Affairs
(562) 989-5216
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . SCAN GroupRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1977Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1985Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 890 full time, 58 part timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .155,528
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAsNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 67 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 121 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Group CapitationPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Group CapitationHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Diagnosis-Related Group, Capitation
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . NoneLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . NoneMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . HMOMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . . NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . . NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMO Healthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . None Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . None Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
74
Seaside Health Plan2840 Long Beach Blvd ., Suite 120 • Long Beach, CA 90806Ph: (562) 933-0950 • Fax: (562) 424-1486 • www.SeasideHealthPlan.org
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . MemorialCare Health System Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2013Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2013Tax Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non-ProfitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .23,071, CA HMO
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Group, IPA’s, and Direct ContractingNumber of Medical Groups/IPAs . . . . . . . . . . . . . . . . . . . 0 owned, 1 contracted Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 7 contracted Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 326 PCP + 1310 SPC contracted Number of other licensed clinicians . . . . . . . . . . . . . . . . . 0 owned, 0 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 0 contracted
COMPENSATION METHODSPhysicians – primary care (ranked by method) . . . . . . . . . Group Capitation, Individual Capitation, FFSPhysicians – specialty (ranked by method) . . . . . . . . . . . . Group Capitation, Individual Capitation, FFSHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Capitation, Case Rate, DRG, Per Diem
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan to PlanSmall group (2– 50 employees) . . . . . . . . . . . . . . . . . . . Plan to PlanLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . Plan to Plan, Direct 100+ EmployeesMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . Plan to PlanMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . Plan to PlanMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . . Plan to PlanMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Large GroupDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Large GroupLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . .NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Large GroupSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .NoneRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . .None
EXECUTIVE OFFICERS
Wendy DorchesterCAO
Jay DavisSenior Vice President
Barry C. Smith, MDCMO
PRIMARY CONTACTS
Peter MacklerGovernment Relations
(714) 377-2946
Rhoda WeissPublic Affairs
(562) 933-1622
75
Sharp Health Plan8520 Tech Way, Suite 200 • San Diego, CA 92123Ph: (858) 499-8377 • Fax: (858) 499-8244 • www.sharphealthplan.com
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . .Sharp HealthCareRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1992Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1992Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .119 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 70,559
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups, IPAs, Individual Practices, Physician Practices Number of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 6 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 12 contractedPhysician practices (including specialists) . . . . . . . . . . . . . 0 owned, 2,008 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 1,279 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Group Capitation, Fee-For-ServicePhysicians– specialty (ranked by method) . . . . . . . . . . . . . Group Capitation, Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Capitation, Discounted Charges, Per Diem
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOCovered California (SHOP) . . . . . . . . . . . . . . . . . . . . . . . . HSA HMO, HMO-1, HMO-2 Small group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . HMOLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMO, POSMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO/OtherDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO/PPOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO/OtherSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OtherDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
EXECUTIVE OFFICERS
Melissa Hayden CookPresident and Chief
Executive Officer
Rita DatkoChief Financial Officer
Leslie Pels-BeckChief Operations Officer
Lori Stone, MDChief Medical Officer
EXECUTIVE STAFF
Michael ByrdBusiness Development
Officer
PRIMARY CONTACTS
Stacy BakerGovernment Relations
(858) 499-8237
Leslie Pels-BeckPublic Affairs
(858) 499-8327
76
SIMNSA Health Plan333 H Street, Suite 6040 • Chula Vista, CA 91910Ph: (619) 407-4082 • www.simnsa.com
EXECUTIVE OFFICERS
Frank CarrilloChief Executive Officer
Christina SuggettChief Operating Officer
Claudia Da CostaChief Financial Officer
EXECUTIVE STAFF
Elizabeth B. DanielsChief Legal Counsel
PRIMARY CONTACT
Elizabeth B. DanielsChief Legal Counsel
Government Relations/Public Affairs
(619) 407-4082, ext. 121
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . Sistemas Medicos Nacionales, SA de CVRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1980Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 full timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 38,374
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network, Direct Contracts and Staff Number of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 3 ownedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 13 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 owned groups, 300 contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 20 contractedNumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . 200
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Individual CapitationPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-ServiceHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Fee-For-Service
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Small group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . HMOLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMO
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . .NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . HMO
77
Sutter Health Plus2880 Gateway Oaks Drive, Suite 150 • Sacramento, CA 95833Ph: (855) 325-5200 • Fax: (916) 614-2487 • www.sutterhealthplus.org
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . Sutter HealthRecent mergers or acquisitions within California . . . . . . . N/AYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2012Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2013Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 fulltime FTE Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .13,500
PLAN-PROVIDER ARRANGEMENTS Model types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAs Number of Medical Groups/IPAs . . . . . . . . . . . . . . . . . . . 4 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 contracted Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . .1,800 contracted Number of other licensed clinicians . . . . . . . . . . . . . . . . . Not tracked – N/ANumber of provider offices . . . . . . . . . . . . . . . . . . . . . . . Not tracked – N/A
COMPENSATION METHODS Physicians – primary care (ranked by method) . . . . . . . . . Group Capitation Physicians – specialty (ranked by method) . . . . . . . . . . . . Group Capitation Hospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Capitation; Per diem
PLAN PRODUCTS PRODUCTS CURRENTLY OFFERED
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . HMO and HSA eligible HMOLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMO and HSA eligible HMOMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/AMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . .N/AMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . N/ASpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .N/AMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .N/AAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .N/AHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/AMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . N/AOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .N/A Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/AAccidental Death & Dismemberment . . . . . . . . . . . . . . . . N/AAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Individual and Small Group HMODurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .N/AOther (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A
EXECUTIVE OFFICERS
Steve NolteChief Executive Officer
Robert CaioneChief Financial Officer
Jennifer SchirmerVP, Operations
Monica Majors VP, Strategic Sales
& Marketing
Robert CarnaroliVP, Commercial Sales
Jennifer Nuovo, MDChief Medical Officer
EXECUTIVE STAFF
Michael Poole Compliance Officer
PRIMARY CONTACT
Sy NeilsenCommunications (916) 292-0666
78
UnitedHealthcare of California5995 Plaza Drive • Cypress, CA 92630Ph: (714) 952-1121 • Fax: (866) 383-0428 • www.uhcwest.com or www.securehorizons.com
EXECUTIVE OFFICERS
Brandon Cuevas President and CEO
John WolterbeekChief Financial Officer
Jeffrey Mason, MD Medical Director
Claire HannanVP Operations
Joy Higa VP Regulatory Affairs
Alexander UhmChief Operating Officer
PRIMARY CONTACT
Elizabeth Hays Regulatory Affairs
(714) 226-3106
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .UnitedHealth GroupUltimate 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1975Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1978Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,000+ UHG employeesHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . 768,416
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAsNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 0 owned, 381 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 397 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 44,343 contracted Number of provider offices . . . . . . . . . . . . . . . . . . . . . . . 27,512 contracted
COMPENSATION METHODSPhysicians – primary care (ranked by method) . . . . . . . . . Depends on IPA/PMG subcontractsPhysicians – specialty (ranked by method) . . . . . . . . . . . . Depends on IPA/PMG subcontractsHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Capitation, Per Diem
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Small group (2 – 50 employees) . . . . . . . . . . . . . . . . . . . . HMOLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMOMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . by affiliateSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . . by affiliateAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PPOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OtherAccidental Death & Dismemberment . . . . . . . . . . . . . . . . OtherAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, PPOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . HMO, PPORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Infertility: HMO, PPO
79
Valley Health Plan (Santa Clara County)
2480 North 1st Street, Suite 200 • San Jose, CA 95131Ph: (408) 885-4080 • Fax: (408) 885-5921 • www.valleyhealthplan.org
PLAN ORGANIZATION Parent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . . Santa Clara CountyRecent mergers or acquisitions within California . . . . . . . N/A Year founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1985Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1985Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .100 FTEHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .120,583
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Two-Plan ModelNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . . 5 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 839 staff/contractedNumber of other licensed clinicians . . . . . . . . . . . . . . . . . 400 contracted
COMPENSATION METHODPhysicians– primary care (ranked by method) . . . . . . . . . . Fee-For-Service, Capitation, SalaryPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Fee-For-Service, SalaryHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Capitation, Per Diem, Percentage of Billed
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Covered California (Individual Market) . . . . . . . . . . . . . . . HMO Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . HMOLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMOMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . HMOHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO Major Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . COBRA: HMO
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NonePrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . . NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None
EXECUTIVE OFFICERS (ACTING)
Pat Cox, RNCEO
VacantCOO
EXECUTIVE STAFF
Dolly Goel, MDMedical Director
PRIMARY CONTACTS
Georgette CookRegulatory Affairs
(408) 885-5606
Joy AlexiouPublic Affairs
(408) 885-4164
80
Ventura County Health Care Plan2220 E . Gonzales Rd ., Suite 210B • Oxnard, CA 93036Ph: (805) 981-5050 • Fax: (805) 981-5026 • www.vchealthcareplan.org
EXECUTIVE OFFICERS
County Board of Supervisors
EXECUTIVE STAFF
Barry Fisher, MPPAHealth Care
Agency Director
Narcisa Reyes-EganInterim Chief
Financial Officer
Dr. Catherine Rajala SandersChief Medical Officer
PRIMARY CONTACTS
Dee PupaPlan Administrator
(805) 981-5006
Sharon ClackFiscal Manager
(805) 981-5002
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . County of Ventura Recent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1993Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1996Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non profitNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Health Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .15,000
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Direct ContractNumber of medical groups/IPAs . . . . . . . . . . . . . . . . . . . None Number of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 County operated, 6 contracted Number of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 469 contracted Number of other (NPs/PAs) . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 75 contractedNumber of provider offices (all specialties) . . . . . . . . . . . 0 owned, 134 contracted, 55 PCPs
COMPENSATION METHODSPhysicians – primary care (ranked by method) . . . . . . . . . FFSPhysicians – specialty (ranked by method) . . . . . . . . . . . . FFSHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Per Diem, Case Rates, % Charges
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED HMO
Individual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoSmall group (2 –50 employees) . . . . . . . . . . . . . . . . . . . .YesLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . .YesMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . .NoMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . .NoMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .No Medicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . .NoAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .YesHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .No
ANCILLARY PRODUCTS HMO
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesDental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoAccidental Death & Dismemberment . . . . . . . . . . . . . . . .NoAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . .YesRehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . .NoOther (please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . .No
81
Western Health Advantage2349 Gateway Oaks Drive, Suite 100 • Sacramento, CA 95833Ph: (916) 563-3180 • Fax: (916) 563-3182 • www.westernhealth.com
PLAN ORGANIZATIONParent Company/Affiliate . . . . . . . . . . . . . . . . . . . . . . . . .NoneSubsidiaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoneRecent mergers or acquisitions within California . . . . . . . NoneYear founded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1995Year licensed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1997Tax status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Non exemptNumber of employees . . . . . . . . . . . . . . . . . . . . . . . . . . .136 full time, 7 part timeHealth Plan Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . .108,599
PLAN-PROVIDER ARRANGEMENTSModel types (ranked in descending order) . . . . . . . . . . . . Network of Medical Groups and IPAs, Direct Contracting with PhysiciansNumber of medical groups . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 4 contractedNumber of IPAs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 2 contractedNumber of hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 14 contractedNumber of physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 owned, 3,276 contracted
COMPENSATION METHODSPhysicians– primary care (ranked by method) . . . . . . . . . . Group CapitationPhysicians– specialty (ranked by method) . . . . . . . . . . . . . Group CapitationHospitals (ranked by payment type) . . . . . . . . . . . . . . . . . Capitation, Discount Charges
PLAN PRODUCTSPRODUCTS CURRENTLY OFFERED
Covered California (Individual Market) . . . . . . . . . . . . . . . HMO, HSA HMOIndividual market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO, HSA HMOCovered California (SHOP) . . . . . . . . . . . . . . . . . . . . . . . . HMO, HSA HMO Small group (2 –50 employees) . . . . . . . . . . . . . . . . . . . . HMO, HSA HMOLarge group (50+ employees) . . . . . . . . . . . . . . . . . . . . . HMO, HSA HMO, PPOMedicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedi-Cal Managed Care . . . . . . . . . . . . . . . . . . . . . . . . .NoneMedigap (Supplemental Insurance) . . . . . . . . . . . . . . . . . NoneSpecial Needs Plans (SNPs) . . . . . . . . . . . . . . . . . . . . . . .NoneMedicare Part D stand-alone . . . . . . . . . . . . . . . . . . . . . .NoneAccess for Infants and Mothers . . . . . . . . . . . . . . . . . . . .NoneHealthy Kids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneMajor Risk Medical Insurance/GIP . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .None
ANCILLARY PRODUCTS
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO/PPOChiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMODental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMO/PPOPrescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOLong Term Health Care . . . . . . . . . . . . . . . . . . . . . . . . . .NoneLife Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneAccidental Death & Dismemberment . . . . . . . . . . . . . . . .NoneAcupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOSubstance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOMassage Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NoneDurable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . HMORehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HMOWorkers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . NoneOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health coaching International travel assistance services
EXECUTIVE OFFICERS
Garry MaiselPresident and CEO
Rita RueckerChief Financial Officer
EXECUTIVE STAFF
Donald Hufford, M.D.Chief Medical Officer
Glenn HamburgChief Client
Services Officer
Bill FigenshuChief Sales Officer
Rebecca DowningChief Legal Officer
Rick HeronChief Marketing and
Brand Officer
Ali DarugarChief Information Officer
PRIMARY CONTACTS
Rebecca DowningGovernment Relations
(916) 563-3183
Rick HeronPublic Affairs
(916) 614-6009
• 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
Helping people get the services that support an improved quality of life where they live
[email protected] | 886.246.5875 | www.logisticare.com
Benefits you’ll receive when you choose LogistiCare:
NURSE TRIAGE
TELEPHONICURGENT
CARE POST DISCHARGE
TRANSITIONAL SUPPORT
CHRONIC DISEASE
MANAGEMENTSUPPORT
BIOMETRIC MONITORING
ER COSTCONTAINMENT
PROGRAMSMEMBER
ENGAGEMENT PROGRAMS
INDEPENDENT LIVING
SUPPORT
HEALTH RISKASSESSMENTS
TRANSPORTATION
TELEMEDICINE SUPPORT
SUPPLY CHAIN BENEFITCOORDINATION
& DELIVERY
We coordinate delivery of traditional and non-traditional
health related services and solutions.
ADVANCING PHARMACY AND
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
HEALTH MANAGEMENTDelivering the Most Appropriate Outcome
Vice President Sales [email protected]
© 2015 Argus Health Systems, Inc.
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.
ADVANCING PHARMACY AND
Chris Henry
HEALTH MANAGEMENT
Chief Revenue [email protected]
© 2015 DST Health Solutions
SCALABLE SOLUTIONS FOCUSED ONADVANCING THE BUSINESS OF HEALTHCARE
AD CAHP FINAL 1 28 15.indd 1 1/28/15 9:22 AM
Our system automates cost containment for healthcare organizations by monitoring your internal claims process to detect fraud and abuse, and maximize financial recoveries. Not only does it analyze claims for abusive billing patterns, but it also identifies claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports.
PCG Software’s Virtual Examiner®
is the ONLY cost containment platform with two million Medi-Cal specific edits!
X codes, Z codes and CMS edits? Virtual Examiner evaluates them all to ensure proper billing and fast payments!
one in a million. wELL... TwO MiLLiON TO bE EXaCT.
Don’t settle for anything less than the most comprehensive claims analysis when it comes to your organization’s financial recoveries!
[email protected] • 877.789.1291 • www.pcgsoftware.com
In•de•pend•ent (adj.) free from control in action or judgment
866.689.0898 • [email protected] @thePAexperts
The specialty drug pipeline is overflowing. Is your PA program consistent, objective, and auditable? Does your PA program allow you to appropriately manage new, expensive therapies?
You need high-quality, evidence-based criteria. You need a program that is not influenced by manufacturer relations. You need a PA solution that is independent.
Gain independence. Gain control.
Access. Outcomes. Personalized Care.
Your innovative pharmacy benefits partner delivering improved clinical outcomes.
PerformRx offers clients:
• Drug therapy management.• Medicare Part D administration.• Prior authorization.
• Rebate management.• Specialty utilization management.• Star Rating support.
Formed in 1999, PerformRx, LLC, is a URAC-accredited, clinician-led pharmacy benefits manager driven by a strong clinical culture, adaptive technology and personalized customization.
Complete specialty pharmacy service. Total pharmaceutical care management.PerformSpecialty offers clients:
• Disease management.• Adherence programs.• Utilization management.
• Member support programs.• Fulfillment.• Refill reminders.
PerformSpecialty, LLC is a high-touch, member-driven specialty pharmacy dedicated to providing personalized member care and better access to achieve healthier outcomes.
1-866-533-5492 | www.performrx.com
1-855-287-7888 | www.performspecialty.com
©2015 Amplifon Hearing Health Care, Corp. 2580ROPA
More and more health insurance companies across the country are harnessing the power of a hearing program to attract and retain members and, ultimately, to grow their bottom line - without affecting their Medical Loss Ratio (MLR). At Amplifon, we can show you how to seize this unprecedented opportunity.
Grow your member base and bottom line. No cost to you, no member premiums.
We have the missing piece.
Learn more by visiting www.amplifonusa.com/cahp
Amplifon Hearing Health Care, formerly HearPO, a voluntary benefit with a difference.
©20
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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.)
Together with our providers we’ll keep growing and caring for our Members – now over one million strong.
Strong Today. Even Better Tomorrow.