HEALTH CARE PLANS (HMO/PPO) IN ORANGE COUNTY

According to Johnson and Johnson Health Management, Inc., a Santa Monica-based firm, health care insurance premiums “rose drastically in the 1980s, flattened out in 1984 and began to soar in 1986.” During the period, premium rates increased from a low of 12% to highs of 60-70%, said Ron Goetzel, director of data analysis and evaluation.

Cost shifting measures due to higher deductibles, co-insurance payments and out-of-pocket expenses will continue to increase premium rates. “The out-patient setting concept was developed to provide services at lower rates than hospitals, however these costs are increasing. At the same time, hospital rates continue to escalate with fewer people using these facilities. The only way to cut costs is to promote and operate effective wellness and disease prevent programs,” Goetzel said.

Based on a report, “Orange County’s Health Care Crisis,” published by the Health Task Force of United Way of Orange County, the types, amounts and costs of health care programs are determined by current levels of governmental services and augmented by voluntary and private programs. The report estimates that health care deprived persons constitute 360,000 or 16% of the county’s 2.15 million population.

According to the report, the health care-deprived fall into the following categories:

Insured Seniors--Medicare, the federal program financed by payroll taxes, general funds and beneficiary payments, insures an estimated 95% of the county’s 300,000 senior citizens. Medicare provides basic health protection. However, the program only covers 38% of all health care expenditures because of deductibles, co-payments and non-covered services.

Financially Assisted Residents--MediCal, the federal/state, 50/50 financed program for which the county administers financial eligibility is designed for persons receiving financial assistance (Aid to Families with Dependent Children, Supplemental Security Income or in-home supportive services) for living expenses.

Medically Indigent Adults--Indigent Medical Services (IMP) is a state-financed, county-administered health care program for adults who cannot afford to pay and who are not eligible under MediCal.

Medical Marginals--Thousands of economically deprived county residents receive some type of health care other than the aforementioned programs. However, thousands do not.

Great Uncounted--Little data exist to clearly show persons rejected from health care services, as well as those refusing to seek services because of financial and/or personal reasons.

HEALTH MAINTENANCE ORGANIZATIONS

Health Maintenance Organizations (HMO) are organized health care delivery systems that assume responsibility for health care, financing and delivery to enrolled members. HMO’s use pre-paid funds, paid on behalf of enrolled members to support staff and facilities serving membership.

Organization / Name of Plan: AETNA Partners Health Plan

1745 W. Orangewood Ave.

Orange

(714) 634-1988 Number of County Plan Members: 1,778 Total Number of Plan Members: 53,614 statewide Number Primary Care Providers *:331 in county Participating Hospitals/Facilities in Orange County: 12 hospitals; 37 medical groups and laboratories Organization / Name of Plan: Blue Cross of Calif. Take Care Plan

575 Anton Blvd. 200

Costa Mesa

(714) 641-1201 Number of County Plan Members: 1,000 Total Number of Plan Members: 167,000 statewide Number Primary Care Providers *: 40 in county Participating Hospitals/Facilities in Orange County: 3 hospitals; 10 medical delivery sites Organization / Name of Plan: Blue Cross of Calif. California Care Plan Number of County Plan Members: 10,320 Total Number of Plan Members: 120,412 statewide Number Primary Care Providers *: 440 in county Participating Hospitals/Facilities in Orange County: 13 hospitals; 29 medical delivery sites Organization / Name of Plan: Care America

20520 Nordoff Ave.

Chatsworth

(800) CARE-4-US Number of County Plan Members: 6,000 Total Number of Plan Members: 32,500 in So. Calif. Number Primary Care Providers *: 1,000 in county Participating Hospitals/Facilities in Orange County: 7 hospitals in county; 44 hospitals statewide Organization / Name of Plan: CIGNA

4141 MacArthur Blvd. 201

Newport Beach

(714) 253-6900 Number of County Plan Members: 75,000 Total Number of Plan Members: 441,000 in So. Calif. Number Primary Care Providers *: 502 in county Participating Hospitals/Facilities in Orange County: 10 hospitals; 7 medical delivery sites Organization / Name of Plan: Family Health Planning (FHP)

9900 Talbert Ave.

Fountain Valley

(714) 963-7233

Number of County Plan Members: 9,437 Total Number of Plan Members: 171,000 statewide Number Primary Care Providers *: 130 in county Participating Hospitals/Facilities in Orange County: 1 hospital; 7 medical delivery sites Organization / Name of Plan: General Med

701 S. Parker, 4000

Orange

(714) 647-2200 Number of County Plan Members: 17,633 Total Number of Plan Members: 115,000 in S. Calif. Number Primary Care Providers *: 224 in county Participating Hospitals/Facilities in Orange County: 27 hospitals; 6 medical delivery sites Organization / Name of Plan: Health Net

3447 Atlantic Ave. 200

Long Beach

(800) 445-5255 Number of County Plan Members: 80,000 Total Number of Plan Members: 505,000 statewide Number Primary Care Providers *: 167 in county Participating Hospitals/Facilities in Orange County: 12 hospitals; 45 medical delivery sites Organization / Name of Plan: Health Plan of America

505 S. Main St. 300

Orange

(714) 972-9200 Number of County Plan Members: 15,000 Total Number of Plan Members: 88,000 statewide Number Primary Care Providers *: 435 in county; 6,000 statewide Participating Hospitals/Facilities in Orange County: 4 hospitals; 85 medical delivery sites in county; 65 hospitals statewide Organization / Name of Plan: Kaiser Permanente Medical Care Program

441 N. Lakeview

Anaheim

(714) 978-4700 Number of County Plan Members: 139,000 Total Number of Plan Members: 1.8 million in So. Calif. Number Primary Care Providers *: 140 in county Participating Hospitals/Facilities in Orange County: 1 hospital Organization / Name of Plan: Maxicare

5200 Century Blvd.

Los Angeles

(213) 568-9000 Number of County Plan Members: 42,500 Total Number of Plan Members: 350,000 in So. Calif. Number Primary Care Providers *: 725 in county Participating Hospitals/Facilities in Orange County: 16 hospitals Organization / Name of Plan: Metlife Health Care Network of So. Calif

4500 E. Pacific

Coast Highway 600

Long Beach

(213) 597-9932 Number of County Plan Members: 19,410 Total Number of Plan Members: 46,214 in So. Calif. Number Primary Care Providers *: 350 in county Participating Hospitals/Facilities in Orange County: 8 hospitals; 350 medical delivery sites Organization / Name of Plan: Pacificare Health Care Systems/Pacificare of Calif. **

5995 Plaza Dr.

Cypress

(714) 952-1121 Number of County Plan Members: 20,563 Total Number of Plan Members: 140,470 in So. Calif. Number Primary Care Providers *: 1,949 statewide Participating Hospitals/Facilities in Orange County: 12 hospitals; 17 participating medical groups Organization / Name of Plan: Peak Health Plan

21800 Oxnard St.600

Woodland Hills

(818) 883-5071 Number of County Plan Members: 1,440 Total Number of Plan Members: 39,769 statewide Number Primary Care Providers *: 598 in county Participating Hospitals/Facilities in Orange County: 16 hospitals; 15 medical delivery sites Organization / Name of Plan: Provident Life and Accident

695 Town Center Dr. 140

Costa Mesa

(714) 432-1593 Number of County Plan Members: 7,906 Total Number of Plan Members: 65,118 statewide Number Primary Care Providers *: 450 in county Participating Hospitals/Facilities in Orange County: 11 hospitals Organization / Name of Plan: Prudential Life Insurance Company of America Prucare/Prucare Plus

1120 W. LaVeta 550

Orange

(714) 547-4088 Number of County Plan Members: 9,000 in county plus Long Beach Total Number of Plan Members: 60,000 statewide; 1.3 million nationally Number Primary Care Providers *: 1,200 in county Participating Hospitals/Facilities in Orange County: 11 hospitals Organization / Name of Plan: Universal Care

12751 Harbor Blvd.

Garden Grove

(714) 841-2177 Number of County Plan Members: 10,000 Total Number of Plan Members: 12,000 in So. Calif. Number Primary Care Providers *: 350 in county Participating Hospitals/Facilities in Orange County: 7 hospitals; 16 medical groups Organization / Name of Plan: Western Health Plan of So. California

5050 Palo Verde Suite 118

Montclair

(714) 625-2347 Number of County Plan Members: 1,000 Total Number of Plan Members: 15,000 in So. Calif. Number Primary Care Providers *: 100 in county Participating Hospitals/Facilities in Orange County: 5 hospitals * Primary care providers represent specialists and/or general practitioners. ** Pacificare of California, no current figures available. Data as of September 1987. PREFERRED PROVIDER ORGANIZATIONS

Preferred Provider Organizations (PPO) are health plans that negotiate discounted fee schedules with physicians and hospitals in exchange for quick payments and business. PPO members must receive services and treatment from physicians and hospitals affiliated with their specific health plan. Organization / Name of Plan: Blue Cross of California Prudent Buyer Plan

575 Anton Blvd. 200

Costa Mesa

(714) 641-1201 Number of County Plan Members: 83,248 Total Number of Plan Members: 1.1 million statewide Number Primary Care Providers *: 2,060 in county Participating Hospitals/Facilities in Orange County: 19 hospitals Organization / Name of Plan: Blue Shield

625 The City Dr. 280

Orange

(714) 978-6402 Number of County Plan Members: 92,341 Total Number of Plan Members: 1.4 million statewide Number Primary Care Providers *: 3,300 in county Participating Hospitals/Facilities in Orange County: 15 hospitals in county; 221 hospitals statewide Organization / Name of Plan: Capp Care

17390 Brookhurst 280

Fountain Valley

(714) 963-8065 Number of County Plan Members: 450,000 statewide Total Number of Plan Members: 750,000 nationally Number Primary Care Providers *: 1,891 in county Participating Hospitals/Facilities in Orange County: 20 hospitals Organization / Name of Plan: Humana Health Care Plan

3010 W. Orange 210

Anaheim

(714) 220-2444 Number of County Plan Members: 4,400 Total Number of Plan Members: 9,700 statewide Number Primary Care Providers *: 170 in county Participating Hospitals/Facilities in Orange County: 12 hospitals Organization / Name of Plan: Orange County Preferred Provider Organization

18141 Beach Blvd. 350

Huntington Beach

(714) 842-0843 Number of County Plan Members: 30,000 Total Number of Plan Members: 500 outside Orange County Number Primary Care Providers *: 1,500 in county Participating Hospitals/Facilities in Orange County: 17 hospitals Organization / Name of Plan: Advanced Delivery System (ADS)

5995 Plaza Dr.

Cypress

(714) 952-1121 Number of County Plan Members: 2,100 Total Number of Plan Members: 5,000 in So. Calif. Number Primary Care Providers *: 744 in county Participating Hospitals/Facilities in Orange County: 6 hospitals Organization / Name of Plan: PPO Alliance ***

5252 Orange Ave.

Cypress

(714) 761-9771 Number of County Plan Members: -- Total Number of Plan Members: 792,000 statewide Number Primary Care Providers *: 477 in county Participating Hospitals/Facilities in Orange County: 9 hospitals Organization / Name of Plan: Travelers Preferred

2600 Michelson Dr. 600

Irvine

(714) 553-9444 Number of County Plan Members: 1,534 Total Number of Plan Members: 20,000 in So. Calif. Number Primary Care Providers *: 710 in county Participating Hospitals/Facilities in Orange County: 8 hospitals * Primary care providers represent specialists and/or general practitioners. *** PPO Alliance, plan membership enrollment figure available on statewide basis only. Source: Individual companies surveyed January 11-15, 1988.

Clipboard researched by Rick VanderKnyff and Deborrah Wildinson / Los Angeles Times