COMPETITION FOR AREA MANAGED HEALTH CARE SHARES HEATS UP

Competition is warming up in the battle for shares of managed health care in Southeast Missouri, and two providers in the area are happy with the way things are going.

Humana Health Plan Inc., one of the nation's largest managed care insurers, recently opened an office at 2137 William in Cape Girardeau and has attracted one of the county's larger employers.

"Our membership in Southeast Missouri is over 8,000," said Jeff Anderson, director of operations at the new Cape Girardeau office that serves the entire Southeast Missouri area.

Included in the membership are about 3,000 state employees and more than 1,300 employees of the Procter & Gamble Paper Products Co.

MedAmerica HealthNet Inc., formed last year, includes five Southeast Missouri hospitals and more than 200 doctors. It started selling insurance in mid-February and already has promises of more than 8,000 members.

"We have 1,900 members enrolled in the plan," said Randy Ressel, vice president of Mid-State Sales, Alliance Blue Cross and Blue Shield, which administers the program.

The five hospitals involved -- Southeast Missouri Hospital and St. Francis Medical Center in Cape Girardeau; Missouri Delta Medical Center of Sikeston; Dexter Memorial Hospital of Dexter; and Perry County Memorial Hospital of Perryville -- will enroll their employees in the program.

"These figures will place the membership at more than 8,000," Ressel said. "Perry County has already joined the organization."

Southeast Missouri Hospital is expected to join MHI within the next 30 to 60 days, hospital administrator Jim Wente said. Wente is also vice chairman of the board of directors of MedAmerica HealthNet Inc.

The membership will increase through the course of the year, Wente said, adding that about 30 businesses, of various sizes, have indicated interests in MHI and may join the program as health benefit packages come up for renewal.

Wente said MedAmerica HealthNet is also looking at other counties in Southeast Missouri and Southern Illinois.

Wente and St. Francis Medical Center President John Fidler came up with the idea for MedAmerica HealthNet two years ago.

"We're pleased to see managed care in Southeast Missouri," said Mary Dunn of the Southeast Missouri Business Group on Health, an association of the area's largest employers. "More competition is needed here."

More competition, Dunn said, results in better quality health care at more affordable prices, and that's the goal of the group on health.

Dunn said the group wasn't encouraging member companies to switch to Humana or MedAmerica Health Net.

"That is their choice," she said. "We just see this as another option in health care."

GenCare Health Systems, has also received approval from the state to market HMO health-benefit services in Butler, Carter, Dunklin, Madison, New Madrid, Pemiscot, Ripley, Stoddard and Wayne counties.

The company has signed contracts with Lucy Lee Hospital at Poplar Bluff, Twin Rivers Hospital at Kennett and Madison Memorial Hospital at Fredericktown.

Humana offers a preferred provider option (PPO), which includes providers in St. Louis, Memphis and in the Bootheel area.

"We plan to offer a Health Maintenance Organization (HMO) in the future," said Anderson, who added that Humana is seeking providers in the immediate area.

Anderson said Humana hasn't reached agreement with Cape Girardeau hospitals.

Humana has a complete network in Poplar Bluff, Kennett and Dexter and its members include teachers and employees of the Poplar Bluff Public School District and employees of Columbia Sportswear Co. of Chaffee.

Anderson said Humana is in Springfield, Columbia, Jefferson City, Kansas City and St. Louis.

Hospital care is available at local hospitals even without the network agreement, Anderson said. The networking agreement would decrease the cost.

Although a number of Humana options are available, one example could be could be the 90-10 networking program, which will be 80-20 outside the network.

Anderson said Humana was also looking at setting up programs in Southern Illinois and western Kentucky.