HUMANA GETS LOCAL CONTRACT

Humana, one of the nation's largest managed care insurers, is working to expand its health care products into Southeast Missouri.

David Fields, chief executive officer of Humana in Missouri and Southern Illinois, said the company entered the area by winning a contract to provide insurance to state employees in Southeast Missouri.

Some 2,000 to 3,000 state employees in this area may choose Humana for health insurance. Fields said that business represents more than $6 million in premiums and expenses.

"Humana has a strategy that it does not want to be everywhere and everything for everyone," Fields said. "But where we do business we want to have enough membership and the capabilities to be successful in that marketplace."

Over the past few weeks, Humana representatives have been meeting with local doctors and employers, testing the waters for Humana's entrance into the Cape Girardeau health care market.

"If we're going to be there, let's do it right," Fields said. "Health care is a local issue and needs to be performed locally and administered locally."

Fields said a lease is being negotiated for a Cape Girardeau office to be opened during the first quarter of 1995. He said staff will be hired to head Humana's efforts in Southeast Missouri.

He hopes to build a provider network of doctors and hospitals in Cape Girardeau. Already 70 provider contracts have been signed, mostly in Poplar Bluff and the Bootheel.

"We've had a lot of very successful interaction with physicians in the Cape," Fields said. "A lot of people are interested in listening. We are not that far along with the hospitals at this time."

More than 30 meetings have been held with doctors.

Humana representatives have also been talking with employers about the insurance products the company offers.

Initially, he said, Humana will sell a Preferred Provider Organization (PPO) option. The PPO includes providers in St. Louis, Memphis, Paducah and other areas where Humana operates.

In the future, he said, a Health Maintenance Organization (HMO) is planned. An HMO offers tighter guidelines.

The SEMO Business Group on Health has offered information about Humana to its members, said executive director Mary Dunn.

Dunn said the group asked Humana representatives to present their plan after the company received the state contract.

"We were excited about them coming in and bringing more competition to Southeast Missouri," Dunn said. "We feel more competition is needed in the Cape."

Dunn said the business group hasn't encouraged member companies to switch to Humana.

"It's their choice. We just see this as another option," she said.

Dunn said Humana is attractive because it has been a provider. In other areas, the company employs doctors and owns many of its own health centers.

Fields said Humana is interested in dealing with members of the local Physician Hospital Organization (PHO), called MedAmerica Health Net.

MedAmerica introduced its own health insurance product earlier this week.

Fields said, "We had our first discussions with MedAmerica more than a year ago. I can't say our discussions went anywhere. But we are certainly interested in what MedAmerica is all about."

Dunn said the business group is waiting for details about a new insurance product offered by the local PHO.

"The PHO, we see that as one option," she said. "We don't want it to be our only option."

Fields said Humana thinks competition is good for health care.

"We are not a bunch of claim adjusters," Fields said. "We have a lot of resources. We are trying to figure out how everything works in the Cape, get a lay of the land. Then we will invite people to work with us."