A. HEALTHCARE PLAN, PAYOR & ADMINISTRATIVE ORGANIZATIONS:
HMO/PPO/PSO/Insurance Company
Medicare/Medicaid/Governmental Plan
Supplemental/Carve-Out Insurance Plan (Dental/Vision/Behavioral Health)
Pharmacy Benefits Management (PBM) including Medicare Part D PDP
Third Party Administration (TPA)
Utilization Review Firm
Contract Management Firm
Group Purchasing Organization (GPO)
Employee Benefits Management (EBM) Firm/Consultant
Other Healthcare Plan, Payor & Administrative Organization
Please specify for Other:
B. HEALTHCARE PROVIDER ORGANIZATIONS: (An entity that directly treats patients)
Integrated Health Organization (IHO) (multi-hospital/practice settings; same ownership)
Integrated Delivery System (IDS) (multiple practice settings; same ownership)
Integrated Health Network (IHN) (multi-hospital; separate ownership)
Multi & Large Group Practice (50+ physicians)
Multi & Large Group Practice (less than 50 physicians)
Independent Hospital (300+ beds)
Independent Hospital (less than 300 beds)
Independent Practice Association (IPA)
Medical Clinic (50+ physicians)
Medical Clinic (less than 50 physicians)
Long-term Care Facility or Multi-Facility
Home Healthcare Organization
Other Healthcare Provider Organization
Please specify for Other:
C. INDEPENDENT CONSULTANT
D. NON-HEALTHCARE EMPLOYERS OF: (Aerospace, Automotive, Banking/Financing, Construction, Consumer Goods, Energy, Federal & State Government, Food/Grocery, IT–Hardware & Software, Retail)
5,000+ Employees
1,000 - 4,999 Employees
200-999 Employees
E. OTHER
Please specify for Other:
NON-CLINICAL EXECUTIVE:
Chief Executive: CEO/COO/President/Executive Director/Owner/Principal/VP/Director
Managed Care Executive: Chief/VP/Director
Administrative Executive: VP/Director
Financial Executive/Contracting Executive/Industry Relations Executive: CFO/VP/Director/Treasurer/Controller
Information Technology & Intelligence Services Executive: CIO/VP/Director (Software, Hardware, Web, Data Processing, Technology Assessment)
Medical Records Executive: VP/Director
Marketing Executive: CMO/VP/Director
Sales Executive: CSO/VP/Director
Patient Relations/Member Services Executive: VP/Director
Human Resources Executive: VP/Director
Employee Benefits Executive: VP/Director
Legal/Regulatory/Affairs Executive: Chief Counsel/VP/Director
Risk Management Executive: VP/Director
Other Non-Clinical Executive: VP/Director
Please specify for Other:
CLINICAL EXECUTIVE:
Medical Director
Chief of Medicine/Chief of Staff
VP/Director/Chief of Medical Affairs
Clinical Program Director/Services VP/Director (Specify: e.g., Oncology, Sports Medicine, Transplant, Disease, ER, Trauma, Wellness, Physical Therapy, Radiology, etc.)
Please specify:
Pharmacy/Formulary Director/Formulary Committee Chair
VP/Director/Chief of Pharmacy Services
Drug Information Officer/Clinical Pharmacist
VP/Director of Nursing/Chief of Nursing Affairs
Utilization Review/Quality Assurance VP/Director
Case Management VP/Director
Provider Relations VP/Director
Other Clinical Executive: VP/Director
Please specify for Other: