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                                                                EXHIBIT 10.21

                             THE TENERE GROUP, INC.

                                AMENDMENT NO. 1
                                       TO
                              EMPLOYMENT AGREEMENT


        This Amendment No. 1 to Employment Agreement ("Amendment") has been
entered into as of this 28th day of February, 1997, by and between The Tenere
Group, Inc., a Missouri corporation ("Company"), and Raymond A. Christy, M.D.,
an individual ("Executive").

                                    RECITALS

        WHEREAS, the Company and the Executive are parties to that certain
Employment Agreement, dated as of May 6, 1996 (the "Agreement"); and

        WHEREAS, the Company and the Executive wish to amend the terms of the
Agreement to extend the initial Employment Period under the Agreement from May
6, 1999 to May 6, 2000;

        NOW, THEREFORE, in consideration of the premises, and other good and
valuable consideration, the receipt and sufficiency of which are hereby
acknowledged, the parties hereto agree as follows:

        1.  AMENDMENT OF SECTION 1.1(g).  Section 1.1(g) of the Agreement is
hereby deleted in its entirety and replaced with the following:

            1.1(g) "EMPLOYMENT PERIOD" means the period beginning on the
                   Effective Date and ending on the later of (i) May 6,
                   2000, or (ii) May 6 of any succeeding fiscal year during
                   which notice is given by either party (as described in
                   Section 1.1(j)) of such party's intent not to renew this
                   Agreement.

        2. AMENDMENT OF SECTION 1.1(j).  Section 1.1(g) of the Agreement is
hereby deleted in its entirety and replaced with the following:

            1.1(j) "TERM" means the period that begins on the Effective
                   Date and ends on the earlier of: (i) the Date of Termination
                   as defined in Section 3.6, or (ii) the close of business on
                   the later of May 6, 2000 or May 6 of any renewed term as set
                   forth in Section 2.1 of this Agreement.

        3. EFFECTIVENESS; LIMITED EFFECT.  The amendments contained in Sections
1 and 2 hereof shall be effective as of the date of the execution of this
Amendment by the Company and the Executive.  Except as amended hereby, terms
and conditions of the Agreement shall continue in full force and effect and
shall be interpreted in light of the amendments contained herein.



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     IN WITNESS WHEREOF, the Executive and the Company, pursuant to the
authorization from its Board of Directors, have caused this Amendment to be
executed in its name on its behalf, all as of the day and year first above
written.


                                                        EXECUTIVE




                                                        Raymond A. Christy, M.D.
                                                        ------------------------
                                                        Raymond A. Christy, M.D.



                                                        THE TENERE GROUP, INC.



                                                        By Andrew K. Bennett
                                                           ---------------------
                                                        Name: Andrew K. Bennett
                                                              ------------------
                                                        Title: General Counsel;
                                                        Vice Press.-Claims
                                                             -------------------
ATTEST:   Michael D. Hoeman, M.D.
          -------------------------
          Michael D. Hoeman, M.D.
          Secretary


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