Guardian/QualCare Fusion Targets Small- to Mid-sized Business

New Jersey Business, Jan 2008 by Aloe, Gina

QualCare, Inc., Piscataway, and The Guardian Life Insurance Company of America (Guardian), New York, join forces to remain competitive in a consolidating healthcare marketplace.

The new healthcare network arrangement focuses on the small-to-midsized business market in New Jersey.

"Guardian has actually built a new PPO product around the QualCare network, so it is actually the creation of a new product," says Annette Catino, president and CEO of QualCare, Inc. She says the PPO product has a number of different plan designs targeted at the small-to-mid-sized employer. "It's a health product that is insured by Guardian and it utilizes the QualCare network in New Jersey as the preferred network provider for people to utilize," she says. "Additionally, QualCare handles all of the case management and utilization management for patients who get care in the state."

QualCare, a full-service managed care organization, has a network which is said to be more expansive than Guardian's old network of providers. Tim Bireley, vice president of Group Medical, Guardian, agrees. "[The joint venture] creates opportunities for us primarily because it's giving us a network that is broader in terms of more hospitals and doctors than we had before, and at greater discounts," he says. Guardian has a strategic focus on the employee benefit needs of small-to-mid-sized business owners and their employees in various markets around the country. Guardian was looking to strengthen that position specifically in New Jersey and went through a process of talking with a number of high quality networks. In the end, it found QualCare, which suited it best.

There were three reasons why Guardian chose to join with QualCare: network access, quality of the organization and the level of provider discount, according to Bireley. Guardian members can now choose from a greater number of physicians, facilities and hospitals in New Jersey. QualCare, owned by 14 non-profit hospitals and physician-hospital organizations, contracts with more than 19,000 physicians and other healthcare providers and 88 hospitals.

Catino and Bireley define the group of small-to-midsized employers as having 50-300 employees. For QualCare, this agreement allows it to reach a different market segment, since it usually deals with self-insured employers, or very large groups. Its expansive network provides Guardian, a mutual life insurance company, with a whole new network of providers in the state. Although it doesn't affect any costs for QualCare, Catino does explain how the company will benefit Guardian's members in New Jersey. "It allows Guardian to offer a lower-priced alternative to small-to-mid-sized employers," she says.

However, this is not just to cover employee medical benefits. "We want to think about the employee insurance benefits, of which obviously medical is the biggest piece and . . . also the dental, the life and disability," says Bireley. "We can provide all those in a single billing and to employers in that size segment. That is fairly valuable."

Guardian also brings its Premium Protect plan to New Jersey for these business owners and employees. This two-year health plan, launched recently before the agreement, enables business owners with 50 to 150 employees to lock-in the rate of their health premiums to keep their costs manageable and predictable. New Jersey is one of just a few states where this premium guarantee is currently available. "We did a focus group with business owners in this segment and with the brokers who represent those owners . . . and it scored very well," says Bireley. "We believe we have a very strong credible network going for us in New Jersey in addition to this Premium Protect product."

Both companies expect to grow and prosper. "We have been on a growth path for 15 years and now that we have Guardian as a partner, we can continue to grow and go after a market segment that we really didn't have here before," says Latino.

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