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Annual Report 2012

Health-Lynx

Compensation Program

Management

CO-OPSolutions

Population Health Management

Association

Health Plans

Captive Insurance

Services

QualCare

Physicians

Employer

Sponsored Plans

HospitalsQual-Lynx

Workers’

Accountable Care

Organizations

The World of QualCare Alliance Networks, Inc. (QANI)

ANNUAL REPORT 2012 | 1

QualCare Alliance Networks, Inc. (QANI) closed

out 2012 with a strong performance across all four of its

divisions, but QualCare, Inc. in particular had exceptional

growth. Over the course of the last 18 months, QualCare

experienced close to a 30 percent growth rate and that

success led to important changes throughout QANI’s

organizational structure. Heading into 2013, QANI is well-

positioned for continued growth and to capitalize on

industry-wide changes related to national health care reform.

As part of the corporate restructuring, I have retained

my role as the Chief Executive Officer for QANI, QualCare,

Inc. and all subsidiaries, with Sharon Seitzman, our former

Executive Vice President and Chief Operating Officer

assuming the role of President of QualCare. Ms. Seitzman

has been a key executive at QualCare since 1999 and over

the last several years has directed our day-to-day opera-

tions. I am confident her leadership will continue to play an

important role in QualCare’s future success.

As a company, QANI has led several transformational

efforts within this region’s health care marketplace. More

specifically, we have become the region’s leader in the

development of Accountable Care Organizations (ACOs).

Most notable was our role in assisting eight health care

systems in the development and filing of applications to

participate in Medicare’s shared savings programs. I am

happy to report all eight were approved by Medicare. We will

continue to assist others like Virtua, Holy Name and the

state’s largest ACO – Atlantic Health – in operationalizing

these new shared savings programs as they enter the payor

world. It is these strategic initiatives that have positioned

QANI to succeed going forward.

In addition, QANI has developed and implemented informa-

tion technology formats that will allow for the tracking,

collection and analysis of critical patient history. It is this

information, when put into the hands of physicians and

members, that will help them make better health care

decisions. This data also will provide a roadmap for improv-

ing the delivery of care so it is better coordinated, more

affordable and exceeds regional quality standards.

I am deeply appreciative of the support and loyalty extended

to QANI over the years by its stakeholders. As the largest

provider-owned company in New Jersey, we will always

have the patient at the center of our decision-making. That

focus is the reason why we are committed throughout

our organization to providing access to high quality and

affordable care. This, when balanced with strong input from

physicians and hospitals in New Jersey, makes us unique in

the marketplace. Thank you for your continued commitment;

we look forward to working with you in the year ahead.

Annette CatinoPresident and Chief Executive Officer

Annette Catino

Chief Executive Officer’s Message

Annette CatinoPresident and Chief Executive Officer

John McSorleyTreasurer and Chief Financial Officer

Karthik GaneshChief Information and Strategy Officer

Tristen HerrstromChief Resource Officer

Kevin JoyceChief Network and Product Officer

Janet BuggleAssistant Treasurer

Mary PapandreaCorporate Secretary

2 | ANNUAL REPORT 2012

QANI had a landmark year as the dynamic changes

in health care led us to realize record growth and bolstered

the success of many of our new innovations. Strategically,

QANI will continue to advance in the regional marketplace

with a variety of care driven models. Each of these is backed

by sophisticated technology that will allow both patients

and physicians to track care and make better treatment

decisions. This information will ultimately be the data that

allows us to improve how care is delivered and, by doing

that, we anticipate being able to lower costs and increase

quality.

I am honored to Chair the QANI Board as we delve into the

world of national health care reform. We are fortunate to have

highly engaged Board members and a very forward thinking

executive team. Annette Catino, our President and Chief Ex-

ecutive Officer, deserves much of the credit for leading this

organization through significant transition and growth.

Health care is clearly evolving and it is the collective leader-

ship of the QANI team that has allowed us to enter into this

new paradigm well ahead of the curve.

Among the efforts we have well-underway is our effort to

aid in developing ACOs. Our success at creating the filing

for Medicare’s pilot program has earned us regional recog-

nition. In a very substantive way, QANI is leading the local

effort to implement the ACO initiatives outlined under

national health care reform.

In closing, I want to reinforce that with all the changes at

hand, there is one thing that will always remain the same:

our commitment to patient-centered care. As the largest

regional provider-sponsored company, QANI was built on

that commitment and it will always be at the core of our

corporate philosophy. Thank you for your continued support

and for working with us toward an even better future.

John Lloyd

Chairman

John Lloyd

Chairman’s Message

QualCare Alliance Networks, Inc.

Company Officers


Ms. Annette CatinoChief Executive Officer QualCare, Inc.President and Chief Executive Officer QualCare Alliance Networks, Inc.

Mr. Michael D’AgnesChairman, Retirement CommitteePresident and Chief Executive OfficerRaritan Bay Medical Center

Mr. John J. GantnerChairman, Finance CommitteeChief Financial Officer and Executive Vice President of Partner Company OperationsMeridian Health

Mr. Robert C. Garrett President and Chief Executive OfficerHackensack University Health Network

Mr. Stephen Jones, FACHEPresident and Chief Executive OfficerRobert Wood Johnson University Hospital

Mr. John K. Lloyd, FACHE Chairman, Board of DirectorsPresidentMeridian Health

Mr. Richard P. Miller President and Chief Executive Officer Virtua

Mr. Barry H. OstrowskyChairman, Executive Compensation CommitteePresident and Chief Executive OfficerBarnabas Health

Joseph A. Trunfio, PhD President and Chief Executive OfficerAtlantic Health System

QualCare Alliance Networks, Inc.

Board Members

Central New Jersey Boy Scouts HonorQualCare CEO with “Good Scout” Award This past year the Central New Jersey Council of

Boy Scouts honored Annette Catino, QualCare’s Chief

Executive Officer, with their “Good Scout” award. This

award honors an outstanding citizen who serves as

an exemplary role model for the youth of central

New Jersey. Ms. Catino accepted this recognition at

the Boy Scout’s Spirit of America Dinner held at the

Westin Princeton in May.

During the presentation ceremony, it was noted thataward recipients are chosen for their outstanding professional leadership, civic and community service,and the respect and esteem in which they are held bytheir colleagues. Ms. Catino noted that she was humbledto be selected and encouraged the Boy Scouts in the audience to continue on their path to excellence. Ourcongratulations go out to Ms. Catino for this notableachievement. =

Annette Catino, Chief Executive Officer, QualCare, Inc. is seen above with the Central Jersey Boy Scouts and the other honorees.

Throughout the healthcare industry there havebeen significant changes, butnone as profound as thosetaking place within the realmof information technology.QANI has fully recognized the

importance of those changes and, in December 2010, beganimplementing a three year strategic effort to transform its organization. Our goal was and is to convert QANI’s servicemodel so that it can meet the following key objectives: accommodate business growth; reduce operating costs; en-hance customer engagement; integrate with other systemseasily; and lastly, be flexible so it is able to adapt to servicemodel changes.

Marking the second year of QANI’s transformation, 2012was a landmark year as we implemented several new keycapabilities. Primary among those was the significantly enhanced core plan administration platform. It is driving ahigher level of operational efficiencies, while at the sametime enforcing an additional set of quality checks.

Secondly, we created a new QualCare corporate websiteand rebranded Scibal Associates as Qual-Lynx, which ledto the creation of a Qual-Lynx website. We also created additional subsidiaries under the QANI umbrella; all of thesenew subsidiaries required important changes to our onlinepresence.

Many noteworthy enhancements were made to the newly-launched corporate QualCare site. Specifically, QualCare’smember portal was recast as “My QualCare” and enhancedwith a number of new member self-service tools. Amongthose tools is an online member Explanation of Benefits(EOB), an online Primary Care Physician (PCP) selection, the ability to print temporary ID cards, and a Health Risk Assessment and Personal Health Record, which can be

accessed with a single click. Additionally, the referral man-agement capabilities on our provider portal, NaviNet, wereenhanced with the addition of a referral inquiry capability.

In 2012, QANI became self-sufficient from a disaster recov-ery standpoint with a fully-redundant, dual-site strategy forbusiness continuity. This included our Piscataway and EggHarbor Township locations serving as disaster recoverysites, each having complete access to all mission-criticalsystems at either location. When Hurricane Sandy hit New Jersey on October 29, 2012, all our mission critical systems were available 100 percent of the time across ourmultiple locations. These systems included our phones,member and provider web portals, Interactive Voice Re-sponse (IVR), claims administration and medical manage-ment systems. Our claims operation resumed processingvia remote access the day after Hurricane Sandy hit. On-siteclaims, customer service and medical management opera-tions resumed on Day Two.

Lastly, 2012 marked the complete ground-up build out ofour ACO infrastructure. This included highly secure and segregated data storage for each ACO, in addition to best-in-class data interfaces with Centers for Medicare and Medicaid Services (CMS).

Additional ACO solutions included a physician portal,Medicare data-driven risk profiling and predictive modelingthat factored in Parts A, B and D claims.

QANI is advancing important information technology solu-tions throughout its organizational structure that will ensuremembers and providers have the data they need to makesound health care decisions. We are committed to makingsure our systems meet and exceed the expectations of ourusers. I am proud of what we have accomplished in twoyears and am confident that year three will bring additionalimportant advances for our members and providers. =


QANI Enters Second Year of IT Transformation

Karthik GaneshQANI, Chief Information and Strategy Officer


Annette Catino, Chief Executive Officer of QualCare,

Inc., was selected from hundreds of nominees to be among

the Top 25 Leading Women Entrepreneurs in New Jersey.

To be a nominee, each candidate was required to be highly

accomplished in her field and making a difference in her

company, industry and community. The initiative was

created in conjunction with New Jersey Monthly magazine to

honor women business owners and highlight their contribu-

tion to New Jersey’s economic recovery.

Ms. Catino noted that twice as many women as men are

starting their own companies today. She contrasted that

with her effort to found QualCare, Inc. almost two decades

ago when there were few women launching their own

businesses. Today, QualCare, Inc. employs more than 750

people and is the largest provider-sponsored managed care

company in the region.

The 2012 finalists were honored on December 6 at Fairleigh

Dickinson University and commended on their service, lead-

ership and contribution to the state’s economic recovery.

During the ceremony, it was noted that collectively the 25

finalists not only employ thousands of people, generating

millions of dollars in economic impact for our state, but also

support numerous non-profits and charitable efforts. Please

join us in commending Ms. Catino for this impressive award

and thanking her and the other honorees for their contribu-

tion to the Garden State. =

Leading Women Entrepreneurs and Business Owners Award Annette Catinowith Highest Honor

QANI Welcomes Tristen Herrstrom as Chief Resource Officer

We are proud to welcome a new addition to

our executive team, Tristen Herrstrom, who was named

Chief Resource Officer of QANI and Vice President of

Human Resources for QualCare, Inc. In these positions,

Ms. Herrstrom is responsible for setting the strategic

direction of human resources, enhancing talent acquisi-

tion, creating development and retention initiatives,

as well as streamlining benefit programs across QANI’s

four divisions.

Prior to joining QANI, Ms. Herrstrom led resource man-

agement at inVentiv Health, Inc. as its Chief Resource

Officer. She brings more than 17 years of experience

building highly effective teams, integrating company

cultures, developing consistent policies and procedures,

and streamlining benefit programs. Ms. Herrstrom holds

a Bachelor of Science in Psychology from the College of

New Jersey, and a Master of Science in Human Resource

Counseling from Northeastern University. Please join us

in welcoming Ms. Herrstrom to the QANI family. =


The aftermath of Hurricane Sandy left enormous

devastation throughout our state, but we want to highlight

the truly extraordinary effort put forth by the QANI family to

support our clients, members and colleagues during that

challenging time.

While the Piscataway headquarters and Egg Harbor Town-

ship offices were closed for two days, by Wednesday,

October 31, disaster recovery procedures were imple-

mented and employees reported to both offices. In the Egg

Harbor Township office, power was quickly restored and

staff was deployed to that office to assist in handling the

high volume of property, liability and workers’ compensa-

tion claims post-storm. Daily calls were held with Joint

Insurance Fund (JIF) clients to ensure they were getting all

the necessary support.

In Piscataway, our back-up generator allowed employees to

have full system accessibility and telephone service so that

incoming calls for medical authorizations, member intakes,

network access and other customer support questions

could be handled as usual. Our team reached out to our

client base to advise them we were ready and able to

handle member and provider calls. Meanwhile, our website,

NaviNet, and Interactive Voice Response (IVR) systems

remained fully functional throughout, even though our power

was not restored until Sunday, November 4.

Our excellent response to Hurricane Sandy would simply not

have been possible without the commitment and dedication

of our QANI employees. Many of those individuals were

fulfilling critical work functions despite their own personal

challenges of being without power, significant personal

damage to their homes and limited access to

gasoline. They did it all with a smile, a hug and even

some laughs. We are so proud of the QANI team and

their response to one of the greatest disasters to hit

New Jersey. On behalf of our Board of Directors,

executive team and clients, thank you for your

professionalism, courage and service. It was you

that made all the difference. =

QANI Response to Hurricane Sandy

Hurricane Sandy batters the Jersey Shore.


QANI’s Charitable Giving

As in years past, QANI invested significant dollars andmanpower in supporting New Jersey charities throughout2012. We contributed more than $600,000 to not-for-profitinitiatives and undertook a dozen volunteer efforts for vari-ous charities. Giving back both financially and with our timeis part of our corporate culture. The QANI leadership team,board and employees all are happy do their part to helpthose in need. Among the charitable efforts QANI undertookin 2012 were:

A Helping Hand

QualCare worked in conjunction with Elijah’s Promise andThe Community Food Bank of New Jersey during the holiday season to help families in need of food.

Blood Drive

QualCare employees continued to support this effort andparticipated in two blood drives in 2012 to help address theblood shortage in our state.

Cooper Norcross Run the Bridge Event

This year we were a bronze sponsor at the Cooper NorcrossRun the Bridge Event, a 10K and 2-mile Bridge Walk, which raised funds for the Larc School. This school serves hundreds of children with disabilities and their families.

Graeme Preston Foundation for Life

This organization supports local families in need through donations. This year, their efforts focused on people dis-placed by Hurricane Sandy. All total, they have granted morethan $200,000 to families and organizations since inception.

Hometown Heroes

Hometown Heroes’ main purpose is to foster an environ-ment of goodwill, generosity, and encouragement by sup-porting local communities when unexpected needs ariseduring a crisis. In 2012, we hosted a bake sale and donatedall proceeds to this organization.

Naomi’s Way

We again partnered with both Naomi’s Way and theWomen’s Center shelters for battered women and childrenand collected coats, hats, gloves, and scarves to assistthem.

The Community FoodBank of New Jersey

We held two food drives to aid The Community FoodBank’sfight against hunger and poverty in New Jersey.

The LIFE Event (LPGA Pros in the Fight to Eradicate Breast Cancer)

As in the past, we supported the LIFE Event, which raisesfunds for the Val Skinner Foundation. The foundation is dedicated to supporting research that will help eradicatebreast cancer as a life-threatening disease.

Toys for Tots

We continued to support the “Toys for Tots” program andprovide less fortunate children with gifts during the holidayseason. We partnered with the United States Marine Corps,the Department of Youth and Family Services (DYFS) andthe Marine Toys for Tots Foundation on this effort.

We recognize that our corporate mission is to help care forpeople and that charitable initiatives are simply an extensionof that. We hope the example set by our actions will inspireothers to take part in giving a hand to the many people in ourcommunities who need help. =

John Lloyd, President, Meridian Health; Morgan Pressel, LPGATouring Professional; Annette Catino, President and Chief Execu-tive Officer, QANI.


QualCare had a truly exceptional 2012. As we head

into 2013, I believe we are well-prepared to continue our

growth trajectory. Our success, which translated into nearly

a 30 percent increase in membership, led us to restructure

responsibilities among our executive team. As part of the

reorganization, I assumed the role of President for QualCare,

Inc. and six members of our executive team were promoted

into new, expanded positions.

QualCare is leading market change regionally and our model

for adapting to national health care reform has distinguished

us from our competition. QualCare’s continued success is

also attributable to our commitment to service excellence

and enhancing our customers’ experience. We spent much

of 2012 doing just that.

With this substantial membership growth, we focused addi-

tional resources on the expansion of our physician network.

We are pleased to report that QualCare’s HMO network saw

a 16 percent increase in the number of participating physi-

cians, while the PPO network grew by 13 percent. More

importantly, this network growth further positions QualCare

as a competitive player in the statewide health care market-

place. Our expanded networks ensure our members have

access to a broad list of credentialed providers.

Also of great importance in 2012 was the Supreme Court’s

June 25 decision that upheld the Patient Protection and

Affordable Care Act as constitutional. Throughout the debate,

QualCare supported our clients and their employees with

information to help guide them as each tried to gauge the

potential impact of the law.

In anticipation of the decision, QualCare established a toll-

free hotline and enhanced our website to answer common

questions about the health care legislation. Additionally, we

were able to support our clients with preparation of the man-

dated summary of benefits and coverage (SBC) documents.

At our core, QualCare is a provider-based organization. We

have an innate interest in providing physicians and members

access to information that can enhance the patient

experience and ultimately improve health outcomes. Our

technology innovations reflect that; in 2012 we introduced

enhancements to better service our customers. We launched

our new website with a member focus on easy access to

their health plan information and self-serve tools empower-

ing members to take an active role in their own health.

Now it is easier than ever for a member to view their health

coverage, print out health statements or record detailed

information about their health status. Additionally, it’s a central

resource to access current health information, record and

track personal health measurements or connect with their

own personal health coach through WellCall.

Provided with information and resources, members can

become engaged in managing their own health by maintaining

a healthy lifestyle and making choices to reduce their health

risks. As data collection becomes more sophisticated, we

believe it will continue to drive changes in processes so that

care is delivered more efficiently, thereby improving health

outcomes and reducing costs.

I am also excited to report that NJBIZ acknowledged Qual-

Care once again as one of the Best Places to Work in New

Jersey. This is the sixth year QualCare has received this im-

portant distinction. QualCare would not be able to enjoy our

continued success without the dedication and support of

Sharon Seitzman

President’s Message

Continued on page 9


QualCare Testimonials

our workforce. When Hurricane Sandy hit in October and left

QualCare’s Piscataway office without power for one week,

our disaster recovery team executed our plan with the

backup resources necessary to service our members,

providers and clients with minimal disruption. I am proud of

the extraordinary efforts of our employees during this crisis

and throughout the entire year.

At the end of the day, we know that our success is based on

three key principals: maintaining and growing our excep-

tional workforce; partnering with our providers and clients;

and ensuring that the patient is always at the center of our

decisions.

I joined QualCare’s executive team 14 years ago and have

been part of its growth into the largest provider-sponsored

managed care company in New Jersey. Today, more than

ever, QualCare remains committed to providing new ways

to deliver innovative solutions and quality services to all of

our employers, members and providers. With your support,

the year ahead is certain to bring even greater success. =

Phyllis Johnson

QualCare Customer Service Advocate

Customer Service received a phone call from a

Meridian member letting us know they spoke with

Phyllis Johnson and wanted to ensure management

knew how compassionate she was. The caller

stated that Phyllis was very understanding to her

needs and was able to quickly address her issues.

She also wanted us to know that Phyllis was cour-

teous and very knowledgeable.

Meridian Member

Dolly Root

QualCare Workers’ Compensation,

Case Management Nurse

Dolly has gone above and beyond working on a claim for the

Gallagher Joint Insurance Fund (JIF). There were eight

claimants on one claim! Dolly took the initiative to go to the

hospital to meet with one of the seriously injured individuals

right before his surgery and ensured him that everything

would be taken care of. This shows exactly the outstanding

nursing care JIF claimants are receiving!

Team Leader, Workers’ Compensation

John LutzQualCare Customer Service AdvocateJohn received an exceptional compliment from amember stating that he always goes the extra mile.The member complimented John for helping herwith her daughter’s claims. They were receiving notifications from bill collectors threatening to takethe member’s daughter to court. The member wasmistakenly being billed and John made that impor-tant discovery.

Atlantic Health Member


Mr. John Bruno Vice President, Human Resources Saint Joseph’s Healthcare System

Mr. Norman V. Buttaci Retired Senior Vice PresidentTD Bank - Healthcare/Finance Group

Ms. Annette Catino Chief Executive OfficerQualCare, Inc.

Ms. Nancy R. Corcoran-Davidoff Executive Vice President and Chief Human Resources Officer Hackensack University Medical Center

Mario A. Criscito, MD President The Saint Barnabas Physician Group

Mr. Michael D’Agnes President and Chief Executive Officer Raritan Bay Medical Center

Mr. John A. DiAngelo Senior Vice President of Finance and Chief Financial Officer South Jersey Healthcare

Robert M. DiRenzo, MDChief Medical OfficerVirtua

Mr. John J. Gantner Chief Financial Officer and Executive Vice President of Partner Company OperationsMeridian Health

Mr. Robert C. Garrett President and Chief Executive Officer Hackensack University Health Network

Mr. John Gribbin President and Chief Executive OfficerCentraState Healthcare System

Mr. Leslie Hirsch President and Chief Executive Officer Saint Clare’s Hospital

Mr. Gary S. Horan President and Chief Executive OfficerTrinitas Regional Medical Center

Mr. Stephen Jones, FACHEPresident and Chief Executive OfficerRobert Wood Johnson University Hospital

Mr. Joseph LemaireChief Financial OfficerHoly Name Medical Center

Mr. John K. Lloyd, FACHE Chairman, Board of DirectorsPresidentMeridian Health

Morey Menacker, DO Medical Director Hackensack University Medical Center

Mr. Richard P. Miller President and Chief Executive Officer Virtua

Mr. Barry H. OstrowskyPresident and Chief Executive OfficerBarnabas Health

Mr. Dennis PettigrewChief Financial Officer and Chief Operating OfficerSt. Michael’s Medical Center

Mr. Jay PicernoExecutive Vice President and Chief Financial OfficerBarnabas Health

Gilbert B. Poon, MDPresidentNorthwest Physician Organization, Inc.

Carl Porcaro, MDPracticing Physician in Essex CountyInternal Medicine

Mr. Brian M. Reilly, Sr.Vice President, Finance and Chief Financial OfficerRobert Wood Johnson University Hospital

Mr. David RicciPresident and Chief Executive OfficerSt. Michael’s Medical Center

Richard S. Schachter, DPMPracticing Physician in Middlesex CountyPodiatry

Mr. Robert SeginExecutive Vice President and Chief Financial OfficerVirtua

Nalini Shah, MDPracticing Physician in Passaic CountyInternal Medicine

David Shulkin, MD PresidentMorristown Medical Center

Mr. Kirk C. Tice President and Chief Executive OfficerRobert Wood Johnson University Hospital at Rahway

Joseph A. Trunfio, PhD President and Chief Executive OfficerAtlantic Health System

Kenneth M. Courey Board Member Emeritus

QualCare, Inc.

Board Members


As part of the QANI reorganization in 2012, QualCare

Management Resources, LLC (QMR) was formed as a

separate limited liability corporation under QANI. This unit’s

focus is to aid our client base in navigating New Jersey’s

health care and insurance-related statutory requirements

and regulatory mandates.

QMR provides both consulting and management support

to clients with regulatory filings, including working with New

Jersey’s Department of Banking and Insurance (DOBI) and

the United States Department of Labor for licensure filings,

regulatory compliance and ongoing administrative support.

Once authorized, QMR serves as the complete solution for

entity management providing Generally Accepted Account-

ing Principles (GAAP) guidance and statutory financial

statement preparation and filing, budgeting and treasury

functions, product design, rate filing and reserve setting

(in coordination with actuaries), sales and small group

client services.

Our QMR team was developed through management of

the Affiliated Physicians and Employers MEWA (APEM),

a regulated Multiple Employer Welfare Association

(MEWA) developed to serve physicians, their office staff and

dependents, who are contracted with the QualCare network.

Since its launch in 2002, the APEM has expanded its

member base to accountants and employers associated

with the Employers Association of New Jersey (EANJ).

QMR also organized, filed and managed the Georgia Health

Plan Trust MEWA (GHPT) in Georgia, which launched in

2010. As a result of QMR’s work in obtaining approval

for the Freelancers Union MEWA for their New Jersey

membership, the company has been selected to support the

implementation and development of the Freelancers CO-OP

plan, resulting from their approval from CMS to be the

consumer plan in New Jersey, among other states.

Since its formation, QMR also has been approved as a

captive manager in New Jersey, which supports our licensed

captive, QualCare Captive Insurance Company, Inc. (QCIC)

in providing alternative risk solutions for our clients’

employer stop loss coverages.

QCIC has been licensed by the New Jersey DOBI to provide

alternative risk products and solutions to the clients of the

company for employer stop loss risks. QCIC is a wholly

owned subsidiary of QANI and is governed by a separate

Board of Directors. =

John McSorley

Executive Vice President’s Message

Management Resources, LLC


For the sixth time, QualCare was selected by NJBIZ as

one of New Jersey’s Best Places to Work. The award pro-

gram, which is designed to honor the best places of em-

ployment in the Garden State, recognized 100 companies:

52 small- to medium-sized (15 to 249 employees) and 48

large companies (250 + employees). QualCare was named

one of the Best Places to Work as a large-sized

company based on workplace policies, philosophy, systems,

demographics and, most importantly, how our employees

feel about working at QualCare!

Both the Board of Directors and

Sharon Seitzman, President of Qual-

Care, Inc., expressed their gratitude

for the hard work and dedication of

QualCare’s employees. It truly is a testament to the quality,

commitment and work ethic of all our QualCare employees

that we have been selected a sixth time. =

NJBIZ Names QualCare Best Place to Work for the Sixth Time

Mr. John GribbinChairman, Board of DirectorsPresident and Chief Executive Officer CentraState Healthcare System

Ms. Annette CatinoVice Chairman, Board of DirectorsPresident and Chief Executive Officer QualCare Alliance Networks, Inc.

Mr. Thomas Shanahan Senior Vice President and Chief Financial Officer Raritan Bay Medical Center

Mr. John Grywalski Retired Senior Vice President and Chief Financial OfficerSaint Michael’s Medical Center

Mr. Norman V. ButtaciRetired Executive Vice PresidentTD Bank – Healthcare/Finance Group

QualCare Captive Insurance Company, Inc. (QCIC)

Board of Directors

QMR assists clients in right sizing their primary coverages for employer stop loss on their self-insured

plans, while providing innovative solutions through QCIC to establish long term program cost reductions and

premium moderation. Any questions you may have about the services of QMR or the QCIC captive program can be

directed to John McSorley at 732-981-7930 or to Dawn Wright, Vice President of Insurance Company Operations

at 732-562-7815.


2012 certainly proved to be a very busy year. We grew,

moved our office, changed our company name, and even

survived a hurricane!

We started the year with a new client, the Garden State

Municipal Joint Insurance Fund (JIF). QualCare has provided

workers’ compensation managed care services to this JIF

for several years. Beginning January 1, we were awarded a

new contract for claims administration for their members

consisting of 28 municipalities throughout the state.

We also added Trinitas Regional Medical Center to our pres-

tigious list of health care clients. Trinitas decided to move

its workers’ compensation program to a self-funded plan

and selected us to handle their claims.

The addition of new clients was the impetus for our move

from the Somers Point office to a new location because we

were completely out of space. After searching long and

hard, we found professional office space in Egg Harbor

Township that was convenient for our staff and large enough

to allow for growth and to incorporate our plans to create a

South Jersey satellite office for QualCare.

Our new corporate headquarters, encompassing 30,000

square feet, has plenty of parking and provides enough

space to house QualCare Workers’ Compensation Unit. This

co-location enables us to provide a more seamless and col-

laborative approach to managing workers’ compensation

claims for our clients. Additionally, we now staff a QualCare

customer service and provider relations team in this

location to handle a fast growing book of QualCare group

health business in South Jersey.

Lastly, our new location provided us with the opportunity to

implement a formal in-house Disaster Recovery Program.

More specifically, in our new office space we installed and

implemented the infrastructure needed for complete system

redundancy for our organization.

Hurricane Sandy put our new Disaster Recovery Program to

the test and we passed with flying colors. Prior to the storm,

comprehensive disaster recovery rooms were set up in Egg

Harbor Township and in Piscataway. All critical systems and

phone lines were brought up and kept operational.

When a devastating storm like Hurricane Sandy hits, our

Property and Casualty Division needs to not only survive the

storm, but to assist our clients through the storm. Our team

was well-prepared and organized to provide the needed

services to our clients. Given that we handle property dam-

age for hundreds of municipalities, school boards, housing

authorities, and utility authorities throughout New Jersey, our

Property Unit took on the heaviest load.

In the month of November, this unit had nearly three times

the normal claims volume for the month with many being

multi-million dollar exposures. I am pleased to report that

the compliments and expressions of appreciation from our

clients flowed in just as fast.

While quite a few of our employees had their own personal

challenges, they set those aside without hesitation to serve

our clients and assist their co-workers. I couldn’t be more

proud of their commitment and feel confident that this kind

of professional dedication is the reason we will continue to

succeed in the future.

Ann Noble

President & CEO’s Message

Continued on page 14


Before the year ended, we

rolled out our new company

name: Qual-Lynx. Initially, we

felt it was important to keep

the Scibal Associates name

because we wanted our em-

ployees and clients to know

that we understood and val-

ued the long history of quality

service associated with that

name. Over the last four

years, I believe we have demonstrated our commitment

to preserving and enhancing that high quality service.

It seemed appropriate that we rebrand to highlight our affil-

iation with the QualCare Alliance Networks, Inc. (QANI).

Our new name, Qual-Lynx, is intended to convey our ability

to integrate complimentary services among all QANI affili-

ates. So effective December 1, 2012, our new name and

logo were introduced across our organization.

We now look forward to 2013 when we will undertake

another significant project; Qual-Lynx will be converting our

claims platform to a new system. Our workers’ compensa-

tion medical case management team also will move onto the

same platform. This further enhances our ability to provide

collaborative and efficient handling of workers’ compensa-

tion claims for our clients. It is an important step forward and

we are confident it will allow us to continue our growth in the

year ahead. =

Ms. Annette CatinoChairman, Board of DirectorsPresident and Chief Executive Officer QualCare Alliance Networks, Inc.

Mr. Norman V. ButtaciRetired Senior Vice PresidentTD Bank - Healthcare/Finance Group

Mr. David Scibal Chairman and Chief Executive Officer Advantage Specialty

Mr. James F. Deutsch Managing DirectorPatriot Financial Partners

Mr. John GrywalskiRetired Senior Vice President and Chief Financial OfficerSaint Michael’s Medical Center

Qual-Lynx

Board Members


Health-Lynx, LLC successfully advanced additional

ACO applications with Centers for Medicare and Medicaid

Services (CMS) throughout 2012. Five applications submit-

ted in September 2012 were approved and became

operational January 1, 2013. All five of those applications

were for Medicare Shared Savings Programs (MSSP) and

were the culmination of many months of work with our

hospital partners. Health-Lynx not only developed those

applications, but also handled the follow-up responses to

questions posed by CMS. For Health-Lynx, this was the

third round of applications that were developed and

submitted in 2012. The approval of these five brings our total

to eight approved ACOs.

Health-Lynx has established itself as a leading MSSP

expert. In addition to preparing successful applications, it

has been able to advise its clients on the latest program

developments and recommend best practices for

responding to them. In its first year of existence, the MSSP

continues to be a work-in-progress for CMS. Program

policy is still evolving and CMS continues to modify its

program guidance. Health-Lynx has supported its clients by

not only making certain that they are in sync with the latest

guidance, but has also advocated on their behalf in clarify-

ing or modifying that guidance.

Health-Lynx has truly become a regional resource and one

of the most advanced organizations in dealing with these

ACOs submissions. New Jersey providers have been among

the most active in submitting MSSP applications. As a

result, we anticipate there will be more than 150,000 New

Jersey Medicare beneficiaries attributed to ACOs during

2013. By comparison, there are only about 195,000 New

Jersey beneficiaries in the Medicare Advantage program,

which has been available for more than 25 years.

To New Jersey’s credit, 90% of all New Jersey ACOs

are sponsored by hospital and health systems. As noted

above, we have helped a significant number of them get

into business. Ultimately, the performance of New Jersey

ACOs will be judged by the ability of providers, not

insurance companies, to raise quality, lower cost, and

improve the experience of care for Medicare beneficiaries.

As a provider sponsored company, we believe that it is

in the best interest of Medicare beneficiaries. Health-Lynx

will continue to update you on our progress and thanks you

for your support. =

Tim Ford

Executive Vice President’s Message


Hospital NetworkNew Jersey


Hospital NetworkNew York, Pennsylvania and Delaware

www.qualcareinc.com

www.health-lynx.com

www.qual-lynx.com

www.qualcareinc.com

Management Resources, LLC

www.qualcareinc.com

Captive Insurance Company, Inc.

QualCare Alliance Networks, Inc.30 Knightsbridge Road

Piscataway, New Jersey 08854Phone: 800-992-6613

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