Kaiser Permanente in the Mid-Atlantic

Brandon Burbage – Sales Executive, Small Group

With the largest multi-specialty physician group practice in the region, supported by state-of-the-art technology, Kaiser Permanente offers our members superior quality, market-leading convenience, and highly coordinated quality care.

Located in the District of Columbia, Maryland and Virginia Over 780,000 members Over 1,700 Mid-Atlantic Permanente Medical

Group physicians Over 10,000 employees 33 medical facilities (Five Hubs) 24 hours / 7 days / 365 days care available Fully supported by Comprehensive EMR

Fast Facts

Most of US health care is fee-for-service driven

and operates in a disjointed fashion

Emergency Room

DM Vendors

Typical U.S. Health Care System

Rehabilitation

Call CenterAdvice Center Skilled Nursing

Facility

Urgent Care

Pharmacy

LaboratorySpecialty Care

Office

Primary CareOffice

HospiceRadiology

Media/Web

Health Plans

HospitalHome(Self-Care)

Kaiser Permanente Value: Integration

A BETTER WAY to take care of business

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Our Foundation is Strong

96% retention across all lines of business

Consistently high retention rates create stability in the market and make your jobs easier.

Value achievement in quality and service drives differentiation and, in turn, growth.

Mem

bers

hip,

KP

MAS

Other notable service expansions:

Additional ZIP codes added to service area in Fauquier County (2020)

New Timonium Medical Center (2021)

Aspen Hill Medical Center

2020 Expansion and Beyond

A BETTER WAY to take care of businessHaymarket Medical Center

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11050 Heathcote BoulevardHaymarket, VA

A BETTER WAY to take care of businessAlexandria Medical Center

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3000 Potomac AvenueAlexandria, VA

A BETTER WAY to take care of businessStafford Medical Center

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125 Hospital Center Blvd., Suite 110, Stafford, VA

Woodbridge

Timonium

Woodbridge

Currently Operating KP Hubs:

Capitol Hill Medical Center, Washington DC

Gaithersburg Medical Center, Maryland

Tysons Corner Medical Center, Virginia

South Baltimore Hub, Baltimore

Largo Medical Center, Maryland

Timonium Hub, Maryland (Coming Soon)

“Super Hubs” = a Game Changer for our Value Equation: Increased Quality of Care, Increased Access, Increased Service, and Reduced Costs to Our Members

• Over 1,000 board-eligible / board-certified physicians have joined us since the beginning of 2009

• Our Medical Group now covers more than 50 medical and surgical specialties

Hundreds of our individual doctors are being recognized as leaders in their field• 172 top doctors in Washingtonian Magazine, November 2018• 125 top doctors in Northern Virginia Magazine, February 2019

• 57 top doctors in Baltimore Magazine, November 2018• 73 top doctors in Washington Consumers’ CHECKBOOK Magazine, Fall/Winter 2018

Plus completion of digital radiology, electronic specialty scheduling, and more

Hubs: Facilities Expansion AND People and Services Expansion TOO

Not all hospitals can be a Kaiser Permanente premier partner. To qualify, each hospital has been carefully evaluated—and is regularly reassessed—for the quality of care, comfort, and services it provides. All premier hospital partners are evaluated by independent third-party safety and quality rankings, and offer top-rated, award-winning care.

Maryland Virginia District of ColumbiaAnne Arundel Medical Center (medicine only)

Reston Hospital Center Children’s National Health System

University of MD Baltimore Washington Medical Center

Stafford Hospital MedStar Washington Hospital Center

Greater Baltimore Medical Center

Virginia Hospital Center

Holy Cross Hospital Silver SpringHoly Cross Hospital Germantown (medicine only)Suburban HospitalDoctor’s Community Hospital

Premier Partner Hospitals

A BETTER WAY to take care of businessMinute Clinics®

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Care away from home. Increasing access to care away from home with CVS Minute Clinics.

For members traveling in states without Kaiser Permanente providers

Staffed by non-Kaiser Permanente nurse practitioners and physician assistants

Providing limited urgent care services Can help improve the financial experience

for members accessing care while traveling

28 1,100+ States with CVS Minute Clinics

CVS Minute Clinic locations

NCQA’s Health Insurance Plan Ratings 2018-2019.

• Out of more than 1,000 health plans evaluated this year, Kaiser Permanente of the Mid-Atlantic States’ Private, Medicare and Medicaid plans all received the highest possible rating (5 out of 5) from the National Committee for Quality Assurance (NCQA).

• No other plan in the country has achieved this before, making Kaiser Permanente of the Mid-Atlantic States among the top 1% of plans in the nation.

Leading the Nation in Quality

• Granted a 3-year accreditation starting in 2018

• Received 5 commendations for areas including oncology nursing care, pathology reporting and clinical trial recruitment

NCQA Health Plan Commercial Performance - National

Measures used in NCQA RatingsNOTE: The source for data contained in this publication is Quality Compass® 2017 Commercial data and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2017 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Value Differentiation: Quality

Out of more than 1,000 plans rated in the NCQA Health Insurance Plan

Ratings 2018-19, Kaiser Permanente Mid-Atlantic States is the only health care entity in the nation to receive a 5.0, the highest score possible, for

both its Medicare and commercial (Private) populations

2018-2019Highest Rating in 34 of 48 Measures

Key Industry Benchmarking Reports | Summary These third-party rankings of health plans customer experience and satisfaction use surveys and capability evaluations that span a variety of functions, factors and market segments. Specific criteria and methods are summarized on the next page.

69.8 (- 0.8 YoY)

62.3 (+ 3.3 YoY) 692 (- 3 YoY)

61.9 (- 0.8 YoY)

62.6 (+ 0.8 YoY)

71.2 (+ 2.8 YoY)

63.3 (- 0.3 YoY)

775 (+ 7 YoY)

833 (- 8 YoY)

692 (- 2 YoY)

704 (-11 YoY)

756 (+ 29 YoY)

803 (+ 7 YoY)

695 (+ 2 YoY)

801 (+ 21 YoY)

788 (+ 10 YoY)

761 (-37 YoY)

764 (- 23 YoY)

886 (+ 20 YoY) 863 (-- YoY)

831 (- 10 YoY)

N/A 836 (+ 17 YoY)

900 (+ 15 YoY) 864 (-- YoY)

869 (+ 8 YoY)

840 (-- YoY)

850 (-- YoY)

862 (-- YoY) #7 74.5 CSAT, 13.7 NPS

855 (-- YoY)

#1 77 CSAT, 26.3 NPS

#9 74.3 CSAT, 14.1 NPS

#8 74.3 CSAT, 14.1 NPS

#3 76.1 CSAT, 29.3 NP

#10 72.8 CSAT, 8.8 NPS

63 (- 4 YoY)

58 (+ 5 YoY)

53 (-- YoY)

55 (- 6 YoY)

64 (- 1 YoY)

60 ( -2 YoY)

Forrester 2019 CX Index

J.D. Powers 2019 Commercial Member

Health Plan Study

J.D. Powers 2019 Medicare Advantage

Study

J.D. Powers 2019 U.S. Pharmacy Study

J.D. Powers 2019 U.S. Telehealth Study

VerintForesee Q2 2019 DX Index

XM Institute/Temkin 2018 Experience Ratings

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Legend: Rank of Health Plans N /A 6 5 4 3 2 1

Network and Value

Aon Hewitt analysis of the financial efficiency and plan performance of Kaiser Permanente by comparing Kaiser Permanente’s financial efficiency and plan performance to those of other plans represented in the Health Value Initiative (HVI) database.

Access to Behavioral Health Services

Baltimore DCSM NOVAAnnapolis

Columbia GatewayTowson

White MarshWoodlawn*

FrederickLargo*

Marlow HeightsNorthwest*

Shady Grove Silver Spring*

AshburnBurke

Falls Church*Fredericksburg

Woodbridge

* Indicates chemical dependency offered

• Modes• In Person• Video Visits• Telephone• Email

• Locations

Access to Behavioral Health Services

Find Signature physicians by going to kp.org/doctorFind Select physicians by going to www.geoaccess.com/Kaiser/po/SelectCriteria.asp

Kaiser Networks

The innovative HMO and DHMO Plus products combine Kaiser Permanente's award-winning integrated care delivery system and price stability with limited access to any licensed provider nationwide.

• Product Highlight• The same comprehensive coverage as KP’s traditional HMO

and DHMO in-network, with limited routine care out-of-network

• Target groups will be new to KP and seeking to:• Lower costs, but still have provider choice• Transitioning from a POS or PPO plan with another carrier• Maintain their relationship with an existing provider • Have options for employees that travel frequently

• Availability• 9/1/2018 in Mid-Large all jurisdictions, and Small group off-

exchange Maryland and Virginia• 1/1/2019 for Small group DC on-exchange

• Market and Price Competitive• The Plus plans are approximately 4% higher than their

equivalent HMO and DHMO plans• Currently no other products like this in the market

Plus Out-of-Network Benefit Design

Limited to 10 medical services and 5 Rx fills per year

PCP Office VisitSpecialty Office Visit

Outpatient Mental Health

PT/OT/STLabs/X-Rays

$20 higher co-pay or 10% higher co-

insurance than in-network

RXGeneric

Preferred BrandNon-Preferred

Specialty

$20 higher co-pay or 10% higher co-

insurance than in-network

Inpatient, outpatient surgery, skilled

nursing facilities, maternity, prenatal care, chiropractic,

acupuncture, dental, and vision

Not Covered Out-of-Network

New | HMO Plus and DHMO Plus

These new products have been added to the Flexible Choice Product Line to improve affordability and meet the need for broad provider access while leveraging Kaiser Permanente’s clinical excellence and quality.

• Product Highlights• HSA or HRA compatible • 5 plan designs to choose from• Flexible network design

• Target groups will be seeking to:• Have a plan with different provider options at

competitive rates • Offer both POS and HDHP plans and want all plans to

be HSA-Qualified plans• Allow employees to manage their health care costs by

selecting plans and providers • Availability

• 9/1/2018 in Mid-Large all jurisdictions• Affordability

• Rates for Deductible Flexible Choice plans are up to 15% lower than the cheapest “traditional” Flexible Choice rate

• The HSA-Qualified Flexible Choice plan rate is 24.5% lower than the cheapest “traditional” Flexible Choice rate

Network and Benefit Design Highlights“Traditional”

Flexible Choice

DeductibleFlexible Choice

HSA-Qualified Flexible Choice

Medical Networks

Tier 1: KP providersTier 2: PHCS and MultiPlan Networks (PPO)

Tier 3: Any Licensed Provider

Pharmacy Networks

• KP Pharmacies• MedImpact Pharmacies

• OON Licensed Pharmacies

HSA Qualified No No Yes

Tier 1 Deductible

No deductible

Some services Most services

Tier 2 Deductible

Some services

Some services Most services

Tier 3 Deductible

Most services

Most services Most services

New | Deductible and HSA-Qualified Flexible Choice

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Your Total Health Care Solution

With Kaiser Permanente’s Choice products, your customers and their employees get choice, flexibility, and convenience.

Before their plan starts, Choice product members will receive a welcome email and phone call to help them get up to speed quickly and easily with their new plan.

Flexible Choice and PPO members will receive a new ID card and sleeve that have been designed to assist them especially when they get care with network providers. Along with the new card, Flexible Choice members will receive an ID card “getting started” insert.

Additional support for our network providers, including proactive communication and education. Improved service metrics and member support from our network partner.

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2020 Affordable Small Group Product Portfolio

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Added one new Bronze Deductible HMO Plus plan in VA for January 1, 2020

Optimized cost and value by redesigning the MD, VA, and DC Silver HSA-Qualified and Bronze DHMO plans and the VA Silver 2750 DHMO with copays after deductible

Modified plan designs to ensure a competitive portfolio and price points at each metal tier level

Through the Total Cosmetic Dental Discount Program, all small group customers continue to have affordable access to dental services such as: Teeth Whitening Crowns Veneers Bonding Orthodontics (Invisalign)

Differentiated products that address customer needs from diverse industries.

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Preliminary Position in the Small Group Market (Off HIX) Based on Preliminary filings, KP rate position improves in VA and DC, remains advantaged in MD. Additional premium/benefit comparisons will be available closer to Open Enrollment

Notes: DC metal tier rate position reflects RA separate rating methodology.

MD DC VA2019 Prelim 2020 2019 Prelim 2020 2019 Final 2020

Overall RP 7% 4% -5% 3% 2% 5%

Platinum

Gold

Silver

Bronze

KP lowest price plan

KP 2nd lowest price plan

Based on 40 YO rates

($43)

(-$68)

(-$53)

(-$85)

#20

#13

#10

($10)

($71)

($18)

($2)

($6)

($100)

($1)

(-$7)#3

($93)

(-$27)

(-$58)#16

(-$86)#10

#5

($53)

($1)

(-$28)

($2)

#5

($79)

($11)

($9)

(-$39)#3

Effective: January 1, 2019

Incentive: Per Subscriber Per Month

Example: Your Kaiser Permanente 1-100 eligible employee group has 65 subscribers enrolled at the end of the month, your compensation will be 65 x $30 = $1,950

2019 Group Broker Commissions

Effective: September 1, 2019 – January 31, 2020

Double Down in December

Earn double the bonus for any December 2019 small groups. For example, you will earn $2,000 for an 8-person subscriber group with a December effective date.

Fall Small Group Bonus

Group size(subscribers) 6 – 10 11 – 15 16 – 20 21 – 25 26+Per groupbonus $1,000 $2,000 $3,000 $4,000 $5,000

Additional $5,000 bonus paid to agency for every 50 subscribers enrolled.

A BETTER WAY to take care of business

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Sales Resources OnlineDon’t forget about our sales resources featured on

BrokerNet (account.kp.org)!

Featuring: • Plan Summaries• Sales Brochures• SBCs• KP News

• New: Medicare Broker • Quoting & Coverage info• Commissions & Bonuses• New: Training Center• Forms and Applications

• Network details• New: BOR Change Process• Updated: Field Sales Guide

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New BOR Change Process

Making our operation faster and more efficient for you!

3 important details you should know:

1. The full process can be found in the Resource Library on BrokerNet

2. We have a new BOR Authorization Form, which needs to be signed by you and the group

3. If you are working with a GA/TPA, you must note that on the form and they need to submit the form to KP

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2

3

More than just a tour

Experience KP

Get a behind-the-scenes look at Kaiser Permanente facilities and care

Take a tour with Kaiser Permanente leadersGain greater insights into our care delivery

model

A BETTER WAY to take care of business

Kaiser Permanente Individual & Family Line

A BETTER WAY to take care of business

Continue to offer Individual Products in all 3 jurisdictions

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Affordable plan options available in all metal tiers, including Platinum

Meeting MD “value” plan requirements for low deductibles and coverage before deductible: Gold compliant, modifications to Silver DHMO 2500/30 and Bronze DHMO 6000/50

Continue to support standard plans in DC: One plan per tier (Platinum, Gold, Silver) and two plans in Bronze tier

Continue to offer a dental rider in MD and VA

Continue to offer value-added benefits such as: Adult dental preventive plan and rider products PCP waiver of copay for children under 5 in all plans, except DC Standard Plans Telemedicine Chiropractic as part of the medical benefit, also acupuncture offered in MD, when medically

necessary ChooseHealthy Program: Offers discounts on gym memberships, massage, vitamins as well

as chiropractic and acupuncture (no referral necessary)

Maintaining a streamlined and simplified portfolio offered on- and off-exchange.

2020 Rate Position

KP lowest price plan

KP 2nd lowest price plan

Based on 40 YO rates

• KP will maintain lowest or 2nd lowest cost Silver position in MD and DC; improves position in VA. Metal Tier Share

MD

DC

VA

Platinum1%

Gold19%

Silver55%

Bronze22%

Catastrophic2%

Platinum16%

Gold19%

Silver28%

Bronze31%

Catastrophic5%

Platinum0%

Gold4%

Silver68%

Bronze26%

Catastrophic1%

MD DC VA2019 Final 2020 2019 Final 2020 2019 Final 2020

Overall RP 12% -1% -2% 0% -20% -13%

Platinum

Gold

Silver

Bronze

Catastrophic

($85)

(-$126)

($29)

($15)#3

($76)

($28)

(-$13)

(-$38)

(-$129)

(-$91)

(-$131)

(-$114)

(-$12)

#3

#3

Notes: In VA, there is a difference in rate position depending on whether Cigna (CareFirst territory) or Anthem is the lowest cost carrier. Position reflects CareFirst territory rate position. Rate position is -16% in Anthem territory.

($13)

(-$133)

(-$2)

(-$24)

(-$64)

(-$65)

(-$91)

(-$123)

(-$9)

(-$30)

(-$143)

($110)

($43)

#3#4

#3

#3

(KP Only) (KP Only) (KP Only) (KP Only)

On-Marketplace Enrollment for Virginia Residents

Kaiser Permanente plans can be selected when purchasing coverage on HealthCare.gov

ON-Marketplace

Kaiser Permanente plans can also be purchased directly through buykp.org

Off-Marketplace Enrollment for Virginia

Individual & Family Plans

OFF-Marketplace

A BETTER WAY to take care of business2020 Individual Commissions

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DC MD VA

New $200 $200 $200Renewal $50 $50 $50

Incentive: Per subscriber per year

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| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.

November 12, 2019

When Is Open Enrollment, again?

November 1 – December 15 for 1/1/20 Coverage

November 1 – December 15 for 1/1/20 Coverage

November 1 – January 31, Coverage for start dates as in past years (1/1, 2/1, 3/1)

It Depends!

A BETTER WAY TO TAKE CARE OF BUSINESS

Thank you.