2019 fall kpif webinar › documents › kaiserindividualwebinar20191024.pdf · 2019 fall kpif...

kp.org/choosebetter ©2017 Kaiser Foundation Health Plan, Inc. All Rights Reserved.

A BETTER WAY TO TAKE CARE OF BUSINESS

2019 Fall KPIF Webinar

A BETTER WAY to take care of business

2


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


3

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

Me

mb

ers

hip

, K

P M

AS



4


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


5

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 Columbia

Anne 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

Spring

Holy Cross Hospital

Germantown (medicine only)

Suburban Hospital

Doctor’s Community Hospital

Premier Partner Hospitals


A BETTER WAY to take care of businessAlexandria Medical Center

6

3000 Potomac Avenue

Alexandria, VA

Medical services include:

• Laboratory

• Obstetrics-gynecology

• Optometry

• Pharmacy

• Physical therapy

• Primary care (adult and pediatric)

• Radiology services

A BETTER WAY to take care of businessStafford Medical Center

7

125 Hospital Center Blvd., Suite 110,

Stafford, VA


• Laboratory


• Optometry and optical

services

• Pharmacy

• Behavioral health

• Physical therapy

• Primary care (adult and

family medicine)


• Various rotating specialty

services

A BETTER WAY to take care of businessHaymarket Medical Center

8

11050 Heathcote Boulevard

Haymarket, VA


• Laboratory


• Optometry and optical services

• Pharmacy

• Behavioral health

• Primary care (adult and family practice)


A BETTER WAY to build the futureThe Future is Looking Bright

9

Timonium, MD

Woodbridge, VA


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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)

Woodbridge, Virginia (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


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“Super Hubs”:

Comprehensive Ambulatory Facilities

Some services can vary by location.


12


5 CDUs located within multi-specialty outpatient “hubs”

• Capitol Hill, 20 Bed Unit

• Gaithersburg, 32 Bed Unit

• Tysons Corner, 43 Bed Unit

• South Baltimore, 18 Bed Unit

• Largo, 31 Bed Unit

24/7 Access to care

• Staffed with EM/FM physicians

24/7 ancillary services

“Super Hubs”: 24/7

Clinical Decision Unit & Urgent Care

Capabilities

▪ Similar to many community acute care settings

▪ Telemetry monitoring

▪ CT & X-ray 24/7

▪ MRI & Ultrasound availability

▪ Bedside Ultrasound

▪ Scheduled Blood Transfusions

▪ Procedural Sedation if needed

▪ Telemedicine services for site to site support and specialty consultations


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“Super Hubs”: Operating Rooms

• Multi-specialty hubs have operating rooms equipped and staffed to perform both minor and moderately complex surgeries, such as uncomplicated spine surgery.

• Ambulatory Surgery available at:

• Gaithersburg, 2 ORs

• Tysons Corner, 6 ORs

• South Baltimore, 3 ORs

• Largo, 6 ORs

• Outpatient Procedure Rooms available at:

• Capitol Hill, 2 suites

• Tysons Corner, 3 suites

• South Baltimore, 1 suite


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Save a trip to the doctor’s office with a phone call Your employees can schedule phone appointments or use our call center for

on-demand urgent care.

Schedule face-to-face video appointments with a doctor Your employees can meet with specialists, and get on-demand video visits with

on-call physicians.

Connect with a care team anytime via email Your employees can expect responses from their doctor’s office within 48 hours.

Stay on top of health concerns 24/7 on kp.org By registering at kp.org, they can choose their doctor, schedule routine appointments,

view most lab results, and more.

Bring a remote specialist into the room During primary care or Emergency Department visits, doctors can consult with

specialists to save crucial time.

Value differentiation: Patient Experience

(Engagement)


15


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 Center

Advice Center Skilled Nursing

Facility

Urgent Care

Pharmacy

Laboratory

Specialty Care

Office

Primary Care

Office

Hospice

Radiology

Media/Web

Health

Plans

HospitalHome

(Self-Care)

Kaiser Permanente Value:

Integration


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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


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• 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

A BETTER WAY to manage costs

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Value differentiation:

Quality (Cancer Screening)

Breast – Total (%) Colorectal (%)

NOTE: The source for data contained in this publication is Quality Compass® 2010-2017 Commercial data and is used with the permission of the Committee for Quality Assurance (NCQA). Quality Compass 2010-2017 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).

All Plan/All Line of Business National Average

Kaiser Foundation Health Plan of the Mid-Atlantic States

2017 Rate of 2nd highest commercially available local competitor

50

60

70

80

90

100

2010 2011 2012 2013 2014 2015 2016 2017

50

60

70

80

90

100

2010 2011 2012 2013 2014 2015 2016 2017

Highest rate in the

nation for 6 years in

a row!

Highest

rate in the

nation!


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Quality (Chronic Cond.)

Controlling High Blood

Pressure – Total (%)

Diabetes Care –

Eye Exams

NOTE: The source for data contained in this publication is Quality Compass® 2010-2017 Commercial data and is used with the permission of the Committee for Quality Assurance (NCQA). Quality Compass 2010-2017 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).

All Plan/All Line of Business National Average

Kaiser Foundation Health Plan of the Mid-Atlantic States

2017 Rate of 2nd highest commercially available local competitor

50

60

70

80

90

100

2010 2011 2012 2013 2014 2015 2016 2017

50

60

70

80

90

100

2010 2011 2012 2013 2014 2015 2016 2017

Highest

rate in the

nation!Highest

rate in the

nation!


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Cost (Reduced unnecessary utilization and migration to lower cost point of care)


21


2020 Product Updates


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 VA

2019 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)

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District of

Columbia2020 KPIF Plan Portfolio

2020 KPIF District of Columbia Portfolio

On Marketplace DC Health Link Plan Type

Available KP DC Bronze 6500/60 Dental Deductible

Available KP DC Standard Bronze 6200/20%/HSA/Dental HSA-Qualified

Available KP DC Standard Bronze 7250/50/Dental Deductible

Available KP DC Standard Silver 4000/40/Dental Deductible

Available KP DC Silver 3200/30%/HSA/Dental HSA-Qualified

Available KP DC Silver 2500/30/Dental Deductible

Available KP DC Gold 1500/25%/HSA/Dental HSA-Qualified

Available KP DC Gold 1000/20/Dental Deductible

Available KP DC Standard Gold 500/25/Dental Deductible

Available KP DC Gold 0/20/Dental Co-Payment

Available KP DC Standard Platinum 0/20/Dental Co-Payment

Available KP DC Catastrophic 8150/0/Dental Deductible

2020 KPIF Portfolio-District of Columbia-Cost Share Reduction

(CSR) Plans

On Marketplace DC Health Link Plan Type

On-Marketplace KP DC Standard Silver 3500/40/CSR/Dental (4000) CSR Deductible

On-Marketplace KP DC Standard Silver 100/15/CSR/Dental (4000) CSR Deductible

On-Marketplace KP DC Standard Silver 0/5/CSR/Dental (4000) CSR Copay

On-Marketplace KP DC Silver 1900/20%/CSR/HDHP/Dental (3200) CSR Deductible

On-Marketplace KP DC Silver 500/10%/CSR/HDHP/Dental (3200) CSR Deductible

On-MarketplaceKP DC Silver 100/5%/CSR/HDHP/Dental (3200)

CSR Deductible

On-MarketplaceKP DC Silver 2200/30/CSR/Dental (2500)

CSR Deductible


CSR Copay


CSR Copay

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Maryland2020 KPIF Plan Portfolio

2020 KPIF Maryland Portfolio

On/Off-

MarketplaceMaryland Plan Type

Available KP MD Bronze Value 6000/55 Dental Deductible

Available KP MD Bronze 6200/20%/HSA/Dental HSA-Qualified

*Available KP MD Silver 6000/40/Dental Deductible

*Available KP MD Silver 3200/20%/HSA/Dental HSA-Qualified

*Available KP MD Silver Value 2500/35/Dental Deductible

Available KP MD Gold 1500/20/Dental Deductible

Available KP MD Gold 1000/20 Dental Deductible

Available KP MD Gold Value 0/20/Dental Copayment

Available KP MD Platinum 0/10/Dental Copayment

Available KP MD Catastrophic 8150/0/Dental Deductible

*There is a difference between the Silver On and Off HIX in that the On-HIX Silver plans have a different cost share for vison and

higher rate due to CSR defunding

2020 KPIF Maryland Portfolio Cost Share Reduction (CSR)

Plans

On/Off-Marketplace MAS/Maryland Plan Type

On-Marketplace KP MD Silver 3500/35/CSR//Dental (6000) CSR Deductible

On-Marketplace KP MD Silver 0/15/CSR/Dental (6000) CSR Copay


On-Marketplace KP MD Silver 1900/20%/CSR/HDHP/Dental (3200) CSR Deductible



On-Marketplace KP MD Silver 2200/30/CSR/Dental (2500) CSR Deductible


On-Marketplace KP MD Silver 0/5/CSR/Dental (2500)CSR Copay

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Virginia2020 KPIF Plan Portfolio

2020 KPIF Virginia Portfolio

On/Off-

MarketplaceKP Direct/FFM Plan Type

Available KP VA Bronze 5500/50 Dental Deductible

Available KP VA Silver 6000/40/Dental Deductible

Available KP VA Silver 3200/20%/HSA/Dental HSA-Qualified

Available KP VA Silver 2500/35/Dental Deductible

Available KP VA Gold 1500/20/Dental Deductible

Available KPVA Gold 1000/20/Dental Deductible

Available KP VA Gold 0/20/Dental Co-Payment

Available KP VA Platinum 0/10/Dental Co-Payment

Available VA Catastrophic 8150/0/Dental Deductible

2020 KPIF Virginia Portfolio Cost Share Reduction (CSR)

Plans

On Marketplace FFM Plan Type

On-Marketplace KP VA Silver 3500/35/CSR//Dental (6000) CSR Deductible

On-Marketplace KP VA Silver 0/15/CSR/Dental (6000) CSR Copay


On-Marketplace KP VA Silver 2200/30/CSR/Dental (2500) CSR Deductible



On-Marketplace KP VA Silver 1900/20%/CSR/HDHP/Dental (3200) CSR Deductible



Tobacco Rating Regional Percentages

Region RateAge for New

members

California Not

Applicable

Colorado 15% 18

Mid-Atlantic States

Maryland Not

Applicable

Virginia 20% 18

Washington,

D.C.

Not

Applicable

Georgia 20% 18

Hawaii 20% 21

Washington 20% 21

Northwest

Oregon 20% 21

Washington 20% 21

On and Off Marketplace Enrollments

RegionON - MARKETPLACE OFF - MARKETPLACE OE Dates

Enrollment Site Enrollment Site Who Enrolls? Enrollment Dates

District of

Columbia DC Health Link

dchealthlink.comN/A N/A

Nov 1st – Jan 31st

Coverage for start

dates (1/1, 2/1, 3/1)

Maryland Maryland Health Connection

marylandhealthconnection.gov

Sign Me Up Tool

or

buykp.org

Licensed Agents

Nov 1st – Dec 15th

VirginiaHealthcare.gov Nov 1st – Dec 15th

Adult and Pediatric Dental - Dominion

Maryland, VirginiaOff-MarketplaceDental HMO rider option ▪ For adults 19 and older▪ Additional $12.93/month premium

Maryland, Virginia and D.C.*On/Off-Marketplace▪ Embedded benefit for members 18 and younger▪ Preventive $30 Dental plan embedded available for adults 19 and older

* In D.C., On-Marketplace ONLY

Whole Health Benefits - Healthy Services

Dental Preventive Services

• $30 for adults

• $0 plus an office visit fee for

children (under 19)

• Includes cleaning, oral evaluation

and bitewing x-rays

Vision Benefit

Pediatric Vision

▪ On/Off & State/Federal Marketplace▪ Frames/Lenses

▪ Contacts

▪ Medically Necessary Contacts

▪ Low Vision Aids

Adult Vision

▪ On/Off & State/Federal Marketplace

▪ Frames/Lenses – 30% off retail price

▪ Contacts – 15% off retail price

kp.org/choosebetter


©2018 Kaiser Foundation Health Plan, Inc. All Rights Reserved.

New Initiatives


38

Medicare Broker Program

Important details about the program and opportunity:

▪ Only available in the Mid-Atlantic States region.

▪ Limited to Medicare Advantage plans for Medicare-eligible

individuals, will not include Medicare group sales.

▪ Supported by two Field Marketing Organizations (FMOs) in the region – GS National

and HealthMarkets – and will not be partnering with individual agents or agencies that

are not under contract with these two FMOs to sell our Medicare plans at this time.

▪ Brokers appointed to sell KPIF and commercial group business will not automatically

be able to sell KP Medicare business. The appointment process is different.

Brokers can now sell Medicare Advantage

plans in the Mid-Atlantic States Region!

• The only 5-star plan in the Mid-Atlantic States area

• Serving the Medicare community for more than 30 years

A BETTER WAY to take care of businessMinute Clinics®

39

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

kp.org/choosebetter



2020 Individual Commissions

A BETTER WAY to take care of business2020 Individual Commissions

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DC MD VA

New $200 $200 $200

Renewal $50 $50 $50

Incentive: Per subscriber per year

Timing of Commission Payment?

• All paid up front in lump sum 60 days after the member’s effective date.

Commission paid outside OE?

• KPIF commissions are paid

regardless of OE.

kp.org/choosebetter



Broker Resources


43

Sales Resources Online

Don’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

• Agent of Record Change

Forms

• Updated: Field Sales Guide

A BETTER WAY to take care of businessBroker Resources

Clinical Excellence

44

insights.kpbiz.org/broker


45


Experience KP

Get a behind-the-scenes look

at Kaiser Permanente facilities and care

▪ Take a tour with Kaiser Permanente leaders

▪ Gain greater insights into our care delivery

model

More than just a tour…


Justin Atwater571-489-1261

[email protected]

Thank you.

Sign Me Up Tool 2.0 - Broker Registration

1. Go to www.kp.org/applyonline.com

2. Hover mouse over the down arrow next to Register, then click select Broker Registration. See red circle.

Let’s start by creating a new Broker account.

Note, be sure to obtain an appointment by Kaiser Permanente so you can create a new account. For assistance, contact the Broker Licensing and Compensation Department.

http://www.kp.org/applyonline.com

Broker Registration (cont’d)

1. Click open the ‘Select Region Where License is Registered’ drop down.

2. Select a State from the dropdown. In this case select MAS.

3. Answer YES/NO to one or both of the ‘Are you registered in [State]?’ prompt.

4. Enter the corresponding Agent License for that State.

5. Click Next.


Note: Your Name, License Number, State and Phone Number should be carried over after your account has been validated.


Complete the Broker registration by providing:

• Mailing Address

• A unique email for this account

• Phone type and verify phone number

Scroll down…


Create a unique User ID and Password by entering them here.

Check the box next to Terms & Conditions and Privacy.

Click Next.


A “Thank you!” page will be displayed stating that the Broker registration process

is complete.

The system will require you to sign in to confirm the use of the correct User ID

and Password.

Click Sign In.

Upon logging on using the newly created account, the Broker Dashboard is shown.

A Welcome message with your Broker name will be shown.


Broker profile may have Firm Name and/or General Agency Name for KPIF.

To chose a Firm or General Agency navigate to your dashboard and click

‘create new quote’

• Link this quote/application to your firm.

Enter your client's ZIP code and county to display the firms in that area.

• Then select the firm you're working with.

• Then select the GA you’re working with.


Justin Atwater571-489-1261

[email protected]

Thank you.

2019 fall kpif webinar › documents › kaiserindividualwebinar20191024.pdf · 2019 fall kpif...

Documents