mt donahoe/kaiser permanente
TRANSCRIPT
A BETTER WAY to take care of business
kp.org/choosebetter
MT DONAHOE/Kaiser Permanente Update
Brandon Burbage, Small Group (1-50 ) Sales Executive
Agenda
1. KP Mid-Atlantic
1. National & Local Presence
2. Expansion & Growth
2. Products
1. What We Sell – A Plan for Everyone
2. Rates
3. Submission Process
4. Broker Compensation
5. Objections Impacting Quoting Activity
6. Support Resources
7. Questions
A BETTER WAY to take care of business
kp.org/choosebetter
KP Mid-Atlantic
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National and Local Presence
Trusted Advisors for Home Healthcare • 44-eligible home healthcare company• Group never considered Kaiser Permanente
before• Broker wasn’t as versed in specific Kaiser
Permanente details and plans• Consulted Sales Executive on the best plan
selections to meet the group’s needs• Helped position the broker as the trusted
advisor and provide the best solution for their client
• Kaiser Permanente was selected because of the quality of care, benefit designs and as the best financial solution for the group
• Our Sales Executive facilitated the enrollment meeting and consulted with members on plan options and details
• Enrolled 27 subscribers and 45 members• The group had an easy and smooth
onboarding process and renewed in 20204
“I have been working with insurance companies for a number of years. While we may have been hesitant to go with Kaiser, this was by far the easiest enrollment process I have been through.”
- Group’s senior leadership
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Quality Care at the Core
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-Our Medical Group now covers over 50 medical and surgical specialties and 1,632 physicians
-Over 1,100 board-eligible / board-certified physicians have joined us since the beginning of 2009 (Board Certification is a mark of distinction. The provider has taken the extra steps to demonstrate mastery of the latest advancements in their specialty and practice at the top of their profession).
Physicians recognized in the November 2020 “Top Doctors” issue
Physicians recognized in the November 2019 “Top Doctors” issue
Physicians recognized in the November 2020 “Top Doctors” issue
167 212 50Northern Virginia Magazine Washingtonian Magazine Baltimore Magazine
Top Physicians
Hiring & Retaining Top Physicians
Kaiser Permanente is the Top Rated Amongst Consumers
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Access to Care Access to Care
The Future Looks Bright
Timonium-Lutherville Medical CenterCaton Hill Medical Center
Projected opening: February 2022• New build medical center• 221,795 square-feet, five-story hub• Primary care, specialty care, Urgent Care,
Advanced Urgent Care, ancillary services
Projected opening: May 2022• New build medical center• 241,357 square-feet, five-story hub• Primary care, specialty care, behavioral health,
optometry, ASC, Urgent Care and Advanced Urgent Care, and ancillary services
• Located 3 miles from current Woodbridge Medical Center11
• Kaiser Permanente Mid-Atlantic States will spend more than $1B in capital investments across NOVA, DCSM and Baltimore over the next few years
• New facilities and expansions: Ashburn (2020), Bowie Fairwood (2021), Timonium and Caton Hill (2022)
2021 Plan Updates – Commercial Group
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Small Group:
Plan additions: VA: DHMO 8200/50/vision in bronze tier MD: $4000/40/vision DHMO and DHMO Plus in silver tier and DHMO Plus 6900/50/vision in bronze tier DC: 0/10/vision 2TPOS and 500/10/vision 2TPOS added to platinum tier
The standard non-pediatric Vision Hardware benefit has changed from a percentage (40%) discount to dollar ($) discount $125 off glasses or $25 off contacts
Embedded adult preventive and embedded cosmetic dental benefits removed to bring KP to parity with market and eliminate overlapping coverage
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NEW | Added ChoiceSimple 2 tier product that combines Kaiser Permanente's award-winning integrated care delivery system, easy member experience and unlimited access to any licensed provider nationwide.
Out-of-Network Benefit Design
Unlimited medical services and Rx fills/refills
PCP Office VisitPreventive Care
Specialty Office VisitOutpatient Mental Health
PT/OT/STLabs/X-Rays
Deductible20% or 30%
Coinsurance in ML1
RXGeneric
Preferred BrandNon-Preferred Specialty
Deductible20% or 30%
Coinsurance in ML1
InpatientOutpatient surgery
Skilled nursing facilitiesMaternity
Prenatal care
Deductible20% or 30%
Coinsurance in ML1
Product Highlight:• The same comprehensive coverage as KP’s traditional
HMO in-network, with unlimited routine care out-of-network
A great fit for groups new to KP and seeking to:• Experience integrated care from KP but still have
provider choice• Transition from a similar POS plan with another carrier• Maintain their relationship with an existing provider • Have options for employees that live on the outskirts of KP
service area
Market and Price Competitive:• Priced competitively compared to Flexible Choice• Combines KP quality with provider choice• Enhanced consumer and employer experience
Availability:• Available now in Mid-Large all jurisdictions• Available now in Small group
• Off-exchange Maryland (3) and Virginia (3)• On-exchange for DC (5), on-exchange for MD (1)
14Notes: 1. Specific plan designs for SG with coinsurance varying between 20%-40%
A BETTER WAY to take care of businessHMO Plus and DHMO Plus
Product Highlight• The same comprehensive coverage as KP’s traditional HMO and
DHMO in-network, with limited routine care out-of-networkTarget 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
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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
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.
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FLEX CHOICE (3TPOS) Kaiser Permanente
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Common Objections
Common Objections
Most Common Objections Employees can’t keep their own doctor/narrow network
My employee’s family member/friend had a bad experience with Kaiser
Kaiser is great for certain blue collar, local industries
Responses to Objections Kaiser offers several options (plans) for employees to
keep their own providers AND enjoy significant cost savings (review plan options in this deck)
It’s unfortunate the employee had a bad experience (can’t minimize someone’s experience)- but Kaiser consistently ranks as the highest quality of healthcare provider according to the NCQA (independent, non profit, no industry influence) and 3rd party ratings
Because of Kaiser Permanente’s consistently high quality of care ratings, plans that allow flexible access to non-Kaiser providers in/out of service area, affordability and commitment to investing in resources (Wellness, Telehealth) that allow groups to contribute to the health of their employees- Kaiser Permanente is best solution for ANY group seeking quality of care, access flexibility and significant cost savings.
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Highly Competitive Rates Across All Jurisdictions
Approved DC 2021Small Group rate position by metal tier
DC
Preliminary 2021
$45
$33
$3
-$37
DC
KP lowest price plan
KP 2nd lowest price plan
Positive values represent rate advantage.
42%
39%
16%
2%Silver Bronze
Platinum
Gold
APPROVED MD 2021 (DC Metro)Small Group rate position by metal tier
MD
Preliminary 2021
$35
-$6
$10
-$1
MD
KP lowest price plan
KP 2nd lowest price plan
Positive values represent rate advantage.
Platinum14%
Gold26%Silver
52%
Bronze7%
#3
APPROVED VA 2021Small Group rate position by metal tier
VA
2021
$44
$13
$8
-$34
VA
KP lowest price plan
KP 2nd lowest price plan
Positive values represent rate advantage.
Platinum20%
Gold46%
Silver26%
Bronze8%
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Small Group Submission Process
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Small Group Enrollment Check List Enrollment
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Broker Compensation
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Broker Compensation Small Group Fall Broker Bonus Extended
Year End Agency Bonus
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Medical Financial Assistance (MFA) Program
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