Kaiser Permanente An Integrated Health Care Model - 2021 Benefits At a Glance October 9, 2020 Presented by: Jeff VanValkenburg Associate Account ...
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Kaiser Permanente An Integrated Health Care Model 2021 Benefits At a Glance October 9, 2020 Presented by: Jeff VanValkenburg Associate Account Manager Replay Link: https://engage.vevent.com/rt/mmc/index.jsp?seid=7097 Passcode: MMCwebcast
Agenda
Benefits At A Glance – 2021 Medical and Prescription
Highlights
Benefits At A Glance – Pharmacy Highlights
Preventive Care
2021 Plan Changes by Region
Health Care Kaiser Permanente
Kaiser Permanente Regional Updates
Questions
2
Benefits At A Glance: 2021 Medical and Prescription
Highlights
Plan Name $400 Deductible Plan $900 Deductible Plan $1,500 Deductible Plan $2,850 Deductible Plan
Deductible $400 individual / $800 family $900 individual / $1,800 family $1,500 individual / $3,000 family $2,850 individual / $5,700 family
OOP Max $2,200 individual / $4,400 family $3,000 individual/ $3,000 individual/ $5,500 individual/
$6,000 family $6,000 family $11,000 family
Coinsurance 20% after deductible 20% after deductible 20% after deductible 30% after deductible
PCP/Specialist $20 / $40 copay 20% coinsurance after deductible 20% coinsurance after deductible 30% coinsurance after deductible
*Preventive care is
covered at 100%
Inpatient Hospital 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible 30% coinsurance after deductible
Emergency Room $150 copay; then 20% coinsurance 20% coinsurance after deductible 20% coinsurance after deductible 30% coinsurance after deductible
after deductible
Urgent Care $50 copay 20% coinsurance after deductible 20% coinsurance after deductible 30% coinsurance after the deductible
Prescription Drugs Retail Retail 20% coinsurance after deductible 30% coinsurance after deductible
Note: Deductible does not $10 generic Generic: 30% (min. $10/max. $20)
apply to copays on the $30 brand Brand: 30% (min.$25/max.$50)
$400 and $900 deductible $60 non-formulary brand Non-formulary Brand: 45% (min.
plans $40/max. $80)
Mail order – 90-day supply Mail Order:
$20 generic Generic: 30% (min.$25/max.$50)
$60 brand Brand: 30% (min.$62.50/max. $125)
$120 non- formulary brand Non-formulary Brand: 45%
(min.$100/Max.$200)
Benefits may vary by Kaiser region. Please refer to your plan documents for more details. 3
Benefits At A Glance: Pharmacy Highlights
• Your Kaiser Permanente ID card works for • Your physician writes prescriptions electronically,
both medical and pharmacy coverage so most are filled automatically and are ready for
pick up during the same medical visit
• Pharmacies are often inside Kaiser
Permanente medical facilities (visit • Refill most prescriptions on-line, by using our
www.KP.org for pharmacy listings/ locations Kaiser mobile app, kp.org, or by calling the
in your area). Some Kaiser pharmacies are number on your prescription bottle
open 24 hours a day, 7 days a week
• Mail order is available on maintenance
medications:
Call our EZ Refill Line at 1-800-700-1479, 24
hours a day, 7 days a week
Mail order quantity may vary by location
4
Preventive Care
Preventive exams are Frequency is based on age, Types of Preventative Services covered
covered at 100% for every gender, current health and are:
age group family history, and Immunizations and wellness care
guidelines based on the Well woman care and exams
U.S. Task Force for Routine physical exams*
Prevention Prenatal care
Preventative labs such as Prostate
Cancer Screening, Colorectal Cancer
Screening, Mammograms, etc.
* Appointments that are scheduled as routine physical exams that are actually
diagnostic in nature will be charged a copay.
5
2021 Plan Changes by Region
California Georgia Mid-Atlantic
States
Enhanced coverage for chronic Pending DOI approval: Expanded preventive care services: Lab,
condition management, at no o Portable Oxygen Concentrators screening & DME
cost: o Transgender Services-Breast Clinically Administered Medications Cost
Augmentation Surgery Sharing:
• A1c testing for diabetes o Craniofacial Conditions • One copayment per visit for clinically
• LDL testing for heart disease administered drugs in addition to the
• INR testing for liver disease office co-pay, when injected or infused
or bleeding disorder during an office visit.
Colorado Northwest Washington
Enhanced coverage for Breast
Imaging, at no cost:
Adding select preventive care Diabetic Education, Devices,
• Expanded coverage for services to be covered without a Equipment & Pharmacy Supplies:
breast cancer screening deductible for individuals diagnosed • Annual Deductible does not apply to
services, when deemed with specific chronic conditions, as glucose monitors, test strips, lancets,
appropriate by PCP and allowed under the IRS and US control solutions, or peak flow
within appropriate Treasury Department Notice 2019- meters
guidelines by ACR or 45
NCCR
6
Health Care
at Kaiser Permanente
7
Health Care at Kaiser Permanente
With an Integrated Health Care Model, care is coordinated, connected, and all in one place
Primary care, OBGYN, Pharmacy
Pediatrician Urgent Care*
Specialty care (referral from your Hospital*
Kaiser PCP are needed for most
care, except OB/GYN) * Not all centers have these options
Laboratory services
X-ray
8
Improving the kp.org care experience
• Easier navigation and fewer clicks mean members can quickly find what they’re looking for
• More personalization and dynamic content provide information that’s relevant for each member
• Responsive design improves the mobile experience for on-the-go members
• Cleaner look and feel enhance how members access and absorb information
9
Mobile Apps
Manage your care on the
go. Kaiser Permanente’s
and partner apps provide
full access to the care you
want conveniently from
your mobile device.
We’ve got you covered
whenever and
wherever you go.
Medical Appointment Pharmacy Message Mobile My KP My Doctor
Record Center Center Center Bill Pay Meds App Online App
KP mobile app Partner mobile apps
1011
Kaiser Permanente is built to deliver care when and where
Telehealth Care
the country needs it most:
More than 80% of care visits are done by video and phone
90,000 telehealth visits happen everyday
Video Visits Online Chat Email
A secure way for members to
Face-to-face care from Quick medical advice get follow-up care by
doctor in an everyday from a Kaiser doctor, messaging their doctor’s
location online and in real-time office with non-urgent
questions
24/7 advice E-visit Phone Appointment
Support from licensed care A personalized care plan High-quality care over the
providers to assist with on – straight from a doctor, phone- just like an in-person
the spot care and guidance entirely online visit
12Care away from home
• If you get hurt or sick while traveling, we’ll help
you get care. Our plans include emergency and
urgent care coverage from qualified providers
anywhere in the world.
• We can also help you before you leave town by
checking to see if you need a vaccination,
refilling eligible prescriptions, and more. Just
call us or go online:
24/7 Away from
Home Travel Line: kp.org/travel
951-268-3900*
*This number can be dialed inside and outside the United States. Before the phone number, dial “001” for landlines and “+1” for mobile lines if you’re outside the
country. Long-distance charges may apply, and we can’t accept collect calls. The phone line is closed on major holidays (New Year’s Day, Easter, Memorial Day,
July Fourth, Labor Day, Thanksgiving, and Christmas). It closes early the day before a holiday at 10 p.m. Pacific time (PT), and it reopens the day after a holiday
at 4 a.m. PT.
13Maximize Your Health
Personalized online wellness programs on KP.org/healthylifestyles
Lose weight Eat healthy
shows you how you can Create a custom-made
work with 3 key areas — mind, food, nutritional plan for your lifestyle, with
and body —to loseweight personalized strategies for making
and keep it off. smart, satisfying food choices.
Quit smoking Manage depression
is designed to help you helps you
quit smoking for good. Your lead a happier, fuller life by
personalized quit plan uses proven finding ways to help manage
strategies to decrease nicotine your depression symptoms.
dependency and deal with cravings.
Get a good night’s sleep
Manage diabetes helps you change the way
Get help managing this complex, you think about sleep. Learn how
ongoing condition with a you can wake up refreshed and
program designed around ready to take on the day.
your personal needs.
Reduce stress
Manage chronic pain looks at your individual sources
A personalized and symptoms of stress, then helps
management plan can help you you develop a customized stress
enjoy life to the fullest while dealing management plan.
effectively with chronic pain.
14Kaiser Permanente
Regional Updates
15Updates in Northern California
Care delivery
Care Essentials in downtown San Francisco Dublin Medical Offices
Located at the Salesforce Transit Center to meet
members where they are, this innovative, new
facility will have extended hours. Services include
same-day appointments, pharmacy, lab tests, Rendering of new Care Essentials facility in downtown San Francisco
vaccines, injections, treatment of minor illnesses
and injuries. Scheduled to open late 2020. Other facilities now open
Cedar Avenue Medical Offices
Mental health and wellness Roseville Riverside Medical Offices
New mental health and wellness facilities: San Francisco Mission Bay
Oakland Clay Street Sports Medicine Center
San Francisco Ellis Street Spruce Medical Offices
Watsonville
Scotts Valley (Fall 2020)
Modesto Stoddard Road (Fall 2020)
*On California’s Annual Clinical-Quality Report Card
16Updates in Southern California
Care delivery
Now open
Baldwin Park Medical Offices Dublin Medical Offices
Carson Medical Offices
Hollywood Romaine Medical Offices
Irwindale Medical Offices
Porter Ranch Medical Offices Rendering of new Porter Ranch Medical Office
Playa Vista Medical Offices Select Target locations partner with Kaiser to offer more than
Clairemont Mesa Medical Offices 85 different services including:
• Care for chronic illnesses such as diabetes and high blood pressure
• Child and adolescent care (starting at 2 weeks old)
• Video consultations with doctors and other providers
• Vaccinations
• Women’s health services
• Treatment for minor illnesses such as cold and flu
• Basic dermatology services
All clinics are staffed and operated by Kaiser Permanente’s Southern
California Permanente Medical Group, including nurse practitioners and
licensed vocational nurses. Kaiser Permanente physicians also have a
physical presence in some locations.
17Updates in Colorado
Care delivery Quality
Frisco Medical Officesof care
In person: Top-rated health plan in Colorado —
30 medical facilities, including: 2 years in a row1
22 in Denver/Boulder Of the 12 commercial health plans in
4 in Northern Colorado Colorado rated by the National
4 in Southern Colorado Committee for Quality Assurance
(NCQA), ours is the top-rated plan in
1,200+ Kaiser Permanente physicians
the state for the second year in a row.
15,000+ network providers
Top-rated Medicare plan in Colorado
One combined service area in 2021;
1-800-632-9700 — 2 years in a row2
Of the 11 Medicare health plans in
On the go: Convenient telehealth options Colorado rated by the NCQA, ours has
with Kaiser Permanente providers, like: been the highest-rated plan in the state
Chat online with a doctor for the last 2 years. And it’s 1 of only 4
Email Medicare health plans in the nation to
Phone consultations get a 5 out of 5 rating — the highest
possible rating for quality and service.
Video visits
E-visits
18Updates in Mid-Atlantic States
(Maryland, Virginia, and Washington D.C.)
Care delivery
30 medical facilities across the region
New medical offices now open:
Alexandria, Virginia
Haymarket, Virginia
Stafford, Virginia
North Arundel Medical Center
Choose from more than 1,600 doctors in the
Mid-Atlantic Permanente Medical Group
Quality of care
Top-rated health plan in the Mid-Atlantic
Newsworthy States — 2 years in a row2
Of the 29 commercial health plans in Maryland,
Hundreds of Mid-Atlantic Permanente Medical Virginia, and Washington, D.C., rated by the
Group doctors named “Top Doctors”1 National Committee for Quality Assurance,
ours is the top plan.
1Permanente doctors are recognized as Top Doctors in Washingtonian magazine (2019), Northern Virginia Magazine (2020), and Baltimore magazine (2019).
the National Committee for Quality Assurance (NCQA) 2019–2020 Private Health Insurance Plan Ratings, Kaiser Permanente of the Mid-Atlantic States’
2In
commercial health plan is rated among the top 1% in the nation, receiving a 5 out of 5 rating.
19Updates in Georgia
Care delivery
Choose from:
26 Kaiser Permanente medical offices
3 locations for 24/7 urgent care
70+ affiliated community urgent
care centers
18 affiliated hospitals West Cobb Medical Center
600+ doctors throughout
metro Atlanta andAthens
Quality of care
Partnership with Emory Healthcare
Emory University Hospital Midtown and Emory
Top-rated health plan in Georgia —
Saint Joseph’s Hospital are now primary
5 years in a row*
hospitals for Kaiser Permanente doctors and
members in Atlanta. Of the 12 commercial health plans in Georgia
rated by the National Committee for Quality
Assurance, ours is the top-rated plan in the
state for the fifth year in a row.
*NCQA’s Private Health Insurance Plan Ratings 2015–2020.
20Updates in Northwest
(Oregon & Southwest Washington)
Care delivery Newsworthy
In person Northwest Permanente, P.C. is a certified B-
Opened new Kaiser Permanente dental Corp — the first physician-led organization
office at Keizer Station in 2019. globally to obtain the designation.
Telehealth Kaiser Permanente Northwest leaders and
Members can schedule phone and video clinicians are on 90+ government and
appointments at kp.org and via the Kaiser nonprofit advisory boards.
Permanente app.
100% of Kaiser Permanente physicians in Quality of care
the Northwest offer primary and specialty
Top-rated HMO and Medicare plans in the
care visits via phone and video.
Northwest1
Members can save time and money by
Our HMO and Medicare plans are the highest-
ordering, refilling most prescriptions online.
rated plans among all health plans in Oregonand
Top 3 most-used telehealth services are for Washington.
ob-gyn, family practice, and psychiatry.
Oregon’s highest-rated heart program2
Updated e-visit capabilities can save Kaiser Permanente is the only program in Oregon
members time in getting nonurgent care. and Washington to earn the Society of Thoracic
Surgeon's highest rating for 3 common heart
1National Committee for Quality Assurance, 2019-2020.
2https://publicreporting.sts.org/
surgeries.
21Updates in Washington
(Western Washington & Spokane Area)
Care delivery Quality of care
1,100 Washington Permanente Medical Group One of the top-ranked medical groupsin
providers1 at 36 Kaiser Permanente medical Washington state 4 years in a row3
facilities in western Washington and Spokane2 Washington's highest-rated Medicare health
9,000+ contracted network providers, including FPO
plan for 2020 at 5 outPHOTO
of 5 stars4
51 affiliated community hospitals for HMO Core
plans
Live Care Chat available to our members
for low acuity medical conditions from
8am-10pm 7 days a week.
24/7 Consulting Nurse Service helpline
9 Kaiser Permanente On-the-Job®
occupational health locations
Bellevue Medical Center
1WashingtonPermanente Medical Group personnel records, January 2020. 2OIC Provider Network Form A. 3Washington Health Alliance 2019 Community
Checkup report, wacommunitycheckup.org. 4CMS, Plan Ratings, 2020.
22Why choose Kaiser Permanente?
Quality care with Your care, Care away Care and coverage built
you at the center your way from home around you
Great care, World-class specialty Healthy Manage your care
great results care resources anytime, anywhere
23Thank you everyone!
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