Transcript Slide 1

Slide 1
FastFacts
Feature Presentation
October 12, 2012
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© 2012 The Johns Hopkins University. All rights reserved.
Slide 2
Today’s Topic
We’ll be taking a look at…
Kaiser Permanente HMO
Changing the conversation to what matters
Slide 3
Today’s Presenter
Jeff J. Fisher, Senior Account Manager, Kaiser
Permanente Mid-Atlantic Region
Slide 4
Session Segments
Presentation
Jeff will address the changes to the plan structure and provide
suggestions for saving on your out of pocket expenses.
During Jeff’s presentation, your phone will be muted.
Q&A
After the presentation, we’ll hold a Q&A session.
We’ll open up the phone lines, and you’ll be able to ask
questions.
Jeff will answer as many of your questions as time allows.
Slide 5
Contact Us
If you would like to submit a question during the presentation or if
you’re having technical difficulties, you can email us at:
[email protected]
You can also send us an instant message!
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Slide 6
Survey
Survey
At the end of this FastFacts session, we’ll ask you to complete a
short survey.
Your honest comments will help us to enhance and improve
future FastFacts sessions.
Slide 7
How To View Full Screen
Kaiser Permanente HMO
Changing the conversation to what matters
Johns Hopkins University 2013 Plan/Benefit Overview
Kaiser Foundation Health Plan of the Mid-Atlantic States
2101 E. Jefferson Street
Rockville, MD 20852
Typical
U.S. health
care
Delivery System:
Fragmented,
uncoordinated
Result: Poor quality, frequent duplication of efforts, low efficiency,
difficult to navigate
Call Center
Advice Center
Primary Care
Office
Skilled Nursing
Facility
Media/Web
Laboratory
Hospital
Specialty Care
Office
Home
(Self-Care)
Urgent Care
Rehabilitation
Health
Plans
DM Vendors
Hospice
Emergency Room
Pharmacy
Radiology
Why is it better at Kaiser Permanente?
With Permanente physicians,
KP members have faster access to care
40.00
35.00
30.00
25.00
20.00
15.00
Mid-Atlantic Community
KPMAS
10.00
5.00
0.00
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Data source: Kaiser Permanente HealthConnect Scheduling System and Diamond Claims System; Data based on referrals initiated during
February 2012 comparing the date a member is referred to a specialist and the date they are seen by a specialist (data is for KP members
only reflecting the experience of internal care versus utilizing a network specialist; may or may not reflect specialty access for members of
other health plans)
With Kaiser Permanente – Permanente doctors can
deliver market-leading access to specialists thanks to
the unparalleled resources and technology they have
at their fingertips
Using a tool called E-consult primary care physicians can instantly schedule patients to see
specialists while the patient is in the exam room -- no more waiting on the phone to schedule
appointments. Frequently, specialty appointments are even available the same day.
Print outs for Patient and
Referring Physician
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With Kaiser Permanente there’s no need to carry
around your x-rays, remember your medical history or
fill out the same forms…over and over again
From any computer with an internet connection, Permanente physicians can securely
view Kaiser Permanente members’ x-rays (or any other radiology image) moments after
the film is taken*.
*The above statements primary applies to Kaiser Permanente members who seek care through Permanente physicians.
13
13
With Kaiser Permanente you get to choose your doctor
based on detailed information, not on who finally returns
your call
Members are able to choose their Permanente primary care doctors online, assisted
by the information contained in the comprehensive home pages of every
Permanente physician.
14
Only with Kaiser Permanente can you get the kind
of online convenience we offer
 From any computer with an internet
connection, at any time (day or night),
Kaiser Permanente makes it fast, easy, and
convenient for members
– Email a Permanente doctor office
– Schedule appointments
– Refill prescriptions
– View lab test results
– Print immunization records
– Get a list of your medications
– And more! Including the NEW kp.org Mobile App
15
With Kaiser Permanente – patients have fast and
convenient access to services offered at our
new multi-specialty hubs
What members get at hubs
What this means for them
24/7/365 Urgent Care
By offering around-the-clock urgent care, members are able to avoid unnecessary,
inconvenient and time-consuming visits to the emergency room
24/7 Pharmacy, Lab and Radiology
In the Mid-Atlantic, most non-KP members are accustomed to traveling to various
locations, with limited hours, to receive these services. With KP, you may visit a
specialty hub to receive these services all at one location.
A vast array of primary and specialty
care – all connected and in one place
Kaiser Permanente offers fast and convenient access – most KP members can
satisfy all their care needs under one roof.
Multiple locations in Mid-Atlantic (and
more coming!)
Members can visit whichever location is most convenient *
*Please note that all specialties are not available at all hub locations. Check the KP directory on kp.org to verify which services are available at the
desired location.
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More physicians and services
coming to your area:
South Baltimore County
Medical Center HUB
Kaiser Permanente is building a state-of-the-art multi-specialty facility in Halethorpe, set to open in April of 2013. The
four-story, 130,000-square-foot South Baltimore County Medical Center is under construction on the 1700-block of Twin
Springs Road and will include primary care, urgent care, ambulatory surgery, advanced diagnostic imaging, pharmacy,
and a variety of specialty services.
One of the innovative features of the new facility is a 14-bed Observation and Clinical Decision Unit where patients can
be held for observation for up to 24 hours. In the Clinical Decision Unit, members can avoid emergency room visits for
evaluation of conditions, or for brief therapy such as IV antibiotics or medications to treat asthma.
Services and hours
When the new center opens, you will have the added convenience of 24/7 urgent care, laboratory, radiology, and
pharmacy. And, you’ll find a number of specialties new to the Baltimore area. Some services will be moving from area
medical centers to the new South Baltimore County Medical Center. You will have the added convenience of 24/7
urgent care, laboratory, radiology, and pharmacy.
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New services to the Baltimore area
• Ambulatory Surgery Center/PACU
(post-anesthesia)
• Endoscopy Unit
• Observation and Clinical Decision Unit
• Pain Management
• Sleep Medicine
• Vascular Surgery
You’ll also have access to a number of
new providers offering these services:
• Adult Medicine
• Ob/Gyn
• Pediatrics
• Primary
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Specialty services
• Allergy
•Cardiology
•Dermatology
•Endocrinology
•Gastrointestinal
•General Surgery
•Head and Neck Surgery
•Infectious Disease
•Nephrology
•Neurology
•Orthopedics
•Podiatry
•Pulmonology
•Rheumatology
•Urgent Cart
•Urology
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We are saving lives at Kaiser Permanente
2011 HEDIS** Measures
**Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America's health plans to
measure performance on important dimensions of care and service. Because so many plans collect HEDIS data, and because the
measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an "apples-to-apples"
basis. 2011 HEDIS Year represents plan performance during the 2010 Calendar Year. All information can be found at
http://mhcc.dhmh.maryland.gov/healthplan/Pages/healthplanquality/default.aspx. Pages 18 - 52 and 56 - 86 of the report (pages 35 68 and 72 - 102 of the PDF ).
Breast Cancer Screening**
United Healthcare Mid-Atlantic
Optima Health Plan
OCI
M.D. IPA
Kaiser Permanente Mid-Atlantic
HealthKeepers, Inc.
Coventry—DE
CIGNA Mid-Atlantic
Carefirst BlueChoice
Aetna MD/DC/VA
50
55
60
Source:
2011
HEDIS
DataData
Source:
**2011
HEDIS,
information found on slide 10
65
70
75
80
85
Cervical
Cancer
Screening**
Cervical
Cancer
Screening
United Healthcare Mid-Atlantic
Optima Health Plan
OCI
M.D. IPA
Kaiser Permanente Mid-Atlantic
HealthKeepers, Inc.
Coventry—DE
CIGNA Mid-Atlantic
Carefirst BlueChoice
Aetna MD/DC/VA
70
72
74
76
Data
Source:
2011HEDIS,
HEDISinformation found on slide 10
Data
Source:
**2011
78
80
82
84
86
88
90
Childhood Immunization Status**—Combo 10^
United Healthcare Mid-Atlantic
Optima Health Plan
OCI
M.D. IPA
Kaiser Permanente Mid-Atlantic
HealthKeepers, Inc.
Coventry—DE
CIGNA Mid-Atlantic
Carefirst BlueChoice
Aetna MD/DC/VA
0
5
10
15
DataSource:
Source:
**2011
Data
2011
HEDISHEDIS, information found on slide 10.
*DTaP,
IPV,
MMR,
HiB,
HepHep
B, VZV,
A, RV,
^DTaP, IPV, MMR, HiB,
B, PCV,
V2V,Hep
PCV,
HepInfluenza
A, RV, Influenza.
20
25
30
35
Weight Assessment and Counseling for Nutrition and Physical Activity for
Children/Adolescents—BMI percentile (Total) **
United Healthcare Mid-Atlantic
Optima Health Plan
OCI
M.D. IPA
Kaiser Permanente Mid-Atlantic
HealthKeepers, Inc.
Coventry—DE
CIGNA Mid-Atlantic
Carefirst BlueChoice
Aetna MD/DC/VA
0
10
20
30
40
Data
2011
HEDISHEDIS, information found on slide 10
DataSource:
Source:
**2011
50
60
70
80
90
100
Comprehensive Diabetes Care-LDL-C Control
**
United Healthcare Mid-Atlantic
Optima Health Plan
OCI
M.D. IPA
Kaiser Permanente Mid-Atlantic
HealthKeepers, Inc.
Coventry—DE
CIGNA Mid-Atlantic
Carefirst BlueChoice
Aetna MD/DC/VA
20
25
Data Source: 2011 HEDIS
30
35
Data Source: **2011 HEDIS, information found on slide 10
40
45
50
55
60
65
Comprehensive Diabetes Care – Medical Attention for Nephropathy
**
United Healthcare Mid-Atlantic
Optima Health Plan
OCI
M.D. IPA
Kaiser Permanente Mid-Atlantic
HealthKeepers, Inc.
Coventry—DE
CIGNA Mid-Atlantic
Carefirst BlueChoice
Aetna MD/DC/VA
60
65
Data Source: 2011 HEDIS
70
75
Data Source: **2011 HEDIS, information found on slide 10
80
85
90
95
100
Adult BMI Assessment **
United Healthcare Mid-Atlantic
Optima Health Plan
OCI
M.D. IPA
Kaiser Permanente Mid-Atlantic
HealthKeepers, Inc.
Coventry—DE
CIGNA Mid-Atlantic
Carefirst BlueChoice
Aetna MD/DC/VA
Data Source: **2011 HEDIS, information found on slide 10
0
10
20
30
40
50
60
70
80
90
100
Number of HEDIS Measures where Plan Rates in the 75th Percentile
**
United Healthcare Mid-Atlantic Plan
Optima Health Plan
OCI
M.D. IPA
Kaiser Permanente Mid-Atlantic
HealthKeepers, Inc.
Coventry—DE
CIGNA – Mid-Atlantic
CareFirst BlueChoice
Aetna MD/DC/VA
0
10
20
Data
Source: **2011
2011 HEDIS
Data
Source:
HEDIS, information found on slide 10
30
40
50
60
Number of HEDIS Measures where Plans Rate in the 90th Percentile
**
United Healthcare Mid-Atlantic Plan
Optima Health Plan
OCI
M.D. IPA
Kaiser Permanente Mid-Atlantic
HealthKeepers, Inc.
Coventry—DE
CIGNA – Mid-Atlantic
CareFirst BlueChoice
Aetna MD/DC/VA
0
5
Data Source: 2011 HEDIS
10
Data Source: **2011 HEDIS, information found on slide 10
15
20
25
Quality & Service – NCQA Ranking
NCQA Health Insurance Plan Ranking
Rank – nationally among private (commercial) plans
1
33
50
100
KPMAS
73
CIGNA
81
Aetna
150
CareFirst
200
250
2009
2010
United
2011
NOTE: The “NCQA’s (National Committee for Quality Assurance) Health Insurance Plan Rankings” is based on combined scores for health
plans in Healthcare Effectiveness Data and Information Set®, commonly called HEDIS; the Consumer Assessment of Healthcare Providers
and Systems®, or CAHPS, and NCQA Accreditation standards scores. http://www.ncqa.org/tabid/1243/default.aspx
Best Performance on Measures Relating to Satisfaction with
Experience of Care
KPMAS is the highest rated plan in Maryland for Measures Relating to Member
Satisfaction with Care Received
UnitedHealthcare
OCI
MDIPA
Kaiser Permanente
Coventry
CIGNA
BlueChoice
Aetna
0
1
2
3
4
5
6
Number of measures with above average scores
Data source: 2011 Comprehensive Health Benefit Plan Performance Report . Page 89 or (105 of 158 in the
PDF)http://mhcc.dhmh.maryland.gov/healthplan/Pages/healthplanquality/default.aspx
7
8
Best Performance on Measures Relating to Preventive
Care
KPMAS is the highest rated plan in Maryland for Preventive Care
Measures
UnitedHealthcare
OCI
MDIPA
Kaiser Permanente
Coventry
CIGNA
BlueChoice
Aetna
0
5
10
15
20
Number of measures with above average scores
Data source: 2011 Comprehensive Health Benefit Plan Performance Report . Page 17or (33 of 158 in the PDF)
http://mhcc.dhmh.maryland.gov/healthplan/Pages/healthplanquality/default.aspx
25
Best Performance on Measures Relating to Treatment
and Management of Care
KPMAS is the highest rated plan in Maryland for Treatment and
Management of Care
UnitedHealthcare
OCI
MDIPA
Kaiser Permanente
Coventry
CIGNA
BlueChoice
Aetna
0
2
4
6
8
10
12
Number of measures with above average scores
Data source: 2011 Comprehensive Health Benefit Plan Performance Report . Page 55 or (71 of 158 in the
PDF)http://mhcc.dhmh.maryland.gov/healthplan/Pages/healthplanquality/default.aspx
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It really is better at Kaiser Permanente – Here’s
what our members had to say
CAHPS^^
^^The Consumer Assessment of Healthcare Providers and Systems (CAHPS) program is funded and administered by the Agency for
Healthcare Research and Quality (AHRQ), which works closely with a consortium of private and public organizations. These organizations are
responsible for conceiving, developing, testing, and refining the CAHPS survey products.
Public organizations that have supported and worked with the Consortium include the Centers for Medicare & Medicaid Services (CMS),
which provides additional funding to support the development of specific surveys, the Centers for Disease Control and Prevention, and the
National Institute for Disability and Rehabilitation Research.
http://mhcc.dhmh.maryland.gov/healthplan/Pages/healthplanquality/default.aspx. Data can be found on pages 87 - 103 of the report (pages
103- 119 of the PDF ) of 2011 Comprehensive Health Benefit Plan Performance Report
Overall Health Care ^^
60%
% Respondents Rating 9, 10 on a 0-10 Scale
55%
Kaiser Permanente is #1 in members rating their care as
the “best care possible”
50%
45%
40%
35%
30%
2008
2009
2010
2011
Kaiser Mid-Atlantic
Aetna (MD) HMO/POS
CareFirst BlueChoice
MD IPA.
Optimum HMO/POS
Aetna PPO (MD/DC)
United
Aetna PPO (VA)
CIGNA PPO (MD/DC)
Anthem BCBS
Data source: ^^CAHPS information located on slide 24
Member Ratings of their Overall Health Plan^^
70%
Kaiser
Permanente
is #1: Overall
Health Plan
% Respondents Rating 9, 10 on a 0-10 Scale
65%
60%
55%
50%
45%
40%
The competition
35%
30%
25%
2008
2009
2010
2011
Kaiser Mid-Atlantic
Aetna (MD) HMO/POS
CareFirst BlueChoice
MD IPA.
Optimum HMO/POS
Aetna PPO (MD/DC)
United
Aetna PPO (VA)
CIGNA PPO (MD/DC)
Anthem BCBS
Data source: ^^CAHPS information located on slide 24
Data source: CAHPS
The outside sources agree with Kaiser
Permanente members too..
Accolades for Kaiser Permanente
in the Mid-Atlantic States
38
J.D. Power and Associates: "Highest Member Satisfaction among Commercial
Health Plans in the Virginia-Maryland-D.C. Region, Four Years in a Row."*
*Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., received the highest numerical score among commercial
health plans in the Virginia-Maryland region in the proprietary J.D. Power and Associates 2012 U.S. Member Health
Insurance Plan Studies.SM 2011 study based on 32,868 total member responses, measuring 6 plans in the VirginiaMaryland-D.C. region (excludes Medicare and Medicaid). Proprietary study results are based on experiences and
perceptions of members surveyed December 2011–January 2012. Your experiences may vary. Visit jdpower.com
39
Kaiser Permanente is not responsible for the content or policies of external Internet sites.
Johns Hopkins University 2013
Benefit Changes
Faculty / Staff Changes
effective for 1/1/2013
41
Bargaining Unit Changes
Effective for 1/1/2013
42
Slide 43
Conclusion
Largest multi- specialty group practice in the Mid-Atlantic Region,
supported by state-of-the-art technology, Kaiser Permanente offers
our members:
#1 Clinical Quality Care in Mid-Atlantic Region
Highly Coordinated Care with sophisticated largest civilian Electronic
Medical Records System
#1 Member Satisfaction rated by J.D. Powers
Convenience, Convenience, Convenience, - most services located
within one of Kaiser’s 32 medical centers throughout MD, DC & VA
Slide 44
Q&A
We’re going to open the phone lines now!
There will be a slight pause, and then a recorded voice will provide
instructions on how to ask questions over this conference call line.
We’ll be answering questions in the order that we receive them.
We’ll also be answering the questions that were emailed to us
during the presentation.
If there’s a question that we can’t answer, we’ll do some research
after this session, and then email the answer to all participants.
Slide 45
Thank You!
Thank you for participating!
We would love to hear from you.
Are there certain topics that you would like us to cover in future
FastFacts sessions?
Would you like to be a FastFacts presenter?
Please email us at: [email protected]
Slide 46
Survey
Before we close, please take the time to complete a short survey.
Your feedback will help us as we plan future FastFacts sessions.
Click this link to access the survey…
http://connect.johnshopkins.edu/fastfactssurvey/
Thanks again!