Individual & Family Plans Rebecca Palazzo & Chris Simonds- August 25, 2020 Agenda
• About Sharp Health Plan • Networks • COVID-19 strategies • CVS Pharmacy® • IFP team Sharp is an integrated Built on a foundation of common systems delivery system and organizational infrastructure
Sharp Health Plan · Not-for-profit serving 3.2 million residents of San Diego County · Largest health care system in San Diego with highest market share · 3 decades of capitation experience Sharp Rees-Stealy Sharp Community Medical Group · Fully licensed health plan serving Medical Group the San Diego MSA for 25 years · 145,000 total covered lives Hospitals · Nationally recognized for quality and service · Below market-medical cost trend and administrative costs Quality & Physician Customer Population IT Leadership Financial Data /Claims Clinical Leadership Experience Health Alignment Effectiveness Management
SharpSeptember Health 14,Plan 2020 | sharphealthplan.com Sharp Health Plan | Confidential – not for public distribution 3 Service leadership position in the market
Sharp Health Plan: Highest member-rated health plan in California
Highest member-rated in California among reporting California Health Plans
Health Plan | Health Care | Personal Doctor | Specialist
*Among reporting CA plans. Based on 2015, 2016, 2017, 2018 and 2019 NCQA Quality Compass CAHPS results. Quality Compass is a registered trademark of NCQA. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
SharpSeptember Health 14,Plan 2020 | sharphealthplan.com Sharp Health Plan | Confidential – not for public distribution 4 Customer leadership position in the market
Member Employer Broker Provider 90th 93% 97% 90th percentile member overall employer overall broker percentile provider satisfaction satisfaction satisfaction satisfaction
SharpSeptember Health 14,Plan 2020 | sharphealthplan.com Sharp Health Plan | Confidential – not for public distribution 5 Sharp HealthCare access Sharp Health Plan is Covered California’s only full access to Sharp HealthCare and Sharp Medical Groups
SharpSeptember Health 14,Plan 2020 | sharphealthplan.com Sharp Health Plan | Confidential – not for public distribution 6 Network Comparison Performance Premier Sharp Rees-Stealy Medical Group X X Medical Sharp Community Medical Group X X Groups Sharp Community Medical Group - Arch X Sharp Community Medical Group - Graybill X Sharp Community Medical Group - Graybill Temecula X Sharp Community Medical Group - Inland North X Rady Children’s Health Network / Children’s Physicians Medical Group X Palomar Medical Center X X Palomar Medical Center Poway X X Rady Children’s Hospital (2 locations) X X Sharp Chula Vista Medical Center X X Sharp Coronado Hospital and Healthcare Center X X Hospitals Sharp Grossmont Hospital X X Sharp Mary Birch Hospital for Women & Newborns X X Sharp Memorial Hospital X X Sharp Mesa Vista Hospital X X Temecula Valley Hospital X X Inland Valley Medical Center X Rancho Springs Medical Center X
September 14, 2020 SharpSharp Health Health Plan Plan | | 1 -Confidential858-499-8300 – not | forsharphealthplan.com public distribution 7 COVID-19 landscape and challenges
Regulatory guidance rapidly evolving
Employers challenged with securing financial assistance
Widespread layoffs and furloughs in group business
Employers/members unable to afford monthly premium
CHALLENGES Traditional access points unavailable to members
Provider bandwidth limited to focus on COVID 19 response
Providers facing financial pressures
Transition of staff to remote work
SharpSeptember Health 14,Plan 2020 | sharphealthplan.com Sharp Health Plan | Confidential – not for public distribution 8 COVID-19 strategic response
Keeping • Greater flexibility for groups/individuals unable to pay premiums members • Relaxing underwriting guidelines so employers can continue coverage for furloughed employees covered • Outreach and support for transitioning members losing group coverage to IFP plans
• Waiving member cost share for COVID-19 screening, testing and treatment • Encouraging expanded use of telehealth • Ensuring mental health support at home with tele-behavioral health Ensuring access • Promoting home delivery, relaxing early refill limits and extending prior authorizations for Rx to care • Conducting outreach calls to vulnerable members • Enhancing our ongoing communication with our medical groups to cross-functionally address concurrent operational and clinical opportunities and/or changes to better support our members and health care providers
Reducing provider • Ongoing support of providers through capitated model financial & • Ensuring prompt claims processing administrative burden • Reimbursing providers for telehealth at the same rate as in-person office visits • Waiving early refill limits and extending prior authorizations
SharpSeptember Health 14,Plan 2020 | sharphealthplan.com Sharp Health Plan | Confidential – not for public distribution 9 Get the care you need, when you need it
After-Hours Nurse Advice Registered nurses are available through Sharp Nurse Connection® after hours and on weekends. They can talk with you about an illness or injury, help you decide where to seek care and provide advice on any of your health concerns.
MinuteClinic® MinuteClinic is the walk-in medical clinic located inside select CVS Pharmacy® stores. MinuteClinic provides convenient access to basic care without an appointment.1
Video and phone visits Get the care you need from wherever you are with a video or phone visit, also known as telehealth. Call your PCP’s office for the latest telehealth service information.
1 Your share of the cost for a MinuteClinic visit is equal to what you pay for a PCP office visit (deductible may apply). There is no copayment for flu vaccinations..
SharpSeptember Health 14,Plan 2020 | sharphealthplan.com Sharp Health Plan | Confidential – not for public distribution 10 Introducing CVS HealthHUB
Easy-to-access Enhanced Dynamic care plans Private Access to expanded clinical care in-store care team and connectivity consultation areas health products – from expanded acute including care concierge by EPIC to providers, as for medication adherence, including durable medical services to chronic and amplified role of the well as connections with chronic condition support equipment – backed by condition management pharmacist – there to guide your community resources and overall health and the support and guidance members every step of the way wellness counseling of CVS care teams
11 ©2020 CVS Health and/or one of its affiliates. Confidential and proprietary. 51881 SharpSeptember Health 14,Plan 2020 | sharphealthplan.com Sharp Health Plan | Confidential – not for public distribution 11 Sharp’s IFP Team
Consider us your personal health care assistant®
[email protected] 1-858-499-8211
Rebecca Palazzo Kelly Johnson Trent Fields Trisha Maatubang Georgina Herrera Sr. Account Executive Account Executive Account Executive Sales Associate Sales Associate
September 14, 2020 SharpSharp Health Health Plan Plan | | 1 -Confidential858-499-8300 – not | forsharphealthplan.com public distribution 12 Thank You!