CHPW 2020 Annual Report Pro

You Are Not Alone

2020 ANNUAL REPORT

COMMUNITY HEALTH PLAN of Washington TM The power of community

Dear friends,

Table of Contents

our state. We are in the second year of the Advancing Health Equity initiative, a partnership between CHPW, CHNW health centers, and the Health Care Authority, as part of a national learning collaborative. Staff also began participation in the Disparities Leadership Program, a national cohort led by Mass General Hospital and Harvard Medical School, designed to help health care leaders achieve equity in a time of health care transformation. Sometimes the amount of work ahead for achieving our vision of an equitable and just system seems daunting. But, when we look back on 2020 and the work that we have done with our community partners, we are energized by the strength, adaptability, and resilience that underlies our progress and look forward to a brighter future ahead.

to provide services and funding so that community needs were met. We were especially sensitive to the increasing needs for our behavioral health partners’ services and took early action to support their transition to telehealth services and their financial stability. The reality of racism as a threat to public health was laid bare by the glaring racial disparities in the numbers of cases, hospitalizations, and deaths from COVID-19. These disparities, along with the very visible displays of racial injustice by the criminal justice system brought clarity to our collective responsibility to address racial and social injustice. I have often said that advancing health equity is the very reason for our organization’s existence. The toll this past year has taken on our communities focuses our mission even more acutely. We strive to actively make a difference in addressing head- on the inequities that impact the health of our members and their communities. Working with partners across the State of Washington and beyond, we are seeking to make progress together. We continued our work with the Immigrant and Refugee Health Alliance, which was formed with our CHC and community partners to address these populations’ particular barriers in

As we look back on our work over the course of the year, it is impossible not to acknowledge the life-altering impact of the COVID-19 pandemic on our communities across Washington, the country, and, indeed, the world. As a health care organization that largely supports the direct provision of care, we were fortunate to quickly move to a remote work environment without missing a beat. While we all experienced the long months of community losses, stress, and anxiety, our organization proved to be highly resilient and more valuable than ever to our community stakeholders. Our staff served our members, providers, and communities with compassion and devotion to our mission, including their outreach to nearly 100,000 members to provide assistance for their increased needs created by the pandemic. Our network of Community Health Centers (CHCs) and other essential providers were nothing short of heroic in responding to communities disproportionately affected by COVID and its wake. We were honored to support their work in whatever ways we could – whether it was helping with food distribution, educating patients about testing sites, or supporting providers’ shift to telehealth services. Our aim was

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Our Vision Letter from the Chief Executive Officer Year in Review Responding to the Pandemic: CHPW Goes Above and Beyond Advancing Health Equity in the Community Advocating for Vulnerable Populations New Partnership Connects Members with Social Services Community Health Workers Bridge the Gap CHPW Enters ‘Public Option’Market, Expands Apple Health Reach Financials Executive Leadership and Board Members

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The vision of Community Health Plan of Washingtonn (CHPW) is to provide services and support that improve the health and well-being of our members, both directly and through our valued partnerships with community-based providers. We meet this challenge by identifying and addressing needs that impact the health of our members, both within the clinical setting and beyond. Our Vision

Leanne Berge, Esq. Chief Executive Officer

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2020 YEAR in REVIEW

September 8 CHPW is among 19 organizations from the U.S. and Canada selected to participate in the Disparities Leadership Program, a year-long executive leadership program designed to address racial and ethnic disparities in health care.

July 9 HCA announces that CHNW (partnering with CHPW) is among five carriers selected to offer Cascade Care “public option” health plans in 2021.

November 4 CHPW’s “You are the

center” video spot earns a 2020 MarCom Platinum Award for The Vida Agency. CHPW worked with Vida to create a marketing campaign to communicate our Apple Health brand.

August 5 CHPW and CHNW create website, waimmigranthealth.org, as a resource to support the health of immigrants and refugees in Washington state.

November 1 CHNW and CHPW

February 6 CEO Leanne Berge is Networking Reception keynote guest at 2020 Washington State of Reform Pre- Conference event.

May Responding to pandemic, CHPW partners with Teladoc to launch 24/7 virtual care service for all members.

July 21 CHPW launches partnership with tech company Unite Us to connect members with local social services.

begin enrollment for new CHNW Cascade Select “public option” health plans in nine Washington counties, for coverage starting in 2021.

March 5 CHPW employees begin working from home as COVID-19 pandemic spreads in Washington state.

June 9 CHPW advances $25 million to Community Health Centers and behavioral health providers to support their continuing operations during the COVID pandemic.

July 20 Connie Mom-Chhing, CHPW’s Director of Integrated Managed Care, is elected to Board of Directors of National Alliance on Mental Illness.

August 5 CHPW announces expansion of its Apple Health offering to five newWashington counties in 2021.

September 9 CHPW donates $230,000 to 23 community-based organizations that serve communities of color and others disproportionally affected by COVID.

November 1 CHPW expands its Apple Health vision benefit to include fully covered eyeglasses for adults.

December 15 CHPW hosts free “Ask the Experts: Winter Mental Health” virtual event to share mental health advice and resources with the Washington public.

$25M

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Access to care CHPW took amyriad of additional steps to ensure the availability of access tomedical and behavioral care across the state. They included: • Creating flexible telehealth billing policies for providers early in the pandemic • Convening regional forums with behavioral health providers to share resources and collaborate around patients’ needs • Helping members with expanded prescription delivery options for many of the medicines they needed most • Expanding meal delivery services for members in need and in quarantine due to COVID-19 • Easing or lifting providers’ credentialing and preauthorization notification requirements and expediting the credentialing of temporary providers

$25 million advanced to Community Health Centers and behavioral health providers

For many behavioral health providers, the advanced funds enabled them to stay afloat financially so they could continue to serve members dealing with mental and emotional stressors like COVID, anxiety, isolation, and job loss, as well as support continuity in medications and other therapies. “As part of our work to deliver whole-person care, we are committed to ensuring that communities across the state receive the behavioral health support that they need,” said Dr. Paul Sherman, CHPW’s Chief Medical Officer. “By rapidly advancing funding early in the pandemic, we helped BH providers remain open – a tangible demonstration of the power of community.”

Responding to the Pandemic: CHPW Goes Above and Beyond

Through stalwart innovation, plain hard work, and selfless dedication, we responded with a resounding “Yes!” We proved time and again to our community partners, our care providers, and our plan members: You are not alone. CHPW advanced $25 million in additional payments to Community Health Centers and behavioral health providers to help cover anticipated lost revenue during the evolving pandemic.

The COVID-19 pandemic ushered in a cascade of health care challenges that tested the mettle of our organization. Could we continue to efficiently deliver accessible care to our members during an emerging health crisis, the likes of which we had never seen in our lifetimes? Could we find new ways to support our providers, many of whom were struggling financially due to temporary closures and lost patient revenue?

“By rapidly advancing funding early in the pandemic, we helped BH providers remain open– a tangible demonstration of the power of community.”

–Paul Sherman, Chief Medical Officer, CHPW

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CHPW also partnered with several Community Health Centers to inform residents in their communities about COVID testing and availability of care services. We sent text messages in multiple languages to Apple Health members with reminders of CHPW’s 24/7 Nurse Advice Line, their mental health benefits, cellphone benefit, and social service resources. To further improve member access to care, we quickly launched a 24/7 telehealth service that kept members connected to providers day or night. The new service gave members the option to confer with a doctor by phone or video – without having to leave

the safety of their home. We also supported our Community Health Centers in ramping up their telehealth services, keeping members connected to their trusted local clinics. Checking in on members On the home front, CHPW employees began a prolonged period of working remotely due to COVID health restrictions. As we asked each other, “Are you OK?” we also began checking on our members. Employees in departments across the organization— Customer Service, Sales & Marketing, Health Services — called nearly 100,000 Medicare and Medicaid members to

check on their well-being. That was virtually every CHPW member for whom we had a phone number. We assured them that they were not alone and offered whatever help we could provide. Many members expressed profound gratitude for the call. Some said our reassuring voice was one of the few—and sometimes only—outside contacts they had received up to that point in the pandemic. One customer service representative summed up the reaction from one appreciative member this way: “She was so grateful that we were worried about HER and her family and how she never felt like just a number with CHPW.”

–Customer Service Representative, CHPW “She was so grateful that we were worried about HER and her family and how she never felt like just a number with CHPW.”

Staying healthy during a difficult time As 2020 drew to a close and with COVID infections still raging, CHPW hosted a virtual panel to share mental health advice and resources with Washingtonians on coping with the pandemic. CHPW Senior Behavioral Dr. Sherman and Dr. Terry Lee, CHPW Senior Behavioral Health Director, joined Blake Edwards, Behavioral Health Director at Columbia Valley Community Health, in the online panel discussion and listener Q&A.

“Managing our emotional well-being is an important part of being healthy overall,” said Sherman. “By giving people everywhere the opportunity to ask experts their most pressing questions, we hoped we could help them receive the advice they need to support their health during these uncertain and hard times.”

To further improve member access to care, we quickly launched a 24/7 telehealth service.

“Managing our emotional well-being is an important part of being healthy overall.” –Paul Sherman, Chief Medical Officer, CHPW

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“More and more, it has become evident that when it comes to the pandemic and health care broadly, we are all in the same storm but we are not in the same boat.” –CEO Leanne Berge

“More and more, it has become evident that when it comes to the pandemic and health care broadly, we are all in the same storm but we are not in the same boat,” CEO Leanne Berge said at a virtual check presentation event in September. “That’s why we are deepening our partnerships with organizations across the state that are extraordinarily committed to increasing access to robust, community-based health care and social supports for people of color.”

Advancing Health Equity in the Community

Racial and ethnic minorities are more likely than whites to contract/die from the COVID–19 virus.

meeting inAugust that the pandemic was“a great revealer.”

One of CHPW’s tenets is that every person deserves access to affordable health care, regardless of their background or circumstances. Advocating and caring for individuals and communities negatively impacted by racial and social injustice is core to our foundingmission as a local, not-for-profit managed care plan. The COVID-19 pandemic laid bare the stark realities of health inequities. Statistics showed that racial and ethnic minorities were much more likely than whites to contract – and die – from the virus. Dr. Benjamin Danielson, a respected pediatrician, and former Medical Director of the Odessa Brown Children’s Clinic in Seattle, told a CHPW all-staff

“This is a virus that reveals our underlying racism and the disproportionate way it affects different populations across all health markers in this state and across this country,” he said. ‘Not in the same boat’ In part to address these disparities, CHPW donated $230,000 to 23 local organizations that directly serve communities of color and others that have systematically faced greater socioeconomic obstacles to health. These community- based partners help address social determinants of health – conditions where people live, work, learn, and play that affect their overall health and well-being.

Nuestra Casa, a Sunnyside-based organization that works to help immigrant women make positive changes both for their families and the community, was among the donation recipients. “This funding provided by Community Health Plan of Washington allows Nuestra Casa to offer our team, which has been working non-stop since the beginning of this pandemic, with additional support to care for their own health and their own family needs,”Nuestra Casa Executive Director Caty Padilla told KIMA-TV.

The following organizations each received a $10,000 check:

$230,000 to 23 local organizations that directly serve communities of color

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Advocating for Vulnerable Populations

Support and advocacy for immigrants and refugees CHPW and its parent organization, Community Health Network ofWashington (CHNW), along with CHC partners, community service organizations, and theWashington Association for Community Health, formed the Immigrant and Refugee Health Alliance, a coalition to support access to health care for immigrants, refugees, and their families in Washington State. The initiative included creation of awebsite, waimmigranthealth.org , as a trusted resource for trainingmaterials and information on policies affecting immigrants and refugees.

Transforming Medicaid CHPW, CHNW, and theWashington State Health Care Authority (HCA) continued their collaboration for a second year on developing the next generation of Medicaidmodels to reduce health disparities. The team is focusing on advancing equity in three key areas: pregnancy care, member experience and access to care, and care for chronic disease with a focus on depression and behavioral health. The work of the CHPW/CHNW/HCA team is part of the Advancing Health Equity Learning Collaborative, an initiative funded by the Robert Wood Johnson Foundation. Ours is just one of seven such teams across the country.

Multicultural Health Care Distinction CHPW was again recognized with the honor of Multicultural Health Care distinction from the National Committee on Quality Assurance (NCQA). CHPW was awarded the distinction in recognition of our excellence in providing culturally and linguistically appropriate services.

CHPW was founded nearly 30 years ago specifically to provide more equitable access to comprehensive, high-quality health care for historically underserved and under-resourced communities. Our efforts to advance health equity in 2020 extended well beyond monetary donations to community organizations. They also included:

Project Girl Mentoring Program (Everett) Mother Africa (Kent) Latino Education Training Institute (Lynnwood) SeaMar CHC–La Posada East &West (Pasco) Asian Counseling & Referral Service Community Passageways El Centro de la Raza Entre Hermanos Horn of Africa Services Na’ah Illahee Fund for the Cedar Rising Coalition Seattle Indian Health Board You Grow Girl! (Seattle) NATIVE Project (Spokane)

The Healing Lodge (Spokane Valley) Consejo Counseling Services Lutheran Community Services NW MetropolitanDevelopment Council (Tacoma) Somali Health Board (Tukwila) Clark County Latino Youth Conference SWWA LULACCouncil 47013 (Vancouver)

Project Girl Mentoring Program

Nuestra Casa

La Casa Hogar (Yakima) Nuestra Casa (Sunnyside) The Support Center (Okanogan)

Our efforts to advance health equity extended well beyond monetary donations to community organizations.

Risho Sapano, Founder and Executive Director, Mother Africa

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CHPW’s community-based approach “pairs perfectly with our mission of improving the health of communities by connecting local social and health services.” –Taylor Justice, Cofounder and President at Unite Us

our member,”CHPW Community HealthWorker Lahura Jenkins related. “As I continued to learn more about Unite Us, I would update his referral requests to open options for assistance. Eventually, I started seeing referrals getting accepted.” Through the Unite Us platform, as well as extensive collaboration with the member’s Community Health Center staff and two dedicated community organizations, the member eventually received a new mattress, box spring, and mattress pad. It was the type of favorable outcome the new partnership was designed to deliver. “The Unite Us partnership allows CHPW to comprehensively address all the needs of our members with a holistic approach,”said Jennifer Polello, CHPW’s Senior Director of Quality and Population Health. “Thanks to this partnership, we can connect our members to the services they need in a timely manner, ultimately improving their overall health and well-being.” Taylor Justice, cofounder and president at Unite Us, said CHPW’s community- based approach“pairs perfectly with our mission of improving the health of communities by connecting local social and health services.”

Community Health Workers Help Bridge the Gap

Social determinants of health (SDoH) are conditions in the environments in which people were born, live, learn, work, play, and age that affect a wide range of health outcomes and risks. One of the ways CHPW addresses SDoH is by helping to coordinate members’ care and link them to community- based resources and support services. Our regionally based Community Health Workers (CHWs) play a pivotal role in that effort. They typically live in the regions they serve and have a deep understanding of their communities. “Our CHWs advocate for member needs and serve as a liaison/ connection between health and social service systems,” said Tashau Asefaw, Manager of Community Programs for CHPW. In 2020, we expanded the reach of our Community Health Worker presence by increasing the number of CHWs in Spokane, Benton, and Franklin counties. In addition to the staffing increase, we leveraged our CHWs to go out into neighborhoods to locate hard-to reach members that our case managers were unable to reach by phone. We recognized that at-risk members face many obstacles in accessing care and meeting their basic needs, such as lack of transportation and access to affordable housing. The goal was to improve health outcomes by providing the members with information about CHPW’s programs, reconnecting them to needed care and case management services, and eliminating barriers to care access.

New Partnership Connects Members with Social Services

disorder, and depression. The member was living in temporary housing and had sustained a gunshot wound to one of his legs. He wore a brace and relied on a cane to walk. He spoke little English. He could not afford basic household needs. He did not have a bed or couch and had been sleeping on the floor. He explained that due to all his medical conditions, he was afraid of getting sick from used furniture.

Our members know their health needs better than anyone. Our role is to be their partner in health by listening andmaking sure they get the care and services they need, whenever they need them. To that end, we forged a partnership with technology company Unite Us to connect members with social services in their communities. By building a public health infrastructure to meet people’s basic needs, Unite Us helps CHPW support care collaboration and coordination, and better enables us to track member outcomes from the clinic to the community.

We launched the Unite Us partnership in King, Pierce, and Snohomish counties and by year’s end expanded it to Spokane and Yakima counties. Under the partnership, CHPW’s social services and care management staff can follow members’ care from health providers to community agencies to ensure it is being delivered seamlessly and that there are no gaps between health and social needs. One of the first referrals to the new Unite Us platformwas a 34-year-old King County member with hypertension, anxiety

Enter the Unite Us partnership.

“Initially, community organizations responded that they did not have the capacity to work with

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Whatcom

Pend Oreille

San Juan

Ferry

Okanogan

Skagit

Stevens

Island

Snohomish

Clallam

Chelan

The newly awarded regions bring CHPW’s total Apple Health service area to 29 counties across the state.

Douglas

Spokane

King

Kitsap

Lincoln

Grays Harbor

Mason

Kittitas

Grant

Adams

Pierce

Whitman

Thurston

Lewis

Franklin

Yakima

Columbia

Cowlitz

Walla Walla

Asotin

Benton

Wahkiakum

Skamania

Klickitat

Clark

required to meet affordability standards and cap the amount health insurance carriers can pay providers for services. CHNW-CHPW’s Cascade Select plans are centered around care provided by Community Health Center clinics. They are tailored to individuals and families who do not currently qualify for Medicaid or Medicare and do not receive health insurance through an employer. A welcome return CHPW also received approval in 2020 from the Health Care Authority (HCA) to offer our Apple Health (Medicaid) plans in five Washington counties where we formerly had a presence (Pierce, Chelan, Douglas, Grant, and Okanogan), beginning in 2021.

HCA had issued a request for proposals (RFP) to allow managed care plans to expand to areas of the state in which they are not currently active if they had demonstrated successful performance in other regions. The goal was to ensure access to care, particularly for behavioral health services, for Apple Health enrollees during the COVID-19 pandemic and beyond. Joe Contris, who was tapped as CHPW’s new Regional Manager for the Pierce region, said CHPW will work with area health providers, community-based organizations, and other entities to advance whole-person care and equity for CHPWmembers. “CHPW is doing vital work to support residents’ health and well-being and has consistently

served as a committed partner dedicated to ensuring that all communities have access to quality health care,”Contris said. The newly awarded regions bring CHPW’s total Apple Health service area to 29 counties across the state. “We are grateful for this opportunity to deliver CHPW’s brand of whole-person care to people in these additional counties, in which we have significant and historic ties,” said CEO Leanne Berge. “At CHPW, we believe in the power of community and value our deep relationships with community partners across the State to support and provide services for all aspects of a person’s health and well-being.”

CHPW Enters ‘Public Option’ Market, Expands Apple Health Reach

affordable health care, and Cascade Care offers that,” Gov. Jay Inslee said in a press release at the time. “I am pleased that health insurance companies, hospitals and medical providers have stepped up to offer this innovative coverage option, despite the COVID-19 pandemic. We are building a solid foundation during this first year of the program and anticipate that Cascade Care will offer even more for consumers over time.” Cascade Care public option plans offer standard benefits and cost-sharing at each of three metal levels – gold, silver, and bronze. The plans are

2020 saw the arrival of Cascade Care, a new health coverage option inWashington State, and CHPWwas an integral part of its launch. The goal of Cascade Care is to increase the availability of quality, affordable health coverage in the individual market, targetingWashington residents who fall between Medicaid eligibility and higher- cost commercial coverage. CHPW was the only health plan to actively support a public option when such legislation was discussed by Washington State lawmakers in 2019.

Community Health Network of Washington, the parent organization of CHPW and partner in this venture, was among five carriers selected to provide first-in-the-nation “public option” plans as part of Cascade Care. The CHNW-CHPW offering, called CHNW Cascade Select and made available through the Washington Health Benefit Exchange, began enrolling members in nine counties in November, for coverage starting Jan. 1, 2021.

“Nowmore than ever, people need access to high quality, affordable health care, and Cascade Care offers that.” –Governor Jay Inslee

“Now more than ever, people need access to high quality,

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Financial Strength As of December 31, 2020

Executive Leadership

Leanne Berge, Esq. Chief Executive Officer Alan Lederman Chief Operating Officer

Stacy Kessel Chief Finance and Strategy Officer Abie Castillo Chief External Relations Officer

Paul Sherman, MD Chief Medical Officer Barbara Westlake Senior Executive Assistant & Board Administrator

Assets

Liabilities/Surplus

Cash & Investments Other Assets

Operating Liabilities Debt Surplus

$526.3M $76.2M

$352.4M $0.0 $250.1M

Total Assets

$602.5M

Total Liabilities/Surplus

$602.5M

Board Members

Composition of Expenses As of December 31, 2020

Sheila Berschauer Board Chair Chief Executive Officer Moses Lake Community Health Center Carla DewBerry Board Vice Chair Independent Director Aaron Wilson Board Treasurer Chief Executive Officer CHAS Health

Angela Gonzalez Chief Executive Officer Community Health of Central Washington Brandy Taylor Interim Executive Director Country Doctor Community Health Centers Jim Coffee Chief Executive Officer Cowlitz Family Health Center

Regina Bonnevie Rogers, MD Medical Director Peninsula Community Health Services Jennifer Kreidler-Moss, PharmD Chief Executive Officer Peninsula Community Health Services Jeffrey Gibbs, MD QI Medical Director Sea Mar Community Health Centers Jim Davis Chief Executive Officer Tri-Cities Community Health Jodi Joyce Chief Executive Officer Unity Care NW Gaelon Spradley Chief Executive Officer Valley View Health Center Rhonda Hauff President/Chief Executive Officer Yakima Neighborhood Health Services Carlos Olivares Chief Executive Officer Yakima Valley FarmWorkers Clinic

2%

Premium & Other Taxes $15M

10%

88%

Administrative Expenses $89M

Claims Expenses $787M

Jesús Hernández Chief Executive Officer Family Health Centers Lisa Yohalem Chief Executive Officer HealthPoint

David Olson Board Secretary Chief Executive Officer Columbia Valley Community Health William Dowling Independent Director Stephen Tarnoff, MD Independent Director David Flentge President/Chief Executive Officer Community Health Care Joe Vessey Chief Executive Officer Community Health Center of Snohomish County

Teresita Batayola Chief Executive Officer International Community Health Services Meredith Vaughan Interim Chief Executive Officer Neighborcare Health

Member Enrollment As of December 31, 2020

Medicare Advantage

Apple Health

Special Needs Plan

6,000 4,500 3,000 1,500 0

12,000 9,000 6,000 3,000 0

400,000 300,000 200,000 100,000 0

6,071

Desiree Sweeney Chief Executive Officer N.E. Washington Health Programs

4,929

251,790

7,336

239,607

5,516

2019

2020

2019

2020

2019

2020

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COMMUNITY HEALTH PLAN of Washington TM

1111 3rd Ave, Suite 400 • Seattle, WA 98101-3207 chpw.org

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