INTRODUCTION/OVERVIEW DATA SOURCES: DEMOGRAPHICS: Maryland Demographics: ANNUAL REPORT October 1, 2014 September 31, Overall Membership: 614,389

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1 Overall Membership: 614,389 INTRODUCTION/OVERVIEW Kaiser Permanente of the Mid-Atlantic States (KPMAS) serves some of the most diverse populations in the nation. We have medical centers located throughout the District of Columbia (DC), Northern Virginia (NOVA) and Maryland (MD). We believe that by understanding our members racial and ethnic backgrounds and their cultural and communication preferences, we can better customize our care delivery system and services by allocating appropriate resources to meet their specific needs. DATA SOURCES: To achieve better health outcomes and satisfaction for our members, we ask our members to self-identify their race, ethnicity, preferred written language and preferred spoken language. This information is collected during a member s visit to a medical center and is stored in the electronic medical record KP HealthConnect. The source for the data used in this annual report comes from KPMAS data warehouse which includes both KP HealthConnect and State 834 file. Populations described in this section of the report include Kaiser Permanente membership/patient population and populations in the surrounding communities/service areas (2010 U.S. Census data). DEMOGRAPHICS: Maryland Demographics: There are approximately 5.9 million residents residing in the state of Maryland. The racial composition of residents in Maryland is reported as 58.2% White, 29.4% Black or African and 8.2% Hispanic or Latino (2010 U.S. Census Data). The graph below summarizes the demographic profile by race for the State of Maryland.

2 Virginia Demographics: There are approximately 8.27 million residents residing in the state of Virginia. The racial composition of residents in Virginia is reported as 68.6% White, 19.4% Black or African and 7.9% Hispanic or Latino (2010 U.S. Census Data). The graph below summarizes the demographic profile by race for the State of Virginia. Washington D.C. Demographic: Washington D.C. (also referred to as the District of Columbia, Washington, the District, or DC) has approximately 601,723 residents. The racial composition of residents in the District is reported as 38.5% White, 50.7% Black or African and 9.1% Hispanic or Latino (2010 U.S. Census Data). The graph below summarizes the demographic profile by race for the District of Columbia.

3 KPMAS Member Demographic Profile: As of September 7, 2015 based on this self-reported data, the racial composition of KPMAS membership is 24.97% White, 32.16% Black or African, 9.08% Hispanic or Latino and 8.58% Asian (KP HealthConnect ). The table below summarizes the demographic profile by race for the overall KPMAS membership as well as by line of business. As we continue to improve our efforts to collect data on race, ethnicity and language of our members, there is 22.42% of overall KP Membership that have either not reported, declined to state, other category, or unknown/patient refusal for Race. KPMAS HIP RACE OVERALL KP HIP - RACE KP MD MEDICAID RACE MD MEDICAID Black/African 197, % Black/African % White 153, % Hispanic/Latino 55, % Asian 52, % White % Hispanic/Latino % Asian % Indian/Alaska % Indian/Alaska % Hawaiian/Other Pacific Islander % Hawaiian/Other Pacific Islander % TOTAL 461, % TOTAL 16, %

4 VA MEDICAID - RACE VA MEDICAID MEDICARE - RACE MEDICARE Black/African % Black/African 14, % White % Hispanic/Latino % Asian % White 23, % Hispanic/Latino % Asian % Indian/Alaska % Indian/Alaska % Hawaiian/Other Pacific Islander % Hawaiian/Other Pacific Islander % TOTAL % TOTAL 47, % COMMERCIAL - RACE COMMERCIAL Black/African 107, % White 87, % Hispanic/Latino 47, % Asian 36, % Indian/Alaska Hawaiian/Other Pacific Islander % % TOTAL 279, % (*Commercial Data includes Marketplace & Non-marketplace) (*% of total population is the data collection rate for Race based on that line of business.)

5 As of September 7, 2015 based on this self-reported data, the ethnic composition of KPMAS membership is 46.91% /United States, 2.87% Salvadoran, 1.73% Asian Indian, 1.15% Ethiopian, 0.99% Vietnamese, and 0.94% Chinese (KP HealthConnect ). The tables below summarizes the demographic profile by Ethnicity for the overall KPMAS membership as well as by line of business. As we continue to improve our efforts to collect data on race, ethnicity and language of our members, there is 45.41% of overall KP Membership that have either not reported, declined to state, other category, or unknown/patient refusal for Ethnicity. KPMAS HIP ETHNICITY OVERALL KP HIP - ETHNICITY /U nited States KP 288, % Salvadoran 17, % Asian Indian/India n (Asia) 10, % Ethiopian % Vietnamese % Chinese % TOTAL 335, % MD MEDICAID - ETHNICITY /U nited States MD MEDICAID 10, % Salvadoran % Asian Indian/India n (Asia) % Ethiopian % Vietnamese % Chinese % TOTAL 12, % VA MEDICAID - ETHNICITY /U nited States VA MEDICAID % Salvadoran % Asian Indian/India n (Asia) % Ethiopian % Vietnamese % Chinese % TOTAL % MEDICARE - ETHNICITY /U nited States MEDICARE 30, % Salvadoran % Asian Indian/India n (Asia) % Ethiopian % Vietnamese % Chinese % TOTAL 34, %

6 COMMERCIAL - ETHNICITY COMMERCIA L /U nited States 156, % Salvadoran 15, % Asian Indian/India n (Asia) % Ethiopian % Vietnamese % Chinese % TOTAL 193, % (*Commercial Data includes Marketplace & Non-marketplace) (*% of total population is the data collection rate for Race based on the line of business.)

7 As of September 7, 2015 based on this self-reported data, the linguistic composition of KPMAS membership is 69.85% English, 7.13% Spanish and less than 1% include Amharic, Vietnamese, French and Mandarin. The tables below summarizes the demographic profile by Language for the overall KPMAS membership as well as by line of business. As we continue to improve our efforts to collect data on race, ethnicity and language of our members, there is 20.45% of overall KP Membership that have either not reported, declined to state, other category, or unknown/patient refusal for Language. KPMAS HIP LANGUAGE PREFERENCE OVERALL KP HIP LANGUAGE SPOKEN KP English 429, % Spanish 43, % Amharic % Vietnamese % French % Mandarin % TOTAL 488, % MD MEDICAID - LANGUAGE SPOKEN MD MEDICAID English 14, % Spanish % French % Amharic % Vietnamese % Mandarin % TOTAL 16, % VA MEDICAID - LANGUAGE SPOKEN VA MEDICAID MEDICARE - LANGUAGE SPOKEN MEDICARE English % Spanish % Arabic % Amharic % Farsi % Urdu % TOTAL 4, % English 41, % Spanish % Korean % Vietnamese % Mandarin % Hindi % TOTAL 45, %

8 COMMERCIAL - LANGUAGE SPOKEN KP English 234, % Spanish 29, % Amharic % Vietnamese % French % Arabic % TOTAL 272, % (*Commercial Data includes Marketplace & Non-marketplace) (*% of total population is the data collection rate for Race based on the line of business.) LANGUAGE SERVICES

9 KPMAS provides language services to limited English proficient (LEP) members. Language services are provided to members to ensure that language is not a barrier to accessing and receiving quality health care. Language Services includes telephonic, Qualified Bilingual Staff (QBS) and onsite interpretation services (including ASL Sign Language). These services allow members to communicate more effectively with their health care provider, as well as with the Member Services Department. The Diversity and Inclusion Department monitors the language services utilization data. The graphs below summarizes the utilization of interpreter services for telephonic interpreter services through Language Select. The total number of calls for KPMAS is 181,708. The top five (5) most utilized telephonic interpreter languages for KPMAS region are: Spanish, Vietnamese, Korean, Mandarin, and Amharic. TELEPHONIC INTERPRETATION SERVICES, LANGUAGE SELECT Spanish Korean Vietnamese Mandarin Amharic Qualified Bilingual Staff Program The Qualified Bilingual Staff (QBS) program was established in 2005 to increase the region s capacity to deliver competent interpretation services to Limited English Proficient (LEP) members. KPMAS employees are identified, assessed, and trained to provide face-to-face interpretation, at their clinical site. As of September 7, 2015, a total of 4,941 QBS encounters were reported. The decrease in QBS encounter is due to a decrease of QBS participation and submission of forms towards the end of year.

10 QBS ENCOUNTERS Q4 Q1 Q2 Q3 The cumulative number of QBS since program is 249. This is an increase of 15 participants since the program s inception. 80% of QBS participants are Spanish speaking. LANGUAGES OF QBS STAFF French Cantonese Amharic Farsi Arabic Korean Mandarin Vietnamese Spanish

11 ASL INTERPRETATION SERVICES Sign Language (ASL) is provided to members through contracted ASL vendors. As of September 2015, there were a total of 4,816 encounters reported by the contracted ASL vendors Q4 Q1 Q2 Q3 In 2015 Video Remote Interpreting was introduced and implemented in majority of KP MAS medical centers as an additional resource for sign language interpretation in an urgent situation. As of September 2015, there were a total of 521 encounters reported by the contracted vendor. *VRI has not been approved for standard language service, but can be used for complex patients and in specific areas such as ASC. As of September 2015, there were a total of 70 language interpretation encounters through VRI.

12 CULTURAL AND LANGUAGE COMPLAINTS There were a total of 398 concerns that had a code related to REL and of those 7 were Service Complaints related to REL concerns. Summary of content from report (all were referred to SMEs/Dept and responded to timely): 1 - correspondence translation concern into Spanish 1- request/concern for access to BH African practitioners at NW DC location 1 - request/concern for Chinese / Mandarin speaking PCP 1 - concern/allegation of KPMAS discrimination that member could not pay bill due to new onset disability 1 - request /concern needs a Spanish interpreter for Dental care 1 - request/concern needs English letter in Vietnamese or at least read to her in Vietnamese 1- request/concern need English Summary of Accumulation (SOA) in Spanish All complaints are taken seriously and a thorough investigation is conducted. Follow up with both the member and health care teams are done after each incident to decrease the likelihood of repeating.

13 CULTURAL COMPETENCY TRAINING/AWARENESS FOR HP AND MAPMG In 2015, a total of 4,424 health plan employees and 818 MAPMG practitioners have completed the cultural competency training. Data was collected monthly at product level, developing and analyzing data of the regional practitioner self-reported race, ethnicity, language spoken and language written twice a year. Date # of health plan employees completed course Total # MAPMG practitioner completed course September The following items fall under Cultural Competency offerings to MAPMG physicians. Not all of the CME's were focused entirely on cultural competency, but had components of learnings targeted around caring for specific populations. 1. Diversity & Inclusion section in new physician orientation 2. Cultural Constructs of Healthcare - October HIV Update Sickle Cell Basics and Transition from Pediatric to Adult Care March Got Milk: Methods to Encourage Breastfeeding and Address Common Challenges 6. Speak My Language, Speak my Culture August Sickle Cell Live CME - September Flu Vaccine: Who, Why & How - September Quality Transgender Cultural Competency Training WORKFORCE DIVERSITY FOR MAPMG AND CONTRACTED PRACTITIONER NETWORK The racial composition of our practitioner network (Mid-Atlantic Permanente Medical Group and contracted network) is monitored to ensure a culturally and linguistically appropriate network is maintained and developed to meet members cultural, racial, and linguistic needs and preferences. The table below shows the racial composition of our practitioner network (MAPMG and contracted) based on the self-reported data from practitioners. The racial composition for the contracted practitioner network is 17.85% White, 5.36% Asian, 2.66% Black, and.64% Hispanic or Latino. As for MAPMG, the racial composition is 36.61% White, 31.89% Asian, 21.65% Black or African America, 3.07% Hispanic or Latino, and 1.97% Indian/Alaskan. Based on the Race analysis, KPMAS could recruit more Black/African and Hispanic Latino practitioners for its MAPMG and contracted practitioner network to mirror its member s demographic composition.

14 MAPMG and Contracted Practitioner Primary Care by Race RACE % OF MAPMG Practitioner % of Contracted Practitioner % of KP Membership Indian/Alaskan 1.97% 0.06% 0.21% Asian 31.89% 4.52% 8.58% Black or African- Hispanic or Latino Hawaiin/Other Pacific Islander 21.65% 2.75% 32.16% 3.07% 0.73% 9.08% 0.39% % White 36.61% 16.06% 24.97% *Not all providers self-reported their REL. ~50% for both MAPMG and Contracted physicians self-identified. *Source: Human Resources, MAPMG, PPQA, and KP Credential. The table below shows the language composition of KPMAS practitioner network (MAPMG and contracted) based on the self-reported data from practitioners. Based on the linguistic analysis, both the contracted and MAPMG practitioners have adequate bilingual practitioners to mirror its member s demographic composition. MAPMG and Contracted Practitioner Primary Care by Language LANGUAGE % of MAPMG Practitioner % of Contracted Practitioner % KP HIP Amharic 2.20% 0.79% 0.75% English % French 7.32% 4.33% 0.57% Spanish 20.94% 12.49% 7.13% Vietnamese 1.89% 0.73% 0.73% Mandarin 3.39% 0.57% 0.52% *Source: Human Resources, MAPMG, PPQA, and KP Credential.

15 WORKFORCE DIVERSITY for HEALTH PLAN STAFF KPMAS monitors the Race composition of our staff to ensure we maintain a culturally and linguistically appropriate network to meet our members cultural, racial and linguistic needs and preferences. Based on the Race analysis below in the table, KPMAS could recruit more Hispanic/Latino s to mirror its member s demographic composition. RACE % OF HEALTH PLAN STAFF % OF KP HIP Indian/Alaskan 0.37% 0.21% Asian 13.92% 8.58% Black or African- Hispanic or Latino Hawaiin/Other Pacific Islander 50.59% 32.16% 5.07% 9.08% 0.33% 0.12% White 29.68% 24.97% TOTAL *99.96% 75.12% *0.04% (~3) employees have not identified their Race. *Source: Human Resources, KPMAS, KP HealthConnect (Self-reported data) DEMOGRAPHIC COMPARISONS In addressing any racial discrepancies the following figures are used to identify, monitor and compare the demographics of the membership, health plan staff, practitioners (MAPMG and contracted network) and communities/service areas. These comparisons allow the region to identify gaps within the workforce to better to mirror the demographics of the membership and service areas and to better assess the needs of our members.

16 RACE COMPARISON BY KPMAS HIP, HEALTH PLAN STAFF, PRACTITIONER NETWORK (CONTRACTED AND MAPMG) AND SERVICE AREA DEMOGRAPHICS RACE Overall KP Workforce Community% HP EES% Practitioner% MAPMG Practitioners% CONTRACTED Total KP Membership% Analysis White 26.60% 29.68% 36.61% 16.06% 24.97% Black or African Indian and Alaska 34.28% 50.59% 21.65% 2.75% 32.16% Practitioner discrepancy 0.46% 0.37% 1.97% 0.06% 0.21% Asian 13.25% 13.92% 31.89% 4.52% 8.58% Hawaiian and Other Pacific Islander Hispanic or Latino (of any race) 0.25% 0.33% 0.39% % 3.70% 5.07% 3.07% 0.73% 9.08% HP and Practitioner discrepancy *The Race sample for Membership is the Total Populated Fields in KP HealthConnect and is NOT necessarily a representative sample of the true demographic characteristics of the Membership. For more detailed information on the data, including specific numbers, please see the December 2012 KPMAS demographics document which is available through the Diversity Programs Dept. *C% is the overall KP workforce community representation in the service area (MD, DC and VA) *M% is the membership *HP% is the health plan staff *P% is the contracted network and MAPMG practitioners The following are efforts by MAPMG/Contracted Physicians to recruit bilingual, bicultural and African candidates: 1. MAPMG Residency Dinner for local residency programs in Washington, DC 2. MAPMG Residency Dinner for local residency programs in Baltimore 3. MAPMG Residency Dinner for residency programs in Philadelphia 4. MAPMG Residency Dinner for residency programs in Pittsburgh 5. MAPMG Recruitment Reception in New York City for Hispanic, Bilingual and Primary Care Physicians 6. Attend National Hispanic Medical Association Meeting in Washington, DC 7. Sponsor Regional NHMA meeting/dinner 8. Attended CareerMD Events in Washington, DC, Baltimore, Philadelphia, New York, Richmond, Hershey, Columbus

17 The following recruitment efforts where attended by HP to address staff racial discrepancy in comparison to our Hispanic and African membership: 1. Latinos For Hire Job Fair - Diversity Career Fair 2. Advance Baltimore Job Fair - All Health care positions (Administrative and Clinical) 3. Hispanic / Latino Professionals Association Career Expo All Health care positions (Administrative and Clinical) 4. Competitive Edge Military Virtual Job Fair - Diversity and Veteran Career Fair 5. Radio One Diversity Career Fair - Diversity Career Fair In addition, HP works closely with our Employee Resource Groups to leverage help with recruitment, retention, social, and volunteer activities to improved satisfaction for our workforce, better health outcomes for our members/patients, extended benefit to our communities, and growth in our local markets: 1. KP AAPA (Kaiser Permanente African Professional) 2. KP APA (Asian/Pacific Islander) 3. KP LA (Kaiser Permanente Latino) 4. KP PRIDE (Lesbian, Gay, Bisexual, Transgender, Intersex) 5. KP WELL (Kaiser Permanente Women Embracing Life and Leadership) 6. KP Vet (Veterans) 7. GEN KP (Millennials/Generation X/Y)