Letter: From Our Chairman and Our Chief Executive Officer

From Turnaround to Transformation in Five Years

Highmark Health was formed in April 2013, when Highmark Inc. purchased the former West Penn Allegheny Health System. Shortly thereafter, our leadership team and employees committed to putting our customers at the center of everything we do and improving their overall health care experience. We committed to preserving choice and competition in the health care marketplace in western Pennsylvania. That commitment extends across the Commonwealth and our core markets of West Virginia and Delaware.

We set aggressive goals and strategies based on the critical needs of our customers and communities, took an honest assessment of what we needed to do to succeed, and we began building the future of health care.

In this report, we are pleased to share the highlights of our 2018 performance, which demonstrate that over the past five years, we have strengthened our financial and competitive position and built the stable foundation necessary to lead the health care revolution by designing, delivering and scaling the value-based experience.

Highmark Health delivered its second-best financial performance, on the heels of 2017's record performance, while Allegheny Health Network continued to improve its financial turnaround, delivering seven straight quarters of operating gains and successfully completing its first $1 billion bond offering. Our most recent Economic Impact report reinforces our commitment to contribute to the vitality and overall quality of life in the communities we serve. As the second-largest integrated delivery and financing system in the country, our growth strategy continues to positively boost the national economy, with direct and indirect spending reaching $18.7 billion. In addition, we support the direct and indirect employment of 112,000 individuals across our core markets, including dental, health insurance, and clinical offerings. In Pennsylvania, our investments in Allegheny Health Network and strategic partnerships have made a positive impact of $12.3 billion on the state's economy.

Better Health by Design

The decisions we've made over the past five years have been deliberate and strategic and always focused on our customers. We have invested more than $2 billion since 2013 to build new facilities and capabilities, or forge strategic partnerships, in the right places to assure patients have affordable access to in-network care regardless of where they live or work.

We also have invested in a number of transformational capabilities that will enable us to redesign our health delivery system to be more consumer-friendly, including True Performance, Doctor Match Quiz, VITAL Innovation, Same-Day Appointments, Enhanced Community Care Management (ECCM), and chronic care models. We know that consumers are responding to these new tools and capabilities; in 2018, Allegheny Health Network scheduled 207,239 same-day appointments, 19 percent of which were for new patients.

Our customers have been, and always will be, our moral and strategic compass. That is why we chose to feature their stories throughout this report. We believe they deserve a remarkable health experience, freeing them to be their best. In fact, that is our renewed mission as we enter the next phase of our transformation. Because it's time for better health by design.

Thank you for joining us on our journey.