Houston’s Accountable Care Plan
KelseyCare. The only Houston-area health plan whose core network is based on the nation’s first NCQA-accredited Accountable Care Organization (ACO).
KelseyCare consistently delivers higher quality at a lower total medical cost.*
kelseycare.com
For the most current information go to kelseycare.com 1
* Source: AON Hewitt, 2004, 2005, 2007, 2008, 2009, 2010 and 2011.
What Our Clients Say About KelseyCare
2 For the most current information go to kelseycare.com
“What sets KelseyCare apart is the fact that it is an efficient and unique delivery model. St. Luke’s plans are running better and are less expensive, when compared to other peer (hospital) industry groups. St. Luke’s cost performance is less than the 50th percentile when compared to these groups. We’ve been able to achieve that because of the KelseyCare plan.”
Drew BrownAdministrative Director, Human Resources
St. Luke’s Episcopal Health System
“MCFA has offered KelseyCare health insurance as an option since 2010. The convenience of this plan is a big deal for our employees. And we know they’re getting quality healthcare from quality doctors. With the KelseyCare health plan, we’ve experienced high employee satisfaction and lower costs. That’s a true win-win.”
Jesse WelshHuman Resources Manager
Mitsubishi Caterpillar Forklift America
• WhenyouchooseKelseyCare,youselectKelsey-Seybolddoctorstocoordinateyourhealthcare.
• SeetheKelsey-Seyboldphysicianyouwantwithnoreferralrequired–370Kelsey-Seyboldphysiciansat 21Houston-arealocations.
• Kelseyphysicianspartnerwith1,800medicalspecialistsandpremierhospitalsincludingSt.Luke’sEpiscopalHospital–TexasMedicalCenter,SugarLandandTheWoodlands;TexasChildren’sHospital;theTexasHeartInstitute;Methodist–SugarLandandWillowbrook;andClearLakeRegionalMedicalCenter.
• CancercareisdeliveredbyKelsey-Seybold’snationallyrecognizedCancerCenterincoordinationwithSt.Luke’sCancerCenter.MDAndersonCancerCenterisavailableaspartoftheaffiliatereferralnetworkforcomplexcancercases.
• Membershavetotalaccesstoall21locationsandphysicians–noreferraliseverneeded.
• Saturdayvisitsforillorinjuredpatientsatfourlocationsfrom9a.m.to2p.m.
• 24-hourappointmentschedulingandAfter-HoursKelseyNurseHotline,withon-callphysicians.
• Securee-mailmessagingwithyourphysician.
• OnsitelabandX-rayatalllocations–withalltestingincludedintheco-pay.
• OutpatientAmbulatorySurgeryCenterandEndoscopyservices.
• PersonalConciergeexclusivelyforKelseyCaremembers.
KelseyCare Conveniences and Quality Make Our Members Smile
For the most current information go to kelseycare.com 3
The KelseyCare Integrated Delivery Model provides quality, “evidence-based” medical care and
consistently scores higher on enrollee satisfaction.*
It is the same model of care used by the prestigious Mayo Clinic and Cleveland Clinic.
*Source: Consumer Assessment of Healthcare Providers and Systems Survey, 2005, 2006, 2007 and 2010.
4 For the most current information go to kelseycare.com
Proactive outreach and monitoring of KelseyCare member’s preventive care.
Advanced Clinical Initiatives (ACI): Integrated Disease Management (DM) and Case Management (CM) delivered by KelseyCare DM/CM Nurses – who
are part of the KelseyCare medical team.
Full integration of electronic medical records and “Best Practice” alerts to all Primary Care, Specialist
and Hospitalist Physicians.
KelseyCare Hospitalist physicians actively manage hospital care and discharge planning at the bedside.
KelseyCare members receive “triple benefit:” Patient-Centered Medical Home
Active monitoring of Rx generics and Therapeutic opportunities through the KelseyCare “RxQI”
initiative.
KelseyCare’sIntegrated Delivery
Model
Kelsey-SeyboldPhysicians Listed
In Networkvs.
3
3
3
3
3
3
The difference BeTween The Kelseycare Plan and large PPO Plans including Kelsey-seyBOld Physicians
+ Integrated Disease/Case Management + Integrated RxQI Initiative + Integrated Hospitalist Program.
According to a leading
benchmark study performed
by the AON Hewitt Health
Value Initiative – a cost and
performance analysis database
of more than 1,800 health
plans throughout the United
States – KelseyCare’s health
benefits plan has a track record
of being rated “the most
financially efficient”* in overall
medical costs compared to all
benefits plans in the greater
Houston market.
KelseyCare’s health benefits plan is “the most financially efficient.”*
*Source: AON Hewitt Associates Health Value Initiative National Benchmarking Survey, 2004, 2005, 2007, 2008, 2009, 2010, and 2011.
The AON Hewitt Health Value Initiative 2011
For the most current information go to kelseycare.com 5
The Strategy: Plan Design and Pricing
KelseyCare Advanced Clinical Initiatives and Coordinated 'Accountable Care' Delivery Model
The Results:
Lower total medical costs, higher quality outcomes and highly satisfied enrolles.
+
Texas – Houston Market Profile
Coordinated accountable care saves lives and shrinks healthcare costs.
6 For the most current information go to kelseycare.com
TheKelseyCareAccountableCareModelconnectsmemberswithKelseyCarephysiciansandtheKelseyCareIntegratedDeliverySystem–wherewespecializeintheprevention,earlyidentification,andongoinginterventionofdisease.Wedramaticallyaltercareoutcomesbecausewearesofocusedandconnectedinourapproachtopatientcare–bestpractices–andintegrateddiseaseandcasemanagement.Ourhealthplanmodelishighlyeffectiveintheongoingtreatmentofchronicallyillandmedicallycomplexplanmembers–whodrivethegreatestcosts.
Weimprovethedeliveryofhealthcarethroughhighly-effectiveclinicalprocessesthatareproventodeliverresultsinqualityandcostsavings.Theseclinicalprocessesincludeacoordinated,accountabledeliverysystembasedonthenation’sfirstNCQA-AccreditedAccountableCareOrganization--alongwithintegrateddiseasemanagement,casemanagement,andonsitehospitalistphysicianswhomeetourpatientsatthehospitalbedside.Nootherhealthplan offers this delivery system and these outcomes.
“Thank God, Sam came into my life.” Hilaria Medrano says that KelseyCare Disease Management Nurse “Sam” Samaniego, R.N., “made the difference in my life.” Today, Hilaria is successfully managing her diabetes with Sam’s continued intervention, her doctor’s support, and “real time” feedback using the Kelsey-Seybold Electronic Medical Record.
For the most current information go to kelseycare.com 7
Recognizedasthenation’sfirstaccreditedAccountableCareOrganizationby theNationalCommitteeforQualityAssurance(NCQA)
Recognizedforexcellenceindiabetescare,heartandstrokecare andbackcarebytheNCQA
Highest Honors by the Accreditation Association for AmbulatoryHealthCare(AAAHC)
Thenation’sfirstfreestandingCancerProgramapprovedwithmultiplecommendations by the American College of Surgeons’
Commission on Cancer
NationallyrecognizedbytheAmericanSocietyofGastrointestinalEndoscopy forSuperiorQualityandSafety
NamedaNationalModelofExcellencein CholesterolManagement(AmericanMedicalGroupAssociation)
RecognizedforExcellenceinBreastHealth(NationalConsortiumof
BreastCenters,Inc.) For a complete list of awards and distinctions,
visit kelsey-seybold.com.
Cholesterol ManagementProgram
RECOGN I T ION
Kelsey-Seybold Clinic has been named the nation's first Accredited Accountable Care Organization by the prestigious National Committee for Quality Assurance (NCQA).
Kelsey-Seybold Clinic.Known for Quality. Nationally Recognized for Excellence.
Open access to all locations, Kelsey-Seybold Clinic specialists and primary care physicians – with no referral required.
Cinco Ranch23000HighlandKnollsDr.Katy,Texas77494713-442-4200
Clear Lake Clinic830GeminiSt.Houston,Texas77058713-442-4500
Clear Lake Medical Center17448Highway3Webster,Texas77598713-442-4300
Cypress Clinic13114FM1960West Suite200Houston,Texas77065713-442-4000
Downtown at The Shops1200McKinneySt.,Suite473Houston,Texas77010713-442-4700
Fort Bend Medical and Diagnostic Center11555UniversityBlvd.SugarLand,Texas77478713-442-9100
Humble Clinic8484WillClaytonPkwy.Humble,Texas77338713-442-2000
Katy Clinic21660KingslandBlvd.Katy,Texas77450713-442-4100
Kingwood Clinic2755W.LakeHoustonPkwy.Kingwood,Texas77339713-442-2100
Main Campus2727W.HolcombeBlvd.Houston,Texas77025713-442-0000
Meyerland Plaza Clinic560MeyerlandPlazaHouston,Texas77025713-442-3222
Pasadena Clinic3508E.PasadenaFrwy.Pasadena,Texas77503713-442-7100
Shadow Creek Ranch10970ShadowCreekPkwy.Pearland,Texas77584713-442-7200
Silverlake Clinic9430BroadwaySt.,Suite120Pearland,Texas77584713-442-7400
Sleep Center3900Essex,Suite500Houston,Texas77027713-442-8700
Spring Medical and Diagnostic Center15665CypressWoodsMedicalDrive,Suite100Houston,Texas77014713-442-1700
St. Luke’s Medical Tower Clinic6624FanninSt.Houston,Texas77030713-442-0000
The Vintage10701VintagePreservePkwy.Houston,Texas77070713-442-1500
The Woodlands ClinicMedicalArtsCenterII17350St.Luke’sWay,Suites175and200
(Pharmacy,Suite150)TheWoodlands,Texas77384713-442-1800
The Woodlands OB/GYN Clinic17198St.Luke’sWay, Suite540TheWoodlands,Texas77384713-442-1900
West Clinic (Galleria-area)1111 Augusta DriveHouston,Texas77057713-442-2400
Woman’s Center7900FanninSt.,Suite2100Houston,Texas77054713-442-7300
Hardy Toll R
d.
Broadway St. / FM 518
Westpark Tollway
146
35
Nasa Rd. 1
3
Ambulatory Surgery Center at this location
Kelsey-Seybold Clinic – Sleep Center
Sleep Center
Meyerland
21 Convenient Locations Close to Home and Work
8 For the most current information go to kelseycare.com
kelseycare.com713-442-0067