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Houston’s Accountable Care Plan
KelseyCare. The only Houston-areahealth plan whose core network isbased on the nation’s first NCQAaccredited Accountable CareOrganization (ACO).KelseyCare consistentlydelivers higher quality at alower total medical cost.*kelseycare.com* Source:AON Hewitt, 2004, 2005, 2007, 2008, 2009, 2010 and 2011.For the most current information go to kelseycare.com 1
What Our Clients Say AboutKelseyCare“What sets KelseyCare apart is the fact that it is an efficient andunique delivery model. St. Luke’s plans are running better and areless expensive, when compared to other peer (hospital) industrygroups. St. Luke’s cost performance is less than the 50th percentilewhen compared to these groups. We’ve been able to achieve thatbecause of the KelseyCare plan.”Drew BrownAdministrative Director, Human ResourcesSt. Luke’s Episcopal Health System“MCFA has offered KelseyCare health insurance as an option since2010. The convenience of this plan is a big deal for our employees.And we know they’re getting quality healthcare from qualitydoctors. With the KelseyCare health plan, we’ve experienced highemployee satisfaction and lower costs. That’s a true win-win.”Jesse WelshHuman Resources ManagerMitsubishi Caterpillar Forklift America2 For the most current information go to kelseycare.com
KelseyCare Conveniences and QualityMake Our Members Smile When you choose KelseyCare, you select Kelsey-Seybold doctors to coordinate your healthcare. S ee the Kelsey-Seybold physician you want with no referral required – 370 Kelsey-Seybold physicians at 21 Houston-area locations. elsey physicians partner with 1,800 medical specialists and premier hospitals including St. Luke’s Episcopal Hospital –KTexas Medical Center, Sugar Land and The Woodlands; Texas Children’s Hospital; the Texas Heart Institute; Methodist– Sugar Land and Willowbrook; and Clear Lake Regional Medical Center. ancer care is delivered by Kelsey-Seybold’s nationally recognized Cancer Center in coordination with St. Luke’s CancerCCenter. MD Anderson Cancer Center is available as part of the affiliate referral network for complex cancer cases. Members have total access to all 21 locations and physicians – no referral is ever needed. Saturday visits for ill or injured patients at four locations from 9 a.m. to 2 p.m. 24-hour appointment scheduling and After-Hours Kelsey Nurse Hotline, with on-call physicians. Secure e-mail messaging with your physician. Onsite lab and X-ray at all locations – with all testing included in the co-pay. Outpatient Ambulatory Surgery Center and Endoscopy services. Personal Concierge exclusively for KelseyCare members.For the most current information go to kelseycare.com 3
The difference Between the KelseyCare Plan and LargePPO Plans Including Kelsey-Seybold PhysiciansKelseyCare’sIntegrated DeliveryModelvs.Kelsey-SeyboldPhysicians ListedIn Network3Proactive outreach and monitoring of KelseyCaremember’s preventive care. 3Advanced Clinical Initiatives (ACI): IntegratedDisease Management (DM) and Case Management(CM) delivered by KelseyCare DM/CM Nurses – whoare part of the KelseyCare medical team. 3Full integration of electronic medical records and“Best Practice” alerts to all Primary Care, Specialistand Hospitalist Physicians. 3KelseyCare Hospitalist physicians actively managehospital care and discharge planning at the bedside. 3KelseyCare members receive “triple benefit:”Patient-Centered Medical Home Integrated Disease/Case Management Integrated RxQI Initiative Integrated Hospitalist Program.3Active monitoring of Rx generics and Therapeuticopportunities through the KelseyCare “RxQI”initiative. .The KelseyCare Integrated Delivery Model provides quality, “evidence-based” medical care andconsistently 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
The AON Hewitt Health ValueInitiative 2011According to a leadingbenchmark study performedby the AON Hewitt HealthValue Initiative – a cost andperformance analysis databaseof more than 1,800 healthplans throughout the UnitedStates – KelseyCare’s healthbenefits plan has a track recordof being rated “the mostfinancially efficient”* in overallmedical costs compared to allbenefits plans in the greaterHouston market.Texas – Houston Market ProfileKelseyCare’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 Strategy: Plan Design and PricingKelseyCare Advanced Clinical Initiatives and Coordinated'Accountable Care' Delivery ModelThe Results:Lower total medical costs, higher quality outcomes andhighly satisfied enrolles.For the most current information go to kelseycare.com 5
Coordinated accountable care saveslives and shrinks healthcare costs.“Thank God, Sam came into my life.” Hilaria Medrano says thatKelseyCare Disease Management Nurse “Sam” Samaniego, R.N.,“made the difference in my life.” Today, Hilaria is successfullymanaging her diabetes with Sam’s continued intervention, herdoctor’s support, and “real time” feedback using the Kelsey-SeyboldElectronic Medical Record.The KelseyCare Accountable Care Model connects members with KelseyCare physicians and the KelseyCareIntegrated Delivery System – where we specialize in the prevention, early identification, and ongoing interventionof disease. We dramatically alter care outcomes because we are so focused and connected in our approach topatient care – best practices – and integrated disease and case management. Our health plan model is highlyeffective in the ongoing treatment of chronically ill and medically complex plan members – who drive the greatestcosts.We improve the delivery of healthcare through highly-effective clinical processes that are proven to deliver resultsin quality and cost savings. These clinical processes include a coordinated, accountable delivery system based onthe nation’s first NCQA-Accredited Accountable Care Organization --along with integrated disease management,case management, and onsite hospitalist physicians who meet our patients at the hospital bedside. No other healthplan offers this delivery system and these outcomes.6 For the most current information go to kelseycare.com
Recognized as the nation’s first accredited Accountable Care Organization bythe National Committee for Quality Assurance (NCQA)Kelsey-SeyboldClinic has beennamed the nation'sfirst AccreditedAccountable CareOrganization by theprestigious NationalCommittee for QualityAssurance (NCQA).RECOGNITIONRecognized for excellence in diabetes care, heart and stroke careand back care by the NCQAHighest Honors by the Accreditation Association forAmbulatory Health Care (AAAHC)The nation’s first freestanding Cancer Program approved with multiplecommendations by the American College of Surgeons’Commission on CancerCholesterol ManagementProgramNationally recognized by the American Society of Gastrointestinal Endoscopyfor Superior Quality and SafetyKelsey-SeyboldClinic.Known for Quality.NationallyRecognized forExcellence.Named a National Model of Excellence inCholesterol Management (American Medical Group Association)Recognized for Excellence in Breast Health (National Consortium ofBreast Centers, Inc.)For a complete list of awards and distinctions,visit kelsey-seybold.com.For the most current information go to kelseycare.com7
21 Convenient Locations Close to Home and WorkOpen access to all locations, Kelsey-Seybold Clinic specialistsand primary care physicians – with no referral required.Cinco Ranch23000 Highland Knolls Dr.Katy, Texas 77494713-442-4200oll Rd.dy THarClear Lake Clinic830 Gemini St.Houston, Texas 77058713-442-4500Clear LakeMedical Center17448 Highway 3Webster, Texas 77598713-442-4300Cypress Clinic13114 FM 1960 WestSuite 200Houston, Texas 77065713-442-4000Downtown at The Shops1200 McKinney St., Suite 473Houston, Texas 77010713-442-4700Main Campus2727 W. Holcombe Blvd.Houston, Texas 77025713-442-0000Meyerland Plaza Clinic560 Meyerland PlazaHouston, Texas 77025713-442-322214635saNaRd. 1Bt.SKingwood Clinic2755 W. Lake Houston Pkwy.Kingwood, Texas 77339713-442-2100MeyerlandyKaty Clinic21660 Kingsland Blvd.Katy, Texas 77450713-442-4100TollwaywaHumble Clinic8484 Will Clayton Pkwy.Humble, Texas 77338713-442-2000WestparkadroFort Bend Medical andDiagnostic Center11555 University Blvd.Sugar Land, Texas 77478713-442-9100Sleep CenterAmbulatory Surgery Center at this location/ FM 51 83Kelsey-Seybold Clinic – Sleep CenterPasadena Clinic3508 E. Pasadena Frwy.Pasadena, Texas 77503713-442-7100Shadow Creek Ranch10970 Shadow Creek Pkwy.Pearland, Texas 77584713-442-7200Silverlake Clinic9430 Broadway St., Suite 120Pearland, Texas 77584713-442-7400Sleep Center3900 Essex, Suite 500Houston, Texas 77027713-442-87008 For the most current information go to kelseycare.comSpring Medical andDiagnostic Center15665 Cypress WoodsMedical Drive, Suite 100Houston, Texas 77014713-442-1700St. Luke’sMedical Tower Clinic6624 Fannin St.Houston, Texas 77030713-442-0000The Vintage10701 Vintage Preserve Pkwy.Houston, Texas 77070713-442-1500The Woodlands ClinicMedical Arts Center II17350 St. Luke’s Way,Suites 175 and 200(Pharmacy, Suite 150)The Woodlands, Texas 77384713-442-1800The WoodlandsOB/GYN Clinic17198 St. Luke’s Way,Suite 540The Woodlands, Texas 77384713-442-1900West Clinic (Galleria-area)1111 Augusta DriveHouston, Texas 77057713-442-2400Woman’s Center7900 Fannin St., Suite 2100Houston, Texas 77054713-442-7300
kelseycare.com713-442-0067
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 . KelseyCare's health benefits plan is "the most financially efficient."* *Source: AON Hewitt Associates Health Value Initiative National Benchmarking Survey, 2004, 2005 .
