View Our Videos Dr. Patrick Carter, Kelsey-Seybold's Medical Director for Care Coordination, explains how Accountable Care Organizations manage all aspects of patient care. View the video. Hear what healthcare administrators and Houston employers are saying about KelseyCare. View the video. Listen to what health care executives across the country are saying about Accountable Care Organizations. View the Video.

By Spencer R. Berthelsen, M.D., F.A.C.P.
Patrick M. Carter, M.D.

Through organized systems of care, individuals are able to access affordable, quality health care. Organized systems of care include some of the most trusted names in health care, such as The Mayo Clinic, Kaiser Permanente, the Geisinger Clinic, Scott and White Clinic, Intermountain Healthcare, and locally, Kelsey-Seybold Clinic. They are able to deliver high quality care at a lower cost because they focus on care coordination, evidence-based care practices and effective use of information technology.

Recent studies strongly support the viewpoint that organized systems of care are a potential solution to the current health care crisis:

• The Centers for Medicare and Medicaid Services (CMS) announced results from the third-year Medicare Physician Group Practice (PGP) Demonstration on August 17, 2009, which revealed that all 10 participating multi-specialty physician groups saved Medicare $32.2 million while improving health care outcomes.

• A 2009 report in the New York Times illustrated the findings from a study conducted by international benefits consulting firm Hewitt Associates, which concluded that integrated systems such as Kaiser Permanente “provided 22 percent greater cost efficiency than competing systems.”

• A similar benchmarking study in Houston described Kelsey-Seybold's "KelseyCare" health benefits plan as the area’s most financially efficient plan. The plan demonstrated comparatively higher-quality measures along with lower overall costs, according to Hewitt Associates. Click here to read the full report.
  

• Other independent studies have consistently scored KelseyCare higher on quality clinical outcomes and patient satisfaction. On the 2009 CAHPS member survey, with 0 = “worst health plan possible” and 10 = “best health plan possible,” 49 percent of the members gave the KelseyCare plan a rating of 9 or 10.

Benefits of KelseyCare
KelseyCare is an organized care delivery system that provides high quality medical care for a lower total cost. KelseyCare is able to deliver care to the patient more efficiently for a variety of reasons.

• Evidence-based Medicine
  Kelsey-Seybold Clinic embraces a medical practice that follows an ethic of medical evidence. In layman's terms, if the treatment helps the patient, and if there is evidence or consensus that it helps the patient, then the physicians perform the treatment. If there is not evidence or agreement that the treatment will help the patient, then it is not performed. With evidence-based medical care, Kelsey-Seybold Clinic patients do not receive or pay for unnecessary tests, hospitalizations, surgeries or complications. This results in better health outcomes and lower out-of-pocket medical expenses for the patient.

• Coordination of Care
  Costs are further reduced by KelseyCare’s system of coordinated care and its use of a comprehensive electronic medical records. Electronic medical records provide a 360-degree view of the patient and include information from all of the doctors the patient has seen at Kelsey-Seybold Clinic. In addition, the Kelsey-Seybold team uses case management, utilization management, medical surveillance and a full range of care coordination to avoid duplicating efforts and make medical care more efficient. Within this system, the patient is more likely to see the right doctor for the right diagnosis and treatment, in the right setting at the right time. Correctly performing all of these steps from the beginning helps lower costs while maintaining high quality care.

• High Quality, Collaborative Care
  Kelsey-Seybold physicians have a 60-year tradition of delivering quality health care based on collaboration among specialists trained in many different medical fields. Patients of Kelsey-Seybold Clinic have access to a collection of skilled specialists under one roof, with all of the diagnostic, therapeutic outpatient tools needed to correctly diagnose a patient and determine the proper course of treatment. Because the Kelsey-Seybold team coordinates care and shares responsibility, the possibility of gaps occurring in care decreases. This model of care makes collaboration more common, because the interconnectivity of physicians working closely is fundamental to a group practice.

• Preventive Services
  According to the U. S. Department of Health and Human Services, chronic diseases are the leading causes of death and disability in the United States. Eighty-five percent of the money spent on health care goes toward people with at least one chronic condition. Some of these conditions include diabetes, heart disease and obesity – preventable conditions. Kelsey-Seybold Clinic focuses on preventive care through health assessment and disease management programs, and works with patients who are at-risk for chronic diseases to help improve their conditions and control their out-of-pocket health care costs.

• Disease Management and Case Management
  Disease Management and Case Management are integrated into the KelseyCare model. KelseyCare has a team of Case Managers who collaborate with Kelsey-Seybold physicians and nurses to incorporate education, prevention, patient care and research into our programs. Their purpose is to make a significant difference in the employee population’s health.

About the Authors
Spencer R. Berthelsen, M.D., F.A.C.P.

Spencer Berthelsen, M.D. began his practice 28 years ago with Kelsey-Seybold Clinic after completing his residency in Internal Medicine at the University of California at San Diego. He currently serves as the Chairman of the Board of Directors at Kelsey-Seybold Clinic. Kelsey-Seybold Clinic is a multi-specialty group practice comprised of more than 350 physicians in 19 locations throughout the greater Houston area.

Dr. Berthelsen has served in various leadership capacities within Kelsey-Seybold Clinic including Chairman of the Department of Internal Medicine, Medical Director for Primary Care, and Medical Director for Managed Care. His responsibilities include managing hospital and health plan relationships for the medical group, as well as public advocacy, and optimizing the performance of the Kelsey-Seybold practice.

Dr. Berthelsen continues to maintain a general Internal Medicine practice at Kelsey-Seybold Clinic – Fort Bend Medical and Diagnostic Center. He has also served two years as the chairman of the Texas Medical Association's Council on Legislation. During this time, effective Medical Liability Tort Reform was passed by the Texas Legislature and a constitutional amendment supporting reform was ratified by Texas voters. Dr. Berthelsen is a Clinical Professor of Medicine at Baylor College of Medicine and The University of Texas Health Science Center at Houston.

He is a graduate of Rice University with a Bachelor of Arts degree in Biology and received his medical degree from Southwestern Medical School in Dallas.

Patrick M. Carter, M.D.
Patrick Carter, M.D. has been practicing at Kelsey-Seybold Clinic since 1994 and currently serves as Medical Director for Care Coordination and Chief of Family Medicine. His specialties include Family Medicine and Geriatrics. Dr. Carter is board certified by the American Board of Family Medicine and he holds the Certificate of Added Qualifications in Geriatric Medicine, granted by the American Board of Family Medicine. He is also certified as a Physician Executive by the American College of Physician Executives.

Dr. Carter has been recognized with a prestigious national certification for excellence in caring for diabetic patients, awarded by the National Committee for Quality Assurance (NCQA). In 2009, Dr. Carter was named Harris County Family Physician of the Year by the Harris County Academy of Family Physicians and was appointed to the Board of Medical Legislation for the Harris County Medical Society (HCMS). In 2002 and 2003, Dr. Carter was the recipient of the Leonard D. Moise Teaching Award from the Family Medicine Residency Program at Baylor College of Medicine.

He received undergraduate degrees in Honors Biology and Chemistry from the University of Illinois at Urbana-Champaign and has a Master of Business Administration degree from Stanford University.