What is KelseyCare? Options Quality Personalized Service Clinical Excellence Disease State Management Comprehensive Provider Network

KelseyCare more than 13 years of experience providing efficient, quality health benefit plans for local Houston companies. KelseyCare was first created at the request of the Pasadena Independent School District in 1994.

Currently, more than 13,000 employees in the Houston area enjoy quality health care through this option, while their employers experience lower costs. Clients include St. Luke's Episcopal Health System, AutoNation H-E-B and Stewart Title.

Now, through a strategic alliance with CIGNA HealthCare of Texas, fully insured companies have access to a similar option for quality health care: KelseyCare powered by CIGNA. This new HMO product expands access to affordable health care to more employers through the use of the select network of Kelsey-Seybold physicians, clinics and affiliated hospitals.

OPTIONS
At Kelsey-Seybold Clinic, we know that employer health care needs are as individual as the companies themselves, and we've designed our KelseyCare products with this in mind. Whether an employer is self-funded or fully insured, with 50 to 5,000 employees or more, we have a Kelsey-Care product that is the right solution for their employee health care needs.

KelseyCare Powered by CIGNA for Fully Insured Companies. Kelsey-Seybold Clinic and CIGNA HealthCare of Texas have recently joined forces to offer a new health benefit option to Houston employers. KelseyCare powered by CIGNA is a fully insured health maintenance organization (HMO) product that gives businesses the ability to offer their employees a quality, cost-effective benefit option.

Employers benefit from the efficiencies of Kelsey-Seybold's group practice model, early and aggressive intervention on disease and focus on evidence-based medicine.

The benefit plan design gives customers the ability to receive in-network care from more than 340 Kelsey-Seybold physicians at 18 clinic locations throughout the greater Houston area and several affiliated hospitals. The plan also features CIGNA HealthCare's health advocacy programs that engage employees in wellness efforts and help them manage chronic conditions.

KelseyCare powered by CIGNA. This health plan focuses on health improvement and the wellness of members, while helping to create cost-efficiencies and savings for employers. KelseyCare powered by CIGNA is available to Houston employers with 50 or more employees in their health plan.

KelseyCare for Self-Funded Companies. KelseyCare continues to be offered to self-funded companies with 500 or more employees. This proven network provides comprehensive medial care for Houston employers and their associates while mitigating employer risk.

In addition to KelseyCare's ability to share employer risk for medical expenses, KelseyCare administrative fees are 7 to 25 percent less than those of major payers. Lower administrative fees are the result of KelseyCare's structure-the number of overall claims transactions are reduced because Kelsey-Seybold Clinic accepts a fixed payment for a large number of services.

QUALITY
Click here for a pdf of Our Declaration of Quality.

KelseyCare is a product of Kelsey-Seybold Clinic, a nationally recognized medical group practice, which is the provider of choice for more than 400,000 unique patients in the greater Houston metropolitan area. Kelsey-Seybold Clinic offers the convenience of 18 Houston-area locations and the clinical expertise of more than 300 physicians practicing together.

Kelsey-Seybold Clinic has earned a three-year accreditation from the prestigious Accreditation Association of Ambulatory Health Care, Inc (AAAHC). Kelsey-Seybold Clinic is part of the St. Luke's Episcopal Health System, which is internationally recognized for innovation and clinical excellence.

The American College of Surgeons' Commission on Cancer (CoC) recently awarded Kelsey-Seybold Clinic a three-year approval with commendation for its achievements in cancer treatment, research and supportive care. Kelsey-Seybold Clinic is the first freestanding, non-hospital based, CoC-approved cancer program in the nation. This commendation also includes Kelsey-Seybold's Breast Diagnostic Center - one of the nation's leading models for fast-tracking diagnostics for women.

In addition to traditional primary and specialty physician services, Kelsey-Seybold Clinic offers a wide spectrum of treatment options and ancillary services at our clinics including on-site laboratory and X-ray, digital radiology (X-ray, mammogram, CT, ultrasound, MRI), chemotherapy and outpatient surgery.

MANAGEMENT OF TOTAL MEDICAL COST
In three consecutive annual benchmarking studies of all managed care plans in the greater Houston area, Hewitt Associates L.L.C. analysis determined that KelseyCare was significantly below the Houston HMO average in "overall total medical costs" and concluded that KelseyCare is the "most financially efficient" managed benefit plan in the Houston market.

Additional quality indicators include the following:

• KelseyCare is among the top three health plans statewide in "overall plan satisfaction" by the Consumer Assessment of Healthcare Providers and Systems (CAHPS).

• CIGNA claims data has shown that members receiving care from Kelsey-Seybold Clinic have demonstrated quality outcomes and lower costs.
  

PERSONALIZED SERVICE
Excellent customer service is no longer optional in today's competitive business culture. Customers demand personalized and professional assistance with routine requests, as well as when problems arise. At Kelsey-Seybold Clinic, we incorporate performance guarantees into our employer contracts to demonstrate our dedication to providing superior customer services to our clients and their associates. Some of our unique customer services are listed below.

Contact Center 24/7, Online Appointment Requests, and After-Hours Nurses. Kelsey-Seybold Clinic's Customer Service Contact Center operates 24 hours a day, 7 days a week, which means extra convenience for patients and family members. Patients can call the clinic any time of the day or night to schedule a future appointment. Patients can also submit appointment requests via e-mail. After hours, patients can speak to a Registered Nurse with any immediate concerns about symptoms or illnesses and obtain direction on the most appropriate setting to receive services.

KelseyCare Concierge Services. Like a concierge in a fine hotel, the KelseyCare Concierge service offers personalized assistance with just one phone call. Our Concierge service can provide personalized assistance in scheduling appointments and taking care of special needs and requests. The Concierge assists with scheduling appointments, answering billing and eligibility questions, and providing expert assistance with anything related to accessing care at Kelsey-Seybold Clinic.

Executive Health Assessments. Kelsey-Seybold's Executive Health Assessment Program offers its customers both preventive care and peace of mind. Each three-hour physical includes a one-hour consultation with a physician, along with same-day results on many medical tests. Each physical is conducted in the elegant Mavis & Mary Kelsey Specialty Suite at Kelsey-Seybold's Main Campus near the Texas Medical Center. The suite features all the conveniences of an office, as well as spa-like amenities, such as a catered breakfast.

DISEASE STATE MANAGEMENT
KelseyCare offers disease state management programs for high-risk obstetrics, renal care, diabetes management and cholesterol management. 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 with the purpose of making a significant difference in the health of an employee population.

KelseyCare partners with clients by analyzing demographic and claims data to manage health risks and intervene on unhealthy behaviors. Our program leads to development of health and wellness interventions, participation in appropriate disease management programs, and targeting of emerging "danger zones" with sound, medically based strategies and innovations. KelseyCare also utilizes our comprehensive health database to identify and contact KelseyCare patients who are overdue for standard preventive testing. This is one way KelseyCare emphasizes prevention and early detection.

Through its Web portal, KelseyCare offers patients the ability to complete an online Health Assessment. Once the patient completes the assessment, the results are used by the KelseyCare Health Services Department to assist patients in making health-wise decisions, as well as to identify patients needing additional clinical intervention or support. KelseyCare can also use the results to develop employer-specific health interventions and wellness programs.

Our care delivery model focuses on improving the health status of individuals enrolled in our KelseyCare plan. Kelsey-Seybold Clinic is unique in its ability to integrate patient care, medical management and value-added services, which positively impact health outcomes, practice efficiency and patient satisfaction.

COMPREHENSIVE PROVIDER NETWORK
KelseyCare members may choose their personal primary care physician from a list of Kelsey-Seybold doctors specializing in Family Medicine, Internal Medicine or Pediatrics. They can select a different doctor for each member of their family. Also, they can directly access any Kelsey-Seybold Clinic specialist, including any participating obstetrician/gynecologist, without a primary care physician referral. However, a referral by a Kelsey-Seybold Clinic physician is required for other participating specialists.

Most non-emergency hospital care will be provided at St. Luke's Episcopal Hospital, St. Luke's Episcopal Hospital - The Woodlands, Methodist Willowbrook, Methodist Sugar Land, Clear Lake Regional, Woman's Hospital of Texas (OB-GYN services only) and Texas Children's Hospital.

CIGNA HealthCare members have access to the CIGNA LIFESOURCE Transplant Network, a network of participating organ and tissue transplant centers. Developed by a team of CIGNA HealthCare clinical professionals, the transplant network includes respected hospitals and medical centers throughout the country.