Rachelle KhalafDirector, Public Relations and Communications
KelseyCare Advantage is one of 3 Medicare Advantage plans nationally to have achieved a 5-out-of-5 star rating five years in a row
Houston (October 15, 2020) – On Friday, October 9, the Centers for Medicare and Medicaid Services (CMS) announced that KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area Medicare beneficiaries, earned 5-out-of-5 stars in an annual assessment of all Medicare Advantage plans for the fifth year in a row. This 5-out-of-5 star rating applies to the 2021 plan year which begins on Jan. 1.
Achieving a 5-star rating in any given year is difficult, but to achieve this rating five years in a row adds a level of distinction, and places KelseyCare Advantage in an elite class of healthcare organizations. Only three other plans in the nation have ever achieved a 5-star rating, five years in a row.
KelseyCare Advantage is one of two 5-out-of-5 star rated Medicare Advantage plans in the Houston area for the 2021 plan year, and the only plan in the area rated 5-out-of-5 for both Part C and Part D. There are only 10 plans in the nation that have achieved a 5-star rating for both Part C and Part D, and 21 plans who have achieved a 5-star rating overall.
"A 5-star rating is the highest possible rating a plan can achieve and to attain this level of quality rating five years in a row is recognition by CMS of our dedication to excellence in both quality and service. Our KelseyCare Advantage members receive clinical care from Kelsey-Seybold Clinic, where all clinicians and team members are committed to the Triple Aim – quality, service, and value – and use evidence-based care as their guide," said Marnie Matheny, President of KelseyCare Advantage. "What we do for our members is very special and since 2008, KelseyCare Advantage has maintained our unwavering dedication to provide clinical and service excellence to the members who place their trust in us. We are very proud of our 5-Star rating and we plan to continue to develop clinical programs and services in partnership with Kelsey-Seybold Clinic that help improve member outcomes and enhance the customer experience."
Each year, Medicare uses information from member satisfaction surveys, clinical data, and healthcare providers to give overall performance ratings to Medicare health and prescription drug plans. These ratings help Medicare beneficiaries choose a plan based on quality and performance. A plan can earn from one to five stars. A 5-star rating is considered excellent. The 2021 overall plan rating is based on 39 healthcare and service quality measures, including detecting illness and keeping members healthy, managing chronic conditions, member satisfaction, and customer service.
"KelseyCare Advantage now serves nearly 40,000 members in the Houston-Galveston region, and this kind of growth has given us the opportunity to show our patients what we do best – taking excellent care of large groups of patients, using evidence-based medicine, and providing an outstanding member experience. Achieving 5-stars every year for the last five years confirms that we offer our patients and community a uniquely successful health plan," said Donnie Aga, M.D., Medical Director for KelseyCare Advantage. "Kelsey-Seybold medical group and our affiliates have worked very hard together for more than a decade to improve our model of care, all based on the values of Accountable Care and the medical home. Our physicians and providers are all committed to this model and it helps us impact real change in health outcomes for our patients."
KelseyCare Advantage is offered in 13 counties including: Fort Bend, Harris, Montgomery, portions of Galveston, Austin, Brazoria, Chambers, Grimes, Liberty, San Jacinto, Walker, Waller, and Wharton. The plan is affiliated with Kelsey-Seybold Clinic, a group of doctors based in Houston who have been serving Houston-area families for more than 70 years.
KelseyCare Advantage plans provide all Medicare Part A and B coverage, and some plans include Part D prescription drug coverage to Houston-area Medicare beneficiaries who want more coverage than traditional Medicare provides. Additionally, KelseyCare Advantage offers four plans that have a point-of-service (POS) benefit which allows members the flexibility to see any provider that accepts traditional Medicare.
Medicare-eligible residents in these areas can enroll in a KelseyCare Advantage plan during the Medicare annual enrollment period between Oct. 15, 2020 and Dec. 7, 2020, with an effective date of Jan. 1, 2021. In addition to receiving high-quality care and exceptional customer service, 5-star excellence means that Medicare beneficiaries may enroll in a 5-star plan at any time between Dec. 8, 2020 and Nov. 30, 2021, without having to wait until the next annual enrollment period. If a Medicare beneficiary is enrolled in another Medicare Advantage plan, they may switch to the KelseyCare Advantage plan at any time without waiting for the next annual enrollment time period.
Every year, Medicare evaluates plans based on a 5-star rating system. To learn more about KelseyCare Advantage, or about the Medicare Star Quality Ratings, visit: www.kelseycareadvantage.com or www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227).
Kelsey-Seybold Clinic is Houston's premier multispecialty group practice, founded in 1949 by Dr. Mavis Kelsey in Houston's renowned Texas Medical Center. More than 650 physicians and allied health professionals practice at 36 locations in the Greater Houston area. Kelsey-Seybold offers quality medical care in 65 medical specialties. The organization operates the largest freestanding Ambulatory Surgery Center in the state of Texas and offers state-of-the-art Varian TrueBeam and Varian Edge radiation therapy technology at a nationally accredited Cancer Center. An accredited Sleep Center, comprehensive laboratory services, advanced imaging and diagnostics, 24 onsite Kelsey pharmacies and one specialty pharmacy, and MyKelseyOnline, a secure web portal, are part of its comprehensive offerings. Kelsey-Seybold partners with major insurers to offer value-based commercial health plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated with Kelsey-Seybold Clinic, has achieved the coveted 5-out-of-5-star rating from the Centers for Medicare and Medicaid for seven consecutive years.
Kelsey-Seybold has been recognized by the National Committee for Quality Assurance (NCQA) as the nation’s first accredited Accountable Care Organization and a Patient-Centered Medical Home. Kelsey-Seybold has many physicians in the Greater Houston area certified for excellence in diabetes and heart and stroke care by the NCQA. In addition to these recognitions, Kelsey-Seybold is home to a nationally accredited Breast Diagnostic Center and Endoscopy Center.
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