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Kelsey Seybold and Humana Slated to Offer ACO Based Level Funded Benefit Solutions

Kelsey-Seybold and Humana Slated to Offer ACO-Based, Level-Funded Benefit Solutions for Small Group Employers

KelseyCare | Humana will offer the only capitated, level-funded plan options in the Houston market, expanding access to coordinated, value-based care 

Houston (October 13, 2020) – Employer groups with 5-99 employees in the greater Houston area will have access to new group health benefit options through "KelseyCare | Humana," a new health plan product developed by the Kelsey-Seybold Accountable Care Organization (ACO) and Humana. 

KelseyCare | Humana plans will include self-funded "level-funded" plans for employers, which combine the flexibility of self-funding with predictable monthly budgeting. Multiple plan options will be offered, including qualified High Deductible Health Plans and copay-based plans.  The plans are designed to improve care coordination, increase engagement in preventive care, and deliver a total lower medical cost through clinically integrated care. 

For employers and health benefit consultants who are interested, KelseyCare | Humana is expected to begin quoting in November, with plan effective dates beginning January 1, 2021.  KelseyCare | Humana plan options may be offered as "standalone" plan options, or alongside other level-funded plans offered by Humana.  The Humana plans include Canopy, Efficiency, and HDHP and will be the only level-funded plans offered in the market as a capitated benefits solution for businesses with 5-99 employees

Employees choosing the KelseyCare | Humana plan may access all Kelsey-Seybold doctors at all 24 clinic locations, either through in-person or the clinic's Virtual Care offerings.  Plan members have access to medical support and care 365 days a year, 24/7 through Kelsey-Seybold's After-Hours Nurse Hotline and Virtual Care.  Members may also schedule same-day and next-day appointments online or by phone 24/7.   No referral is required to see any Kelsey-Seybold specialist.

"Our team works diligently to collaborate with organizations that understand our value proposition: comprehensive, coordinated, and evidence-based care that lowers total medical cost for employers and improves health outcomes for patients," said Tony Lin, M.D., Chairman, Board of Managers and CEO, Kelsey-Seybold Clinic. "Humana is well known in the marketplace for their suite of level-funded products targeting small employer groups. Working collaboratively to develop these innovative, value-based plan offerings with Humana, we have the opportunity to actively participate in a solution that will reduce total medical cost while also improving quality outcomes."

Level-funded products provide predictable monthly costs for health benefits. The KelseyCare | Humana  level-funded plans combine the benefits of self-funding and capitation, a monthly fixed rate for healthcare costs, with Kelsey-Seybold's extensive experience in providing comprehensive, coordinated, and evidence-based care – the trifecta that enables even small employers to see a flat or downward trend in healthcare costs while offering affordable health benefits to employees.

"This new offering fills a gap in the Houston market to help lower costs for employers and members without sacrificing access to high quality care," said Donnie Hromadka, Regional Vice President Provider Experience, Humana. "KelseyCare | Humana is a new and innovative solution offered as part of Humana's level-funded plans for small-group, self-funded employers. Kelsey-Seybold's ability to manage populations, at a fixed rate under capitation gives small group employers access to plans that can positively impact their bottom line, while giving their employees access to high-quality, coordinated care."

Kelsey-Seybold has been an in-network provider for Humana PPO and Humana Choice products since the early 1990s and will continue to be offered as an in-network provider for these plans.

In 2007, Kelsey-Seybold created its first KelseyCare partnership arrangement, offering a Kelsey Network Plan as a benefit option to Houston-area employers who were looking for innovative solutions to the unsustainable escalation in healthcare costs. Since then, Kelsey-Seybold has established collaborative relationships with four major carriers to offer a Kelsey Network Plan to employers in the greater Houston area.

About Kelsey-Seybold

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 850 physicians and allied health professionals practice at 40 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 eight 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 is home to a nationally accredited Breast Diagnostic Center and Endoscopy Center.

Kelsey-Seybold Clinic achieved a Net Promoter Score (NPS) of 91. NPS is the global standard for measuring customer loyalty and satisfaction. An NPS score of 70 or higher is considered by industry experts to be "world class" and an indicator of overwhelming customer loyalty.

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