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 Organization (ACO).

KelseyCare consistently delivers higher quality at a lower total medical cost.*

kelseycare.com

For the most current information go to kelseycare.com 1

* Source: AON Hewitt, 2004, 2005, 2007, 2008, 2009, 2010 and 2011.

What Our Clients Say About KelseyCare

2 For the most current information go to kelseycare.com

“What sets KelseyCare apart is the fact that it is an efficient and unique delivery model. St. Luke’s plans are running better and are less expensive, when compared to other peer (hospital) industry groups. St. Luke’s cost performance is less than the 50th percentile when compared to these groups. We’ve been able to achieve that because of the KelseyCare plan.”

Drew BrownAdministrative Director, Human Resources

St. Luke’s Episcopal Health System

“MCFA has offered KelseyCare health insurance as an option since 2010. The convenience of this plan is a big deal for our employees. And we know they’re getting quality healthcare from quality doctors. With the KelseyCare health plan, we’ve experienced high employee satisfaction and lower costs. That’s a true win-win.”

Jesse WelshHuman Resources Manager

Mitsubishi Caterpillar Forklift America

• WhenyouchooseKelseyCare,youselectKelsey-Seybolddoctorstocoordinateyourhealthcare.

• SeetheKelsey-Seyboldphysicianyouwantwithnoreferralrequired–370Kelsey-Seyboldphysiciansat 21Houston-arealocations.

• Kelseyphysicianspartnerwith1,800medicalspecialistsandpremierhospitalsincludingSt.Luke’sEpiscopalHospital–TexasMedicalCenter,SugarLandandTheWoodlands;TexasChildren’sHospital;theTexasHeartInstitute;Methodist–SugarLandandWillowbrook;andClearLakeRegionalMedicalCenter.

• CancercareisdeliveredbyKelsey-Seybold’snationallyrecognizedCancerCenterincoordinationwithSt.Luke’sCancerCenter.MDAndersonCancerCenterisavailableaspartoftheaffiliatereferralnetworkforcomplexcancercases.

• Membershavetotalaccesstoall21locationsandphysicians–noreferraliseverneeded.

• Saturdayvisitsforillorinjuredpatientsatfourlocationsfrom9a.m.to2p.m.

• 24-hourappointmentschedulingandAfter-HoursKelseyNurseHotline,withon-callphysicians.

• Securee-mailmessagingwithyourphysician.

• OnsitelabandX-rayatalllocations–withalltestingincludedintheco-pay.

• OutpatientAmbulatorySurgeryCenterandEndoscopyservices.

• PersonalConciergeexclusivelyforKelseyCaremembers.

KelseyCare Conveniences and Quality Make Our Members Smile

For the most current information go to kelseycare.com 3

The KelseyCare Integrated Delivery Model provides quality, “evidence-based” medical care and

consistently 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

Proactive outreach and monitoring of KelseyCare member’s preventive care.

Advanced Clinical Initiatives (ACI): Integrated Disease Management (DM) and Case Management (CM) delivered by KelseyCare DM/CM Nurses – who

are part of the KelseyCare medical team.

Full integration of electronic medical records and “Best Practice” alerts to all Primary Care, Specialist

and Hospitalist Physicians.

KelseyCare Hospitalist physicians actively manage hospital care and discharge planning at the bedside.

KelseyCare members receive “triple benefit:” Patient-Centered Medical Home

Active monitoring of Rx generics and Therapeutic opportunities through the KelseyCare “RxQI”

initiative.

KelseyCare’sIntegrated Delivery

Model

Kelsey-SeyboldPhysicians Listed

In Networkvs.

3

3

3

3

3

3

The difference BeTween The Kelseycare Plan and large PPO Plans including Kelsey-seyBOld Physicians

+ Integrated Disease/Case Management + Integrated RxQI Initiative + Integrated Hospitalist Program.

According to a leading

benchmark study performed

by the AON Hewitt Health

Value Initiative – a cost and

performance analysis database

of more than 1,800 health

plans throughout the United

States – KelseyCare’s health

benefits plan has a track record

of being rated “the most

financially efficient”* in overall

medical costs compared to all

benefits plans in the greater

Houston market.

KelseyCare’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 AON Hewitt Health Value Initiative 2011

For the most current information go to kelseycare.com 5

The Strategy: Plan Design and Pricing

KelseyCare Advanced Clinical Initiatives and Coordinated 'Accountable Care' Delivery Model

The Results:

Lower total medical costs, higher quality outcomes and highly satisfied enrolles.

+

Texas – Houston Market Profile

Coordinated accountable care saves lives and shrinks healthcare costs.

6 For the most current information go to kelseycare.com

TheKelseyCareAccountableCareModelconnectsmemberswithKelseyCarephysiciansandtheKelseyCareIntegratedDeliverySystem–wherewespecializeintheprevention,earlyidentification,andongoinginterventionofdisease.Wedramaticallyaltercareoutcomesbecausewearesofocusedandconnectedinourapproachtopatientcare–bestpractices–andintegrateddiseaseandcasemanagement.Ourhealthplanmodelishighlyeffectiveintheongoingtreatmentofchronicallyillandmedicallycomplexplanmembers–whodrivethegreatestcosts.

Weimprovethedeliveryofhealthcarethroughhighly-effectiveclinicalprocessesthatareproventodeliverresultsinqualityandcostsavings.Theseclinicalprocessesincludeacoordinated,accountabledeliverysystembasedonthenation’sfirstNCQA-AccreditedAccountableCareOrganization--alongwithintegrateddiseasemanagement,casemanagement,andonsitehospitalistphysicianswhomeetourpatientsatthehospitalbedside.Nootherhealthplan offers this delivery system and these outcomes.

“Thank God, Sam came into my life.” Hilaria Medrano says that KelseyCare Disease Management Nurse “Sam” Samaniego, R.N., “made the difference in my life.” Today, Hilaria is successfully managing her diabetes with Sam’s continued intervention, her doctor’s support, and “real time” feedback using the Kelsey-Seybold Electronic Medical Record.

For the most current information go to kelseycare.com 7

Recognizedasthenation’sfirstaccreditedAccountableCareOrganizationby theNationalCommitteeforQualityAssurance(NCQA)

Recognizedforexcellenceindiabetescare,heartandstrokecare andbackcarebytheNCQA

Highest Honors by the Accreditation Association for AmbulatoryHealthCare(AAAHC)

Thenation’sfirstfreestandingCancerProgramapprovedwithmultiplecommendations by the American College of Surgeons’

Commission on Cancer

NationallyrecognizedbytheAmericanSocietyofGastrointestinalEndoscopy forSuperiorQualityandSafety

NamedaNationalModelofExcellencein CholesterolManagement(AmericanMedicalGroupAssociation)

RecognizedforExcellenceinBreastHealth(NationalConsortiumof

BreastCenters,Inc.) For a complete list of awards and distinctions,

visit kelsey-seybold.com.

Cholesterol ManagementProgram

RECOGN I T ION

Kelsey-Seybold Clinic has been named the nation's first Accredited Accountable Care Organization by the prestigious National Committee for Quality Assurance (NCQA).

Kelsey-Seybold Clinic.Known for Quality. Nationally Recognized for Excellence.

Open access to all locations, Kelsey-Seybold Clinic specialists and primary care physicians – with no referral required.

Cinco Ranch23000HighlandKnollsDr.Katy,Texas77494713-442-4200

Clear Lake Clinic830GeminiSt.Houston,Texas77058713-442-4500

Clear Lake Medical Center17448Highway3Webster,Texas77598713-442-4300

Cypress Clinic13114FM1960West Suite200Houston,Texas77065713-442-4000

Downtown at The Shops1200McKinneySt.,Suite473Houston,Texas77010713-442-4700

Fort Bend Medical and Diagnostic Center11555UniversityBlvd.SugarLand,Texas77478713-442-9100

Humble Clinic8484WillClaytonPkwy.Humble,Texas77338713-442-2000

Katy Clinic21660KingslandBlvd.Katy,Texas77450713-442-4100

Kingwood Clinic2755W.LakeHoustonPkwy.Kingwood,Texas77339713-442-2100

Main Campus2727W.HolcombeBlvd.Houston,Texas77025713-442-0000

Meyerland Plaza Clinic560MeyerlandPlazaHouston,Texas77025713-442-3222

Pasadena Clinic3508E.PasadenaFrwy.Pasadena,Texas77503713-442-7100

Shadow Creek Ranch10970ShadowCreekPkwy.Pearland,Texas77584713-442-7200

Silverlake Clinic9430BroadwaySt.,Suite120Pearland,Texas77584713-442-7400

Sleep Center3900Essex,Suite500Houston,Texas77027713-442-8700

Spring Medical and Diagnostic Center15665CypressWoodsMedicalDrive,Suite100Houston,Texas77014713-442-1700

St. Luke’s Medical Tower Clinic6624FanninSt.Houston,Texas77030713-442-0000

The Vintage10701VintagePreservePkwy.Houston,Texas77070713-442-1500

The Woodlands ClinicMedicalArtsCenterII17350St.Luke’sWay,Suites175and200

(Pharmacy,Suite150)TheWoodlands,Texas77384713-442-1800

The Woodlands OB/GYN Clinic17198St.Luke’sWay, Suite540TheWoodlands,Texas77384713-442-1900

West Clinic (Galleria-area)1111 Augusta DriveHouston,Texas77057713-442-2400

Woman’s Center7900FanninSt.,Suite2100Houston,Texas77054713-442-7300

Hardy Toll R

d.

Broadway St. / FM 518

Westpark Tollway

146

35

Nasa Rd. 1

3

Ambulatory Surgery Center at this location

Kelsey-Seybold Clinic – Sleep Center

Sleep Center

Meyerland

21 Convenient Locations Close to Home and Work

8 For the most current information go to kelseycare.com

kelseycare.com713-442-0067