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​​Learn How KelseyCare Reduces Catastrophic Plan Costs

​Traditional health plans do not offer an effective process to coordinate care delivery and remove avoidable costs.

Traditional health plans are not working. They offer broad networks of disconnected primary care and specialist physicians. Coordinated care does not exist in these models. Third-party disease management and case management programs have little to no connection with the providers of care. Traditional care is rife with overutilization of services. 

The Institute of Medicine estimates that as much as 30% of care delivered is non-evidence-based. In other words, "broad networks" of thousands of disconnected providers, with no effective processes in place to coordinate care delivery and remove avoidable costs, are not working. Businesses, individuals, and families are financially poorer and experiencing lesser health outcomes because of this.

High-cost claimants with complex co-morbid conditions account for the majority of healthcare costs. High-cost claimants are not being effectively managed through traditional health plans or wellness programs. The only proven model to effectively manage high-cost claimants is coordinated, accountable care. 

In the Greater Houston area, the evidence shows — over and over again — that high-cost claimants cost 50 – 7​0% less in the KelseyCare Accountable Care Plan.

Typical Distribution of Healthcare Spend by Plan Members per Calendar Year

$0-1,000 = 51%
$1-5K = 4​​2%​
$5-25K = 7%​
​​​>$25K = 3% of claimants​

We believe better care delivery leads to better health outcomes. With the KelseyCare Accountable Care model, members are linked with highly focused KelseyCare physicians and our Integrated delivery system to dramatically improve care outcomes. Our health plan model is effective because we are focused and connected in our approach to patient care.