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