Quality Care for First Choice Members
Quality: our focus is on the care you receive
First Choice by Select Health has served South Carolina as the top-rated Medicaid health plan since 2010 in our mission to help our members get care, stay well, and build healthy communities. The Quality Improvement (QI) program at First Choice supports this mission by working to improve the health care and services we provide you and your family.
The goal of the QI program is to improve the quality and safety of physical and behavioral health care of our members. First Choice strives to provide access to overall health care that is safe, timely, effective, and patient-focused. We look at health areas like well visits, mammograms, disease management screenings and control, hospital stays, and access to health care when members get care when sick. Our QI work is often behind the scenes, but you can also find us out in the community connecting with our members.
We do things like:
- Plan events to help members get care, find resources, and learn better ways to take care of themselves and their family.
- Reach out to our members through mailing and telephonic messages.
- Survey members and providers for better ways to provide health care and services for our members and their families.
- Review the quality of care from First Choice providers to make sure our members receive optimal care from our network providers.
- Look into concerns when we get reports from members who think they were not given proper care. Our members can contact our Member Services Department at 1-888-276-2020 to report quality of care or access concerns.
- Work with South Carolina Healthy Connections to improve the health of all Medicaid members in the state.
- Host meetings in the community for plan members and community partners to share feedback and give us ideas on how we can improve our benefits and services. For information on how to join our Community Advisory Committee (CAC), please call our Member Services Department.
Check out some of the things we have been working on and where we hope to do even better in 2019.
In 2018, we:
- Continued as the highest-ranked South Carolina Healthy Connections Medicaid plan in the state according to the National Committee for Quality Assurance (NCQA) Health Insurance Plan Rankings.
- Maintained NCQA Commendable Accreditation through our dedication to clinical and service quality.
- Renewed NCQA’s Multicultural Health Care Distinction, remaining the only Medicaid health plan in South Carolina to earn this prestigious distinction four consecutive times.
- Improved and met goals in measures of quality health care, like:
- Members receiving well visits in the first 15 months of life
- Adolescent well visits
- Asthma medicine use and management
- Immunizations for Adolescents
- Childhood Immunizations and Lead Screening in Children
- Weight Assessment & Counseling for Children and Adolescents
- Breast and Cervical Cancer Screenings
- Diabetic eye exams, A1C testing, and screening for kidney function
- Blood Pressure Control
- Prenatal care and Postpartum care 21 – 56 days after delivery
- Reached out to our network providers to provide HEDIS compliance rates and best practices on how to increase member compliance to provide optimal coordination of care for our members.
- Held our annual Jump-Start Back-to-School event. Members received back-to-school information, on-site health screenings, and backpacks with school supplies.
- Hosted 4 First Choice Fit® football camps featuring former South Carolina Gamecock running back Marcus Lattimore to encourage healthy behaviors, like getting a well visit. He encouraged kids to make healthy choices.
- Provided more member resources and assistance for mental health conditions.
- Mission GED and Reading Assistance Program.
View quality data (PDF).
We plan to do even better in 2019 we aim to:
- Continue to help members increase their health literacy through our Reading Assistance and Mission GED Programs. For more information on this program, please contact: firstname.lastname@example.org for reading assistance and email@example.com for our Mission GED program.
- Connect members with their primary care providers (PCPs) and outline the best way to get care when feeling sick. Our Member Services Department helps members find an urgent care center near them to avoid the emergency room for regular sick visits. Member Services can also help members schedule PCP visits and transportation to these visits.
- Encourage members to access their personal health information by utilizing member portal with key features.
- Keep our members well and out of the hospital. Most hospital stays can be prevented. Our goal is to help our members get what they need to stay healthy and out of the hospital. For members who are admitted, we aim to reach out to connect them to the right support before leaving the hospital.
- Increase the availability of community baby shower events in more counties across South Carolina. Our community baby showers are fun events that provide education and supplies, as well as needed resources so members have healthy pregnancies and babies.
- Host more Community events to promote healthy eating using healthy recipes and cooking demonstrations along with more health screenings for blood pressure, diabetes, and heart health.
- Spread the message of well visits and preventive care. Members should see their PCP for a well check at least 1 time each year and get the right screenings.
- Help members with diabetes get their screenings and keep results in-control. Members can stop the long-term problems that come with diabetes. The key is to stay on top of blood sugar levels and get a diabetic eye exam at least 1 time a year and HbA1C screenings at least 2 times each year. First Choice covers annual diabetic eye exams.
- Reach out to more teen members. We want to help our teens start now when it comes to making healthy choices.
- Educate more members with high blood pressure and heart disease on the best ways to take control of their health and their lives.
- Continue to assess the availability of network providers and specialists to properly serve the physical and behavioral health care of our members.
- Renew NCQA accreditation in 2019.
- Continue to provide culturally and linguistically appropriate care and services to First Choice plan members and prepare to renew our Multicultural Health Care Distinction in 2019.
Call Member Services at 1-888-276-2020 if you:
- Want to learn more about our quality program and its goals, activities, and outcomes.
- Think you or your family did not get quality care. Our Quality team will look into the issue.
- Are going home from the hospital and need help or resources. Our care connectors can help.