Quality Care for Our Members
Our Quality Program
Hometown health plan, hometown health care. The right care, the right place, the right time — every time.
Since 1995, Select Health of South Carolina has served the state of South Carolina in our mission to help people get care, stay well, and build healthy communities. Over the past 22 years, we have expanded our network, allowing us to serve all 46 counties of South Carolina in pursuit of this mission.
With more than 350,000 members in South Carolina, Select Health leverages community partnerships and our robust provider network, along with a comprehensive and structured Quality Assurance Performance Improvement (QAPI) program to continuously monitor, evaluate, and improve the quality of our health care and services. The QAPI program oversees all Select Health operations to ensure the provision of safe, clinically appropriate, and fiscally responsible care and services to our members.
The QAPI program is steered by the QAPI Committee and coordinated by the Select Health Quality Improvement (QI) department. The QAPI Committee directs the plan’s efforts to monitor, evaluate, and improve the quality of clinical care and services. The committee is comprised of Select Health senior leadership, network physicians, and non-physician health care providers and meets at least five times a year. The QI team, under guidance from the committee, provides assistance and support in implementing the QAPI program. All departments at Select Health collaborate with the QI department in executing and monitoring QAPI program initiatives. This shared responsibility strengthens the program and allows Select Health to act swiftly on improvement opportunities as they are identified.
Select Health annually evaluates program design and overall performance to identify the strengths and limitations of QAPI activities and programs. Data from this analysis is used to develop recommendations for improvement and to propose goals and objectives for the upcoming year. The QAPI program evaluation, along with the program description and work plan, are submitted to the QAPI Committee for review and program modification as needed. The finalized evaluation and program documents are submitted to the South Carolina Department of Health and Human Services (SCDHHS) for review at least annually.
2016 achievements and strengths
The following information, derived from the 2017 Healthcare Effectiveness Data and Information Set (HEDIS®) results in review of calendar year 2016, demonstrates that Select Health:
- Remained the highest nationally ranked health plan for South Carolina Healthy Connections.
- Maintained National Committee for Quality Assurance (NCQA) Commendable accreditation status, demonstrating that the plan’s programs for service and clinical quality are well established and meet rigorous requirements for consumer protection and quality improvement.
- Again received NCQA’s Multicultural Health Care Distinction.
- Maintained position as a top performer in the state for member experience according to the Child Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores.
- Achieved 90 percent member satisfaction regarding experiences with primary care providers.
- Met SCDHHS quality improvement goals for nine out of 11 quality measures.
- Achieved scores at or above the 75th percentile in 10 HEDIS clinical measures and improved scores in 24 out of 42 measures.
- Was a top performer for clinical performance when compared to other plans in the state.
- Maintained scores for prenatal care (frequency and timeliness) at the 75th percentile; exceeded Quality Compass 95th percentile for postpartum care.
- Has an overall provider satisfaction rating of 89 percent. Increased scores were noted in six of the eight measures, with notable improvement made in Network Operations/Network Management, Utilization and Quality Management, Care Management, Provider Self Service, Claims Reimbursement, and Network. Providers continue to rate Select Health higher than our competitors in the state.
Achieved highest plan scores ever in the following HEDIS measures:
- Well-child visits — first 15 months.
- Adolescent well visits.
- Immunizations for adolescents, combo 2 and 10.
- Lead screening in children.
- Weight assessment and counseling for children and adolescents.
- Body mass index (BMI) percentile.
- Physical activity.
- Cervical cancer screening.
- Diabetes — retinal eye exams, HbA1C testing, and nephropathy screening.
- Avoidance of antibiotic medications in adults with acute bronchitis.
- Medication management for people with asthma, total 50 percent and 75 percent.
View quality data (PDF).
2017 program goals
The following goals will be reflected in the HEDIS 2018 results, available fall 2018.
- Maintain NCQA Commendable accreditation for 2017 NCQA re-survey scheduled for June 2019; improve score compared to 2016 and develop strategies to regain Excellent accreditation.
- Create and implement strategic outreach plans to reduce health disparities and collect data on social determinants of health.
- Improve CAHPS score through continued efforts to maintain high levels of member satisfaction.
- Identify providers who are documenting required components of care in member medical records but not using the V-codes which measure and track nationally and state-monitored clinical performance objectives.
- Earlier identify special-needs members to ensure better outcomes in health and quality of life.
- Coordinate on-site “clinic days” at federally qualified health centers and other provider offices to improve access to care by providing block appointment times for First Choice members with care gaps.
- Strengthen prenatal outreach through a grassroots approach by hosting at least four community baby shower events in areas of health disparity to identify and mitigate barriers to prenatal and postpartum care.
- Focus on the preventive health arenas of teen health, women’s health, and newborn and child health.
- Promote human papillomavirus (HPV) and Pap screening for appropriate age and risk populations.
- Improve rates of adolescent screening for chlamydia and promote "universal urine screening"; because ages 16 – 24 have the lowest rate of compliance for chlamydia screening, continue to promote this screening as a component of the annual adolescent well visit.
- Improve colonoscopy screening rates by 80 percent.
- Implement initiatives to improve outcomes for members born preterm and at low birth weight.
Implement initiatives to improve behavioral health measures and outcomes, specifically:
- Follow-up after hospitalization for mental illness.
- Follow-up for children with attention-deficit/hyperactivity disorder (ADHD).
- Antidepressant medication management.
- Screening for depression.
Improve comprehensive diabetes care through:
- Earlier identification and outreach to new members, focusing on screening and control measures for HbA1C.
- Increased outreach to teens and newly diagnosed members to promote and help them adopt early good behaviors.
- Targeted outreach and education in low-performing and rural areas.
- Increased efforts to improve member, provider, and community knowledge of the dilated eye exam benefit.
- Mobile eye exams.
- Increase outreach and interventions for cardiovascular disease and hypertension.
- Implement a targeted medication adherence strategy.
- Conduct targeted outreach to Hispanic members with asthma to assist with access to asthma medications and Spanish-speaking providers.
- Increase outreach and interventions for members with chronic obstructive pulmonary disease (COPD) to improve management and reduce emergency room and inpatient admission rates.
For more information about the QAPI program, please contact your Provider Network Management Account Executive.