Quality Care for Our Members

Our Quality Assurance and Performance Improvement 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.

With more than 334,000 members across all 46 counties 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 for each member. The QAPI program encompasses all Select Health operations to help ensure the provision of safe, clinically appropriate, and fiscally responsible care and services to our members.

The Quality Assurance and Performance Improvement (QAPI) Committee provides direction for the QAPI program. The quality program is steered by the QAPI committee and coordinated by the Select Health Quality Management (QM) department. The QAPI Committee directs the plan’s efforts to monitor, evaluate, and improve the quality of clinical care and services. The committee is composed of Select Health senior and executive leaders, network physicians, and nonphysician health care providers and meets at least five times a year.

The QM team, under guidance from the Quality Assurance and Performance Improvement (QAPI) Committee, provides assistance and support in implementing the QAPI program. All departments at Select Health collaborate with the Quality Management department in executing and monitoring the 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 the QAPI program design and overall performance to identify the strengths and limitations of the quality improvement activities that are conducted throughout the year. 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 throughout the year. The finalized evaluation and program documents are submitted to the South Carolina Department of Health and Human Services (SCDHHS) for review at least annually. Select Health of South Carolina follows the National Committee for Quality Assurance (NCQA) standards for health plan accreditation as our roadmap and commitment to quality management and improvement. These national standards evaluate our plan on quality management and improvement, population health, network management, utilization management, credentialing and recredentialing, our members rights and responsibilities, member connections, and Medicaid benefits and services.

2023 achievements and strengths

Based on the 2024 Healthcare Effectiveness Data and Information Set (HEDIS) (2023 measurement year results), the Select Health plan:

  • Assisted members with scheduling physical and telehealth visits with primary and specialist doctors.
  • Assisted providers with member outreach and scheduling appointments.
  • Maintained 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.
  • Received annual Multicultural Health Care Distinction by NCQA.
  • 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.
  • Increased rates for 25 (74%) of the 34 measures reviewed.
  • Expanded plan and provider maternal education.
  • Developed at least one disparity intervention for African American women to address the disparity during pregnancy and birth outcomes.
  • Continued provider review and education on individual HEDIS reports and status.
  • According to the 2023 Provider Satisfaction survey results, Select Health received an overall provider satisfaction rating of 90%. Providers continue to rate Select Health higher than our competitors in the state.
  • Continued and improved upon with member-centered value-added benefits:
    • Maternity support and dedicated Care Managers for pregnant moms through our Bright Start® prenatal program and Keys to Your Care® texting program for expectant moms.
    • Regional baby showers. Qualifying members receive diaper bags and other supplies, plus they now have a choice of a car seat, a portable crib, or a stroller.
    • Diaper Days for children ages 0 – 30 months.
    • Electric breast pump for new and expectant moms, with a prescription from your OB/GYN. Conditions apply.
    • Home-delivered meals for new moms enrolled in Bright Start. Conditions apply.
    • Newborn circumcision up to 6 months old.
    • Rewards, like gift cards, for completing qualifying healthy behaviors. For more information, please visit First Choice’s Staying Healthy page.
    • Jump-Start back-to-school events with health screenings, haircuts, and backpacks filled with school supplies for grades K – 12.
    • Voucher for swim lessons or youth sports programs for qualified members at participating regional YMCA locations.
    • GED assistance and college scholarships for qualifying members.
    • Rewards, like gift cards, for completing qualifying healthy behaviors.
    • First Choice Take Flight Enhanced foster care program for youth who are aging out of foster care.
    • Adult vision care, including eye exam and glasses every 2 years. Conditions apply.
    • State-of-the-art community center, open to members and the public, access to assistance offered by our community partners, such as Benefit Bank services — with certified counselors and tax appointments. (Note: Certain events are for members only.)
    • Fresh Produce Box and Meal Program — Free home-delivered fresh produce boxes or meal kits for qualifying members.

2024 program goals

The following goals will be reflected in the HEDIS 2025 results (reporting on performance for calendar year 2024), available fall 2025:

  • Maintain NCQA Commendable accreditation for NCQA resurvey.
  • Improve CAHPS score through corporate and local workgroups to maintain high levels of member satisfaction.
  • Improve behavioral health member satisfaction scores and survey response rates.
  • Identify providers who are documenting required components of care in member medical records but are not using the Category II and V codes, which measure and track nationally, and state-monitored clinical performance objectives.
  • Address and eliminate health disparities in maternal care amongst specific populations in our plan. Explore and investigate identified population for factors that could be impacting prenatal/postpartum outcomes through improved data and dashboards.
  • Promote immunizations for members of all ages.
  • Improve rates of adolescent screening for chlamydia, and promote universal urine screening for people ages 16 – 24 years old, as this age group has the lowest rate of compliance for chlamydia screening. Continue to promote this screening as a component of the annual adolescent well visit.
  • Improve rates for childhood body mass index (BMI) assessments and counseling for nutrition and physical activity.
  • Improve member access to primary care doctor.
  • 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.
    • Improve screening for depression in both physical and behavioral health, including for adolescents and for pregnant people.
    • Follow-up after an emergency department (ED) visit for alcohol and other drug use or dependence.
  • Improve comprehensive diabetes care through:
    • Earlier identification and outreach to new members, focusing on screening and control measures for HbA1C and blood pressure.
    • 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.

For more information about the QAPI program, please contact your Provider Network Management account executive.

Providers