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 23 years, we have expanded our network, allowing us to serve all 46 counties of South Carolina in pursuit of this mission.
With more than 360,000 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 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 QAPI 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 comprised of Select Health senior and executive leadership, network physicians, and non-physician health care providers and meets at least five times a year.
The QM team, under guidance from the committee, provides assistance and support in implementing the QAPI program. All departments at Select Health collaborate with the QM 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 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.
2017 achievements and strengths
Based on the 2018 Healthcare Effectiveness Data and Information Set (HEDIS®) results, in review of calendar year 2017, Select Health:
- Remained the highest nationally ranked health plan for National Committee for Quality Assurance (NCQA)-rated health plan for South Carolina Healthy Connections.
- 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.
- 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 91 percent member satisfaction regarding experiences with primary care providers.
- Met or exceeded SCDHHS quality improvement goals for all 12 quality indices measured.
- Achieved scores at or above the 75th percentile in 23 HEDIS clinical measures and improved scores in 72 out of 93 measures.
- Was a top performer for clinical performance when compared to other plans in the state.
- Exceeded scores for prenatal care (frequency and timeliness) and postpartum care at the 95th percentile.
- According to the 2018 Provider Satisfaction survey results Select Health received an overall provider satisfaction rating of 93 percent. Increased scores were noted in all eight composites of the survey. 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.
- Childhood immunization series — Combo 10.
- Weight assessment and counseling for children and adolescents (including body mass index percentile, physical activity, and nutrition).
- Cervical cancer screening.
- Postpartum care.
- Diabetes — retinal eye exams, HbA1C testing, and nephropathy screening, and controlling blood pressure.
- Controlling blood pressure.
- Avoidance of antibiotic medications in adults with acute bronchitis.
- Medication management for people with asthma, with controller medication ≥50 percent and ≥75 percent.
- Metabolic monitoring for children and adolescents on antipsychotics.
- Follow up after hospitalization for mental illness.
- Follow up after emergency department visit for mental illness.
View quality data (PDF).
2018 program goals
The following goals will be reflected in the HEDIS 2019 results (reporting on performance in calendar year 2018), available fall 2019.
- Maintain NCQA Commendable accreditation for NCQA re-survey scheduled for June 2019; improve score compared to last survey 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 Category II and V-codes, which measure and track nationally and state-monitored clinical performance objectives.
- Earlier identification of 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 a block appointment times for First ChoiceSM 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.
- 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.