Quality Care for First Choice Members
Quality: our focus is on the care you receive
First Choice by Select Health of South Carolina is the state’s first-established and largest Medicaid plan, serving more than 350,000 members across all 46 counties. First Choice is most preferred by Medicaid beneficiaries and top rated by providers.* Our mission is to help people get care, stay well, and build healthy communities. The Quality Improvement (QI) program at First Choice supports this mission by working diligently to improve the health care and services we provide plan members and their families.
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, medication management, hospital stays, and access to health care when members get 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 families.
- Reach out to our members through mailing, member portal alerts, text and telephonic messages, and social media.
- Survey members and providers for better ways to provide access to health care and services for our members and their families.
- Review the quality of care from First Choice providers to help 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.
- As part of our Community Advisory Committee, we host meetings in the community for plan members and community partners. They 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 Member Services.
Check out some of the things we have been working on. We hope to do even better in 2021.
In 2020, we:
- Have helped – and continue to help – our members get access to needed care during the COVID-19 pandemic through expanded telehealth options, waiving copays for office visits, covering the cost of COVID-19 testing, and other temporary benefit changes.
- Maintained National Committee for Quality Assurance (NCQA) Commendable Accreditation through our dedication to clinical and service quality.
- Are a five-time recipient of NCQA’s Multicultural Health Care Distinction award. We are the first health plan in South Carolina to earn this distinction, which recognizes the delivery of culturally and linguistically appropriate services.
- Improved and met goals in measures of quality health care, like:
- Members receiving well visits in the first 15 months of life.
- Well-child visits in the third, fourth, fifth and sixth years of life.
- Adolescent well visits.
- Asthma medicine use and management.
- Immunizations for adolescents.
- Cervical cancer screenings.
- Diabetic A1c testing, blood pressure and A1c control, and screenings 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.
- Hosted four First Choice Fit® fitness camps featuring former South Carolina Gamecock running back Marcus Lattimore to encourage healthy behaviors through preventive health care.
- Offered services at our Community Center with no-cost resources like healthy living classes, tax filing, and other programs.
- Distributed backpacks and school supplies with well visit and immunization information to community partners across the state who could get the materials and information to school-aged children in need.
- Provided more member resources and assistance for mental health conditions.
- Continued our Mission GED and Reading Assistance Program.
View 2019 quality data (PDF). In response to the COVID-19 pandemic, NCQA is not publishing Health Plan Ratings in 2020.
In 2021 we plan to do even better! We aim to:
- Continue to help members increase their health literacy through our Reading Assistance and Mission GED programs. For more information, please contact: email@example.com for reading assistance and firstname.lastname@example.org 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 using the member portal with key features.
- Keep our members well and out of the hospital. 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 to help 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 one 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 one time a year and HbA1c screenings at least two times each year. First Choice covers annual diabetic eye exams.
- We want to help our teens start to learn how to make 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.
- Continue to provide culturally and linguistically appropriate care and services to First Choice plan members. Increase services provided through our First Choice Community Center which currently offers health and wellness services like computer access, special community events, cooking demonstrations, and Benefit Bank counselors.
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.
- Have questions regarding coverage or need help with getting prescriptions filled.
* First Choice by Select Health is rated higher by network providers than all other Medicaid plans in South Carolina, according to an independent provider satisfaction survey conducted by SPH Analytics, a National Committee for Quality Assurance-certified vendor, November 2019. It is the preferred plan by Medicaid beneficiaries as evidenced by the Healthy Connections Choices Maximus Monthly Enrollment Report for Choice Enrollment and Transfer-In Rates.