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.
With more than 420,000 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 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.
2021 achievements and strengths
Based on the 2021 Healthcare Effectiveness Data and Information Set (HEDIS®) results, in review of calendar years 2020 to 2021, Select Health:
- Helped our members get needed care quickly during the COVID-19 pandemic with relaxed pharmacy benefit by softening the prior authorization requirement for extensions to previously authorized medications as well as newly requested medications when medically necessary and assisted members on how to schedule telehealth visits.
- Assisted members with scheduling telehealth visits.
- Assisted providers with member outreach.
- 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 92% member satisfaction regarding experiences with primary care providers.
- Increased rates across all SCDHHS quality indices withholds.
- Increased rates for diabetes care.
- Expanded plan and provider maternal education. Partnered with the March of Dimes Corp for prenatal and postpartum education.
- Developed at least one disparity intervention for African American people to address the disparity during pregnancy and birth outcomes.
- Continued provider review and education on individual HEDIS reports and status.
According to the 2021 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.
View quality data (PDF).
2022 program goals
The following goals will be reflected in the HEDIS 2021 results (reporting on performance in calendar year 2020), available fall 2021.
- Maintain NCQA Commendable accreditation for NCQA resurvey scheduled for July 2022. Improve CAHPS score through continued efforts 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 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.
- Focus on the preventive health areas of teen health, women’s health, and newborn and child health.
- Promote immunizations for children of all age groups.
- Improve rates of adolescent screening for chlamydia and promote universal urine screening; because people of 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 rates for childhood body mass index (BMI) assessments.
- 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.
- Follow-up after emergency department visit for alcohol and other drug abuse or dependence.
- Improve comprehensive diabetes care through:
Earlier identification and outreach to new members, focusing on screening and control measures for hemoglobin A1C (HbA1C).
- 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.