Quality Care for First Choice Members

Quality: We focus on the care you get.

First Choice℠ by Select Health of South Carolina is the first and largest Medicaid health plan in the state. We serve more than 300,000 members in all 46 counties. In 2024, South Carolina reviewed Medicaid coverage for the first full year since the COVID-19 pandemic. Because of this, fewer people had Medicaid in the state and with First Choice.

First Choice is one of the top Medicaid health plans chosen by members and providers. Our mission is to help people get care, stay well, and build healthy communities. We care deeply about people who may not have easy access to care. We work with doctors, providers, and staff who are focused on good service and quality care. Our Quality Management program helps members get health care and behavioral health care, find support in their community, and have a better health care experience.

The goal of our Quality Management program is to help members get safer, better care. We look for ways to improve care, such as well visits, mammograms, health screenings, vaccines, medicine use, and access to care when members are sick. Most of our team works behind the scenes. Some team members also go into the community to meet and help members.

Here are some things we do:

Work with our Community Outreach Team at special events. We help members get care, find resources, and learn ways to stay healthy.
Work with provider groups to find members who may need well visits, vaccines, screenings, or help managing long-term health needs.
Reach out to members by mail, member portal messages, texts, phone messages, and social media.
Ask members and providers how we can make care and services easier to get.
Review care from First Choice providers to help make sure members get good care.
Look into concerns when members tell us they may not have received proper care. Members can call Member Services at 1-888-276-2020 to report care or access concerns.
Work with South Carolina Healthy Connections to help improve the health of Medicaid members in the state.

Here are some things we worked on:

Kept our National Committee for Quality Assurance (NCQA) Commendable Accreditation. This shows our focus on quality care and service.
Hosted 12 baby showers and helped host two more community baby showers for pregnant members. A total of 366 members came. We gave out 193 infant car seats, 112 Pack and Plays, 80 strollers, and other prenatal resources. These events are fun and teach members about pregnancy, mental health, and newborn care.
Hosted more than 200 community events across the state, including back-to-school events, Warming for Winter events, member appreciation events, fairs, mobile mammograms, well-visit days, vaccine clinic days, parent meetings, and faith-based events.
Gave backpacks and school supplies to children in need across the state.
Gave blood pressure cuffs to pregnant members who may be at risk.
Shared messages about well visits and preventive care. This includes screenings, vaccines, and follow-up care. Members should see their primary care provider (PCP) at least once a year for a well visit.
Helped members with diabetes get important screenings. We also encouraged them to keep blood sugar and blood pressure in a healthy range. Members with diabetes should get an eye exam each year. First Choice covers diabetes screenings, including yearly eye exams.
Taught members with high blood pressure and heart disease ways to care for their heart health.
Supported mobile preventive exams and appointment events.
Called provider offices to help schedule visits for members.
Checked to make sure we have enough providers and specialists to care for members’ physical and mental health needs.
Kept giving members support and resources for mental health.
Kept working to provide care and services that respect each member’s culture and language.
Added more services at our First Choice Community Center. These include computer access, community events, cooking demos, and Benefit Bank counselors.
Became the first health plan in South Carolina to earn NCQA’s Multicultural Health Care Distinction Award. We have earned this award six times.
Improved 80% of the 40 HEDIS measures we review each year. These measures include care such as cancer screenings, vaccines, diabetes care, blood pressure control, pregnancy care, and mental health care.
Kept giving network providers monthly updates on their HEDIS rates.
Shared best practices and resources with providers to help members get needed care.
Kept offering our Mission GED and Reading Assistance programs.
Shared safety and disease management tips on social media and in member newsletters.

View quality data (PDF)

Next, we plan to:

Ask more members to take member satisfaction surveys.
Keep working to improve the plan’s STAR rating.
Reach more members with rewards, texts, and phone call campaigns.
Help members connect with their PCP when they are sick. Member Services can help members find nearby urgent care, avoid the emergency room when it is not an emergency, schedule PCP visits, and get rides to visits.
Encourage members to use the member portal to see their health information.
Encourage teens to make healthy choices.
Teach members how to care for their body and mind. This can help prevent emergency room visits or hospital stays. We want to help members get the care they need from their PCP and specialists. If a member is in the hospital, we can share resources to help prevent another hospital stay. Our Care Connectors can also help members before they leave the hospital.
Help members improve reading skills through our Reading Assistance and Mission GED programs. Email read@selecthealthofsc.com for reading help. Email ged@selecthealthofsc.com for Mission GED.

Call Member Services at 1-888-276-2020 if you:

Want to learn more about the First Choice Quality Management Program.
Have a concern about the care you or a family member received. Our Quality team can look into it.
Are leaving the hospital and need help or resources. Our Care Connectors can help.
Have questions about coverage or need help getting medicine.