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 and largest Medicaid plan, serving more than 300,000 members across all 46 counties. In 2024, the state implemented the first full year of Medicaid redetermination since the pandemic in 2020, resulting in a decline in Medicaid membership for the state and First Choice.   

First Choice is a top preferred managed care organization (MCO) for Medicaid beneficiaries and providers. Our mission is to help people get care, stay well, and build healthy communities. We have a special concern for those who are underserved. Select Health stresses quality medical care by providing members with a choice of health care practitioners, providers, and staff dedicated to service excellence. Select Health is committed to developing health care resources that will help the underserved in South Carolina improve their health status. The Quality Management (QM) program promotes access and availability of health and behavioral health care services, activities to impact social determinants of health and improve health outcomes, and initiatives to improve satisfaction for members and providers.  

The overall goal of the QM program is to improve the health outcomes, quality, and safety of services provided to members. We evaluate and recommend ways to improve health through well visits, mammograms, disease management screenings, immunizations, medication management, and access to health care when members get sick. While the majority of the QM team is working diligently behind the scenes, we do have staff who go out into the community to connect with our members.

We do things like:

  • Work with the First Choice Community Outreach Team at special plan events to help members get care, find resources, and learn ways to take better care of themselves and their families.
  • Work with provider groups by identifying members in need of preventive screenings, well visits, immunizations, and chronic care management.
  • Reach out to our members through mailings, member portal alerts, texts, phone messages, and social media.
  • Survey members and providers for better ways to provide access to health care and services.
  • Review the quality of care from First Choice providers to ensure 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.

Check out some of the things we have been working on:

  • Maintained National Committee for Quality Assurance (NCQA) Commendable Accreditation through our dedication to clinical and service quality.
  • Hosted 12 baby showers and cohosted two additional community showers for expectant members. 366 members attended the baby showers. Distributed 193 infant car seats, 112 Pack and Plays, 80 strollers, and additional prenatal resources. Our community baby showers are fun events. Providing education on maternity care for both physical and mental health, as well as newborn care.
  • Hosted over 200 community events across the state, including:
    • Back-to-School events.
    • Warming for Winter events.
    • Member appreciation events.
    • The South Carolina State Fair and the Coastal Carolina Fair.
    • Mobile mammography.
    • Well-visit days with providers.
    • Immunization clinic days.
    • First Steps/Head Start Parent Meetings.
    • Faith-based community events.
  • Distributed backpacks and school supplies across the state to children in need. 
  • Provided at-risk expectant members with blood pressure cuffs.
  • Spread the message about the importance of well visits and preventive care, including lifesaving screenings, immunizations, and follow-up care. Members should see their primary care provider (PCP) for a well visit at least once a year to evaluate their health care needs. 
  • Assisted and encouraged members with diabetes to get their important screenings and keep their results within the controlled limit guidelines. Members can prevent the long-term problems that accompany having been diagnosed with diabetes. The key is to monitor blood sugar levels and blood pressure, and to get an annual diabetic eye exam. GSD A1c screenings should be conducted at least two times each year. First Choice covers diabetes screenings, including annual diabetic eye exams.
  • Educated members with high blood pressure and heart disease on the best ways to take control of their heart health. 
  • Continued the promotion of mobile preventive exams and block scheduling events.
  • Conducted outreach calls for provider offices to help schedule appointments for members.
  • Continued to assess the availability of network providers and specialists to properly serve both the physical and behavioral health care of our members.
  • Continued to provide member resources and support for mental health conditions.
  • Continued to provide culturally and linguistically appropriate care and services to First Choice plan members. 
  • Increased services provided through our First Choice Community Center to include computer access, special community events, cooking demonstrations, and Benefit Bank counselors.
  • Became the first health plan in South Carolina to earn the NCQA’s Multicultural Health Care Distinction Award, a six-time achievement.
  • 80% of the 40 HEDIS measures analyzed annually showed improvement in 2024, including the following:
    • Weight Assessment and Counseling for Nutrition and Physical Activity
    • Breast Cancer Screening
    • Cervical Cancer Screening
    • Adult Immunization Series
    • Kidney Health Evaluation for Patients With Diabetes (KED)
    • Statin Therapy and Adherence for Members With Diabetes or Cardiovascular Disease (SPD)
    • Glycemic Status Control for Patients With Diabetes
    • Retinal Eye Exams
    • Appropriate Testing for Children With Pharyngitis (CWP)
    • Controlling High Blood Pressure and Blood Pressure Control for Patients With Diabetes
    • Timeliness of Prenatal and Postpartum Care
    • Prenatal Immunization Series
    • Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)
    • Metabolic Monitoring for Children and Adolescents on Antipsychotics — Blood Glucose and Cholesterol Testing (APM)
    • Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications
    • Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics
  • Continued to provide network providers their monthly HEDIS compliance rates.
  • Continued to discuss and provide best practice resources to increase member compliance and optimal coordination of care.
  • Continued our Mission GED and Reading Assistance Program.
  • Created member safety and disease management posts on social media and articles in the member newsletters.

View quality data (PDF)

Moving forward, we aim to:

  • Increase participation in the member satisfaction surveys.
  • Continue to increase the plan's STAR rating.
  • Continue expanding member outreach with additional incentives, texting, and auto-dialer campaigns.
  • Continue to connect members with their PCPs as the best way for them to get care when feeling sick. Our Member Services Department assists members in locating a nearby urgent care center to avoid the emergency room for non-emergency-related issues (i.e. regular sick visits). Member Services can also help schedule PCP visits and transportation to these visits.
  • Encourage members to access their personal health information by using the member portal.
  • Encourage teens and adolescents to make healthy choices.
  • Continue to educate our members on prioritizing their physical and mental health. This can help prevent or minimize emergency department visits and/or being admitted to the hospital. Our goal is to help our members get what they need to stay healthy and manage their care through their PCP and specialists. For members who are admitted to the hospital, we aim to provide them with education and/or resources to prevent a hospital readmission. Our Care Connectors can also reach out to members for continued support needs before being discharged.
  • Continue to help members improve health literacy through our Reading Assistance and Mission GED programs. Please contact read@selecthealthofsc.com for reading assistance and ged@selecthealthofsc.com for our Mission GED program.

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

  • Want to learn more about First Choice’s Quality Management Program.
  • Question the quality of care for yourself or a family member. Our Quality team will look into the issue.
  • Are being discharged from the hospital and need help or resources. Our Care Connectors can help.
  • Have questions regarding coverage or need help with getting prescriptions filled.