Keystone First started more than 35 years ago with the idea that by connecting Medicaid members to a doctor and a medical home – that is, improving access to care – it would be possible to improve the quality of care and lower costs.
It all started in the early 1980s when the staff at Misericordia Hospital, a health ministry of the Sisters of Mercy in West Philadelphia, noticed that many of its Medicaid patients were using the emergency room for their primary care. That was, and still is, a very expensive and inefficient way to receive medical care.
To address this issue, they created Mercy Health Plan, a voluntary Medical Assistance managed care plan that later became Keystone Mercy Health Plan. It helped connect each member with a primary care physician to encourage consistent and proactive health care. Over time, more Medicaid recipients began seeing their primary care doctors on a regular basis, rather than putting off care until the condition got so severe they had to go to the emergency room.
From that modest start in 1982 with only 35 members, the plan has grown to become a leader of health care solutions for the underserved. In 1992, Mercy Health Plan’s commitment to access and quality care helped it to become the first Medical Assistance plan to earn full NCQA accreditation. NCQA accreditation is a nationally recognized evaluation standard that purchasers, regulators and consumers can use to assess health plans.
The plan continued to grow, and in 1996, entered into a partnership with Keystone Health Plan East, the managed care entity of Independence Blue Cross, to form Keystone Mercy Health Plan.
In 2012, backed by parent companies Independence Blue Cross and Blue Cross Blue Shield of Michigan, Keystone Mercy became Keystone First. Today, Keystone First serves more than 300,000 Medical Assistance recipients in the five-county Greater Philadelphia area.