Joanne McFall is the Market President for Keystone First, Pennsylvania’s largest Medicaid managed care organization, and is responsible for providing day-to-day leadership, stakeholder engagement, and strategy to ensure improved population health for the health plan’s more than 579,000 members.
As Market President, Ms. McFall oversees the strategic direction, growth and leadership of Keystone First, including the daily operations of Provider Network Management, Member Outreach and Engagement, Communications and Marketing, Compliance, and Regulatory/Legislative Affairs. She is also responsible for coordinating day-to-day operational support with AmeriHealth Caritas, the parent organization of Keystone First.
Ms. McFall brings to the role more than 30 years of experience in health care operations, strategic planning, medical cost management, information technology and financial oversight.
Prior to her role as Market President, Ms. McFall was Vice President and Chief of Staff at AmeriHealth Caritas, a national leader in health solutions for people in need, where she served as a liaison between the corporate Chief Operating Officer and all direct reporting departments and corporate functions. In this role, she was also responsible for all corporate project management and new business implementations in support of the organization's growth strategy.
Previously, Ms. McFall was Associate Vice President at AmeriHealth Caritas with responsibility for high-level oversight of operational functions and process improvement/cost containment opportunities.
Ms. McFall is a member of the Boards of Directors for the Urban Affairs Coalition and the Girl Scouts of Eastern Pennsylvania, and the Executive Advisory Board for Special Olympics PA. She also serves as the board chair for the Pennsylvania Medicaid Managed Care Coalition. She received her MBA in Health and Medical Services Administration from Widener University and her BA in Communication from the University of Delaware.
Lily Higgins, M.D., M.B.A., M.S.
Network Medical Director
As network medical director, Dr. Lily Higgins is responsible for Keystone First’s quality assurance efforts and the management of its relationships with the local medical community, including primary care providers, specialists and hospitals.
Previously, Higgins served as utilization management medical director for Keystone First where she was responsible for the medical care of the health plan’s membership. She significantly improved health outcomes and quality of care by providing direct oversight of programs, medical policy and provider relations.
Higgins is a fellow of the American Academy of Pediatrics and a member of the Asian American Women’s Coalition (AAWC). She serves on the board of Pennsylvania’s chapter of March of Dimes and Pennsylvania’s Premie Society.
Higgins received a Bachelor of Arts degree from Cornell University, a Master of Nutrition degree from Columbia University of Physician and Surgeons and a medical degree from Drexel University School of Medicine. She also holds a Master of Business Administration in Medical Services Management from John Hopkins University.