Quality Care

Keystone First has a mission to help people get care, stay well, and build healthy communities.

Our Quality team supports this mission by monitoring the health care and services you and your family get.

Our goal is to improve the health and wellness of our members. The Quality department works behind the scenes, but you can also find us at the front line in your communities. Our team:

  • Offers health and disease programs for our members.
  • Reaches out to members to help them get the care and health education they need.
  • Creates programs to serve our members who have special health care needs.
  • Surveys members and providers and uses the answers to improve our services.
  • Reviews the quality of care and services given by Keystone First medical, dental, vision, and pharmacy providers.

We look for areas that need improvement.

Here are some of our recent successes and our plans for 2022.

Successes in 2021

  • Maintained NCQA "Commendable" accreditation status.
  • Maintained NCQA Multicultural Health Care Distinction through efforts to improve culturally and linguistically appropriate services and reduce health care disparities.
  • Met our service goals in Member Services for answering and handling your calls.
  • Expanded our efforts to promote services that meet the cultural and language preferences of our members.
  • Developed and improved initiatives to improve the care our members receive by:
    • Coordinating transportation to appointments.
    • Making reminder calls to members about doctor appointments and health screenings.
    • Finding new ways to connect with our members by mail, phone, text, and face-to-face in the community.
    • Expanding telehealth visits.
    • Helping members understand why it is important to take their medicine as the doctor tells them to when they have asthma or hypertension.

Goals for 2022

  • Maintain or exceed NCQA "Commendable" accreditation status.
  • Identify and prioritize opportunities to implement or redesign clinical programs to reduce health care disparities.
  • Continue to help members get connected with their primary care providers (PCPs) and teach members how to best use urgent care centers. We want members to avoid unnecessary trips to the emergency room if their doctor or an urgent care center can help in implementing their care plans to maintain and/or improve their health, and to reduce health disparities.
  • Improve care of our members who have diabetes by promoting our Diabetes Pathway program, supporting dilated eye exams and A1c screenings by sending text messages to our members.
  • Improve children’s health by increasing the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) visits to their providers.
  • Improve care of our pregnant members with more education about the importance of health care from the minute they know they are pregnant to 6 weeks after delivery to make sure they are healing properly.
  • Educate our members who have high blood pressure and/or heart disease about the best ways to take control of their health and lives by providing blood pressure cuffs to monitor their blood pressure.
  • Help our members on the road to health and wellness by getting the screenings and well visits they need.
  • Continue to bring health screenings to areas where our members are most in need.
  • Improve member satisfaction as measured by overall CAHPS satisfaction scores.
  • Help our providers stay informed and up-to-date on the care that our members receive.
  • Empower members to work more collaboratively with their doctors in implementing their care plans to maintain and/or improve their health and to reduce health disparities.
  • Continue to enhance collaborations between case management and behavioral health service providers.

Call Member Services at 1-800-521-6860 (TTY 1-800-684-5505) if you:

  • Would like to learn more about our Quality program and its goals, activities, and outcomes.
  • Think you or your family did not get quality care. Our team will look into the issue.
  • Are going home from the hospital and don't have the help and resources you need. Our Care Connectors can help.