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 2020.

Successes in 2019

  • Achieved 4 out of 5 rating from the National Committee for Quality Assurance (NCQA) Medicaid Plans ranking.
  • 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.
  • Improved our CAHPS® member survey scores, including an overall rating of the health plan in the 90th percentile of all Medicaid plans.
  • Improved and met goals in the following measures:
    • Annual Dental Visits for Children.
    • Adolescent Well Care.
    • Well-Child Visits in the First 15 Months.
    • Timeliness of Prenatal Care.
  • Developed and improved initiatives to improve the care our members receive by:
    • Coordinating transportation to appointments.
    • Helping coordinate sending health care professionals to where our members live.
    • 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.
  • Well-child visits in the First 15 Months.
  • Timeliness of Prenatal Care.

Goals for 2020

  • Maintain or exceed NCQA "Commendable" accreditation status.
  • Identify and prioritize opportunities to implement or redesign clinical programs to reduce health care disparities.
    • Continue to bring health screenings to areas where our members are most in need.
    • Achieve improvement in the following HEDIS® measures:
        • Comprehensive Diabetes Care.
          • A1c testing for members with diabetes.
          • Nephropathy testing for members with diabetes.
          • Diabetic eye exams.
        • Controlling Blood Pressure for members with hypertension.
        • Postpartum Visits.
        • Breast Cancer Screenings.
    • 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.