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Quality Improvement

Keystone First VIP Choice has a Quality Improvement (QI) program to make sure health care and services our members receive are:

  • High quality.
  • Safe.
  • Right for the members' needs.
  • Efficient.
  • Effective.

We review our program each year to see how we are doing. This review includes suggestions for improvement, as well as goals for the next year.

Our mission is to help people get care, stay well, and build healthy communities.

Our Quality team supports this mission by checking on the health care and services members receive. Our team:

  • Offers health and disease management programs for 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 VIP Choice medical, dental, vision, and pharmacy providers.

Program successes in 2016

  • Scored above the national average in "Care Coordination" and "Getting Needed Prescription Drugs" in a survey of members.
  • Met our goals in the following Data and Information Set measures:
    • Breast cancer screenings.
    • Colorectal cancer screenings.
    • Members taking medications for asthma.
    • Medication reviews after a hospital stay.

Our goals for 2017

  • Continue to promote services that meet the cultural and language needs of our members.
  • Improve member scores.
  • Improve network provider satisfaction.
  • Improve access to primary care, specialty care, and ambulatory health services.
  • Continue to hold community health screening events.
  • Improve programs, including diabetes care and the promotion of our eye exam benefit.
  • Continue to reduce gaps in health.
  • Improve care between medical and behavioral health care providers.
  • Improve member safety by continuing to check and review all complaints and appeals.
  • Empower members to work more with their providers to develop care plans and to help reduce health gaps.

Call Member Services at 1-800-450-1166 (TTY 711), seven days a week, 8 a.m. – 8 p.m., if you:

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

Keystone First VIP Choice has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until December 31, 2021, based on a review of the Keystone First VIP Choice Model of Care.