Keystone Family Health Plan
Keystone First is a Pennsylvania Medicaid managed care health plan serving 300,000+ Medical Assistance recipients across five southeastern Pennsylvania counties under capitated contracts with the state Department of Human Services, and is part of the AmeriHealth Caritas family of companies with Independence Blue Cross as parent.
- Company typePrivate
- Founded1982
- HeadquartersPhiladelphia, United States
- Headcount101–250
- GTM typeB2C
- OfferingServices
What Keystone Family Health Plan does
Keystone Family Health Plan (doing business as Keystone First) is a Pennsylvania Medicaid managed care health plan headquartered at 200 Stevens Drive in Philadelphia. Founded in 1982 as Mercy Health Plan at Misericordia Hospital, the organization entered into a 1996 partnership with Keystone Health Plan East (the managed care entity of Independence Blue Cross) to form Keystone Mercy Health Plan, and rebranded to Keystone First in 2012 with backing from Independence Blue Cross and Blue Cross Blue Shield of Michigan. It holds coverage through Vista Health Plan, an independent licensee of the Blue Cross and Blue Shield Association, and operates as part of the AmeriHealth Caritas family of companies. It earned full NCQA accreditation in 1992, the first Medical Assistance plan to do so.
Keystone First serves more than 300,000 Medical Assistance (Pennsylvania Medicaid) recipients across five southeastern Pennsylvania counties: Bucks, Chester, Delaware, Montgomery, and Philadelphia. Members receive coverage through Pennsylvania's HealthChoices program under capitated contracts with the Pennsylvania Department of Human Services; no premiums are charged to eligible members. The product portfolio includes a core Medicaid HMO plan, two subsidiaries (Keystone First CHC for Community HealthChoices/LTSS and Keystone First VIP Choice for Medicare/dual-eligible coverage), pharmacy services with prior authorization routing via CoverMyMeds and Surescripts, and a Digital Member Portal plus iOS/Android mobile applications. Distribution relies on a contracted provider network, the NaviNet provider portal, a 24/7 member services call line, bilingual materials, and physical community infrastructure (a Wellness and Opportunity Center in Chester and a Mobile Wellness and Opportunity Center deployed across the service area).
Specialized care management and community programs include the Bright Start prenatal program (~12,000 births/year with 50% flagged high-risk, built on the Optum OB Care platform), Moms2B for members with prior premature deliveries, Gift for Life mammogram outreach with Fox Chase Cancer Center, the 12-week Lose to Win diabetes and weight management program with five YMCA branches, Healthy Hoops asthma education, Youth.Philly.Fit with City Year, 4 Your Kid's Care (which reduced pediatric ER visits by 25% in its first year), Toothy Tune-Ups with St. Christopher's, Health Ministry (faith-based outreach recognized by NCQA and AHIP), and Tools for Tomorrow job readiness training. Technology integrations include WebMD Ignite for member health content, CoverMyMeds and Surescripts for pharmacy prior authorization, Optum OB Care for maternity management, NaviNet for provider administration, and Healthsparq for provider directory. Enrollment is routed through state-administered PA Enrollment Services rather than direct consumer selection, with community outreach and provider referrals supplementing acquisition.
Keystone Family Health Plan firmographics
Firmographics- Name
- Keystone Family Health Plan
- Legal name
- Keystone Family Health Plan
- Website
- https://keystonefirstpa.com
- Company type
- Private
- Founded year
- 1982
- Operating status
- Operating
- Headcount range
- 101–250 employees
- Short description
- Keystone First is a Pennsylvania Medicaid managed care health plan serving 300,000+ Medical Assistance recipients across five southeastern Pennsylvania counties under capitated contracts with the state Department of Human Services, and is part of the AmeriHealth Caritas family of companies with Independence Blue Cross as parent.
- Ownership category
- akta.pro rank
Keystone Family Health Plan industry classification
Industry- Product category
- Medicaid Managed Care
- NAICS
- Other Individual and Family Services (62419), Child and Youth Services (624110)
- SIC
- Services-Health Services (8000), Services-Social Services (8300)
- akta.pro primary industry
- Children’s & Family Medicaid Managed Care Plans (HLAEAEAF)
Keywords
Where Keystone Family Health Plan is headquartered
LocationHeadquarters
- HQ city
- Philadelphia
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
Keystone Family Health Plan business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure
Revenue model
- Medicaid Capitated Premium Payments: Keystone First operates as a Medicaid managed care organization receiving capitated premium payments from the Pennsylvania Department of Human Services (DHS) for each enrolled member. The plan assumes responsibility for providing covered healthcare services to members within the five-county service area.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Medical Assistance managed care coverage |
Go-to-market motion1 record
Distribution channels5 records
Marketing channels5 records
Keystone Family Health Plan product offering
Product offeringCore offering
Keystone Family Health Plan (d/b/a Keystone First) is a Medicaid managed care health plan that provides Medical Assistance (Pennsylvania Medicaid) coverage to more than 300,000 low-income individuals and families across Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. The plan offers core health benefits (primary care, preventive, emergency, prescription, behavioral health) funded through capitated payments from the Pennsylvania Department of Human Services, supplemented by care management programs (Bright Start prenatal, Moms2B), wellness initiatives (Lose to Win, Healthy Hoops, Gift for Life, Toothy Tune-Ups), and community-based outreach including Wellness and Opportunity Centers.
Product overview
Keystone First is a Medicaid managed care health plan serving over 300,000 Medical Assistance recipients in five southeastern Pennsylvania counties. The offering is a platform-ecosystem combining a core health plan with integrated digital portals (Member Portal, NaviNet Provider Portal), a mobile application (iOS/Android), pharmacy services (formulary, prior authorization, NDC billing), and an array of specialized care management and community wellness programs. Key programs include Bright Start prenatal care (delivering ~12,000 babies/year), Healthy Families Safe Communities, the Wellness and Opportunity Center in Chester, a Mobile Wellness Center, Health Ministry, Gift for Life mammogram outreach, Lose to Win diabetes management, and Tools for Tomorrow job readiness. The plan leverages third-party integrations including WebMD Ignite (health library), CoverMyMeds and Surescripts (pharmacy prior authorization), Optum OB Care (maternity management), and NaviNet (provider portal).
Differentiator
Problem solved
Functional benefit
Products and services
- Keystone First Medicaid Health Plan Pennsylvania's largest Medical Assistance (Medicaid) managed care health plan covering over 300,000 recipients across Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. Includes primary care, preventive care, emergency services, prescription drugs, behavioral health, and specialty care funded through PA DHS capitated payments.
- Keystone First Mobile App iOS and Android mobile application for members to access benefits, find providers, view claims, and manage their health plan on the go.
- Member Portal Online portal for members to access benefits, claims, prior authorizations, formulary, and personal health information.
- NaviNet Provider Portal Provider-facing portal for claims, billing, prior authorization lookup, member intervention requests, and communications with Keystone First.
- Prior Authorization Lookup Tool Online self-service tool allowing providers to enter CPT codes to determine whether outpatient services require prior authorization.
- Secure Contact Form Online form for members and providers to submit inquiries, disputes, fraud reports, HIPAA privacy requests, and general questions.
- Pharmacy Services Pharmacy benefits including formulary (preferred drug list following PA DHS PDL plus supplemental formulary), pharmacy directory, prior authorization, and NDC billing information.
- Bright Start Prenatal Program High-risk pregnancy care management program coordinating medical care and social services for expectant mothers. Includes case management, dental screenings, behavioral health screenings, postpartum outreach, and doula services. Delivered approximately 12,000 babies per year with 50% considered high-risk.
- Moms2B Intensive maternity care management program for members with prior premature deliveries or serious medical conditions. Uses mobile technology, provides cell phones, and arranges transportation to appointments.
- Gift for Life Mammogram outreach program partnering with Fox Chase Cancer Center and mobile mammography vans to deliver screenings at convenient neighborhood locations for women who have never had or have not had a mammogram in over two years.
- Lose to Win 12-week diabetes and weight management program presented in partnership with five YMCA branches. Includes fitness programs, personalized wellness coaching, nutrition workshops, and cooking demonstrations; participants receive a year-long YMCA membership upon completion.
- Healthy Hoops Health education program using basketball to help children with asthma and their families learn about disease management through nutrition, medication use, and monitored exercise.
- Youth.Philly.Fit. Child wellness program in partnership with City Year engaging 6th through 8th graders from eight Philadelphia middle schools with physical activities and healthy food choice education.
- 4 Your Kid's Care Pediatric ER utilization reduction program encouraging ongoing relationships with primary care practitioners. Reduced pediatric ER visits by 25% in its first year.
- Toothy Tune-Ups Pediatric oral health program where dentists and hygienists provide children with oral assessments, cleanings, sealants, fluoride treatments, fillings, and referrals.
- Health Ministry Program Faith-based health and wellness education program delivered in churches, synagogues, and mosques. The 40-Day Journey component engages women in a 6-week educational series on nutrition, exercise, and medication compliance.
- Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Child health outreach team telephonically contacting parents and guardians to educate about and schedule age-appropriate periodic well visits, screenings, and preventive services for children up to age 21.
- Community Outreach Solutions (COS) Team Field outreach team making home visits to help vulnerable members schedule preventive care appointments, arrange transportation, and address barriers to accessing healthcare.
- Let Us Know Program Clinical resource program allowing providers to notify Keystone First's Rapid Response and Outreach Team (RROT) about members needing assistance with missed appointments, behavioral health, medication noncompliance, ER misuse, or social determinants of health.
- Keystone First Wellness and Opportunity Center Fixed-location community center at 1929 W. 9th Street, Chester, PA 19013 offering art classes, music, exercise/fitness, educational opportunities, job training, GED classes, cooking demonstrations, weekly food pantry, caregiver support, health education and screenings, and assistance understanding plan benefits.
- Mobile Wellness and Opportunity Center Mobile unit bringing health education, screenings, healthy food demonstrations, fitness classes, job readiness events, baby showers, and training to community locations throughout southeastern Pennsylvania.
- Tools for Tomorrow Quarterly job readiness webinar series (10 a.m.-11 a.m. on Zoom) open to the community at no cost, covering skill identification, resume writing, online job searching/networking, and interview preparation.
- Retention Unit Eligibility maintenance support partnering with the Pennsylvania Department of Public Welfare to help members navigate caseworker access and maintain Medical Assistance eligibility.
- Health Library Member health education tool powered by WebMD Ignite offering quizzes and calculators on eating healthy, exercise, mental health, smoking cessation, stress management, substance use, and weight management (BMI tools).
- Healthy Families, Safe Communities Safety and wellness initiative addressing gun safety, teen dating violence, bullying, prescription medicine abuse, and food insecurity for both members and providers.
Companies that use Keystone Family Health Plan
Customer profileNamed customers3 records
Segments5 records
Ideal customer profiles3 records
Keystone Family Health Plan technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration7 records
Feature4 records
Keystone Family Health Plan partnerships and signals
Strategic signalPartnerships
14 partnerships are on record, tiered core, secondary and minor.
- Vista Health PlancoreVista Health Plan provides coverage as an independent licensee of the Blue Cross and Blue Shield Association, enabling Keystone First to serve the health insurance needs of Philadelphia and southeastern Pennsylvania.
- YMCA of Philadelphia and VicinitysecondaryPartnership with five local YMCA branches to deliver the Lose to Win diabetes and weight management program, including fitness programs, personalized wellness coaching, nutrition workshops, and cooking demonstrations.
- Fox Chase Cancer CentersecondaryPartnership with Fox Chase Cancer Center for the Gift for Life mammogram program, delivering breast cancer screenings to members at convenient neighborhood locations.
- City YearsecondaryPartnership with City Year to implement Youth.Philly.Fit program promoting healthy lifestyle to children in 6th through 8th grade at eight Philadelphia middle schools.
- St. Christopher's Hospital for ChildrensecondaryPartner for Toothy Tune-Ups dental program, providing children with oral assessments, cleanings, sealants, fluoride treatments, and ongoing dental care referrals.
- Philadelphia Transitional Work CorporationsecondaryPartnership for job creation program providing paid work experience and training to Medical Assistance recipients, with goal of permanent employment.
- Philadelphia County Assistance OfficessecondaryCollaboration for transitional work program providing employment opportunities and training for Medical Assistance recipients.
- People's Emergency CenterminorPartner in job creation program providing employment opportunities for individuals receiving Medical Assistance.
- Pennsylvania Department of Human ServicescoreState agency that administers Medical Assistance program and contracts with Keystone First as a HealthChoices managed care organization. Also partners for Retention Unit helping members maintain eligibility.
- Welfare PridesecondaryPartnership to help members navigate eligibility issues and establish expedited processes for caseworkers and County Assistance Offices.
- Lackawanna Mobile MammographysecondaryMobile mammography partner enabling delivery of breast cancer screenings to members at convenient neighborhood locations like grocery stores.
- AmeriHealth CaritascoreParent company family of health plans. The Keystone First website is hosted on AmeriHealth Caritas infrastructure. Careers page links to AmeriHealth Caritas careers site.
- Optum OB CaresecondaryTechnology platform for Bright Start maternity program providing provider resources, user guides, and training for obstetric care management.
- WebMD IgnitesecondaryHealth information and tools provider powering the Health Library with interactive quizzes and calculators for member health education.
Scale indicators4 records
Recent moves8 records
Expansion highlights5 records
Keystone Family Health Plan competitors and assessment
Company assessmentBroad incumbents
- Centene Corporation: The largest U.S. Medicaid managed care operator and the parent of multiple state-specific Medicaid plans. Comparable as a broad incumbent competing in the same Medicaid managed care category, though not directly licensed in PA under the same name.
- AmeriHealth Caritas: Keystone First's parent corporate family and a multi-state Medicaid managed care operator. Directly comparable because Keystone First's infrastructure, careers, and digital platforms are hosted on AmeriHealth Caritas systems, and the two share clinical and operational programs.
- Independence Blue Cross: Keystone First's parent company and a major southeastern Pennsylvania commercial health insurer. Comparable as the corporate parent and as an adjacent health plan brand within the same regional ecosystem.
Direct peers
- Molina Healthcare of Pennsylvania: A national Medicaid managed care organization operating in Pennsylvania under HealthChoices. Direct competitor for Medical Assistance enrollment in the five-county area.
- Aetna Better Health of Pennsylvania: A national carrier's Medicaid managed care plan offering Medical Assistance coverage in Pennsylvania. Competes for the same HealthChoices members in the southeastern service area.
- Geisinger Health Plan Family: A Pennsylvania-based Medicaid managed care product under HealthChoices, serving Medical Assistance recipients in central and northeastern PA with provider-aligned care models analogous to Keystone First.
- Gateway Health / Highmark Wholecare: A Pennsylvania Medicaid and dual-eligible managed care plan serving low-income members across multiple regions, including the Philadelphia area. Direct competitor for HealthChoices enrollment.
- Health Partners Plans: A Philadelphia-based, provider-sponsored Medicaid managed care plan serving Medical Assistance recipients in southeastern Pennsylvania. Direct competitor for the same five-county HealthChoices contract.
- UPMC for You: A Pennsylvania-based Medicaid managed care plan operating under the HealthChoices program, including the southeastern region. Competes head-to-head with Keystone First for the same Pennsylvania DHS contract.
- UnitedHealthcare Community Plan of Pennsylvania: UnitedHealth Group's Medicaid managed care product in Pennsylvania, serving Medical Assistance recipients in the same regions as Keystone First. Direct competitor with substantially greater national scale.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
Keystone Family Health Plan social profiles
Digital presenceKeystone Family Health Plan compliance and trust
Trust signalCompliance1 record
Keystone Family Health Plan financial estimates
Financial estimateRevenue estimate
Valuation estimate
Keystone Family Health Plan leadership team
Management profileNumber of profiles
Profiles1 record
Keystone Family Health Plan subsidiaries and ownership
Company hierarchySubsidiaries2 records
Keystone Family Health Plan funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Keystone Family Health Plan M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Keystone Family Health Plan
What does Keystone Family Health Plan do?
Keystone Family Health Plan (d/b/a Keystone First) is a Medicaid managed care health plan that provides Medical Assistance (Pennsylvania Medicaid) coverage to more than 300,000 low-income individuals and families across Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. The plan offers core health benefits (primary care, preventive, emergency, prescription, behavioral health) funded through capitated payments from the Pennsylvania Department of Human Services, supplemented by care management programs (Bright Start prenatal, Moms2B), wellness initiatives (Lose to Win, Healthy Hoops, Gift for Life, Toothy Tune-Ups), and community-based outreach including Wellness and Opportunity Centers.
Is Keystone Family Health Plan a public or private company?
Keystone Family Health Plan is a private company. It is classified as corporate owned and is currently operating.
When was Keystone Family Health Plan founded?
Keystone Family Health Plan was founded in 1982. It employs 101 to 250 people.
Where is Keystone Family Health Plan based?
Keystone Family Health Plan is headquartered in Philadelphia, United States, in the North America region.
How does Keystone Family Health Plan make money?
One revenue line is on record: medicaid Capitated Premium Payments.
Who are Keystone Family Health Plan's main competitors?
Broad incumbents on record are Centene Corporation, AmeriHealth Caritas and Independence Blue Cross. Direct peers are Molina Healthcare of Pennsylvania, Aetna Better Health of Pennsylvania, Geisinger Health Plan Family, Gateway Health / Highmark Wholecare, Health Partners Plans, UPMC for You and UnitedHealthcare Community Plan of Pennsylvania.
Does Keystone Family Health Plan have an API?
No public API is recorded for Keystone Family Health Plan.
What industry is Keystone Family Health Plan in?
Keystone Family Health Plan's product category is Medicaid Managed Care. Its primary akta.pro industry code is HLAEAEAF, Children’s & Family Medicaid Managed Care Plans. Its NAICS code is 62419 and its SIC code is 8000.