NEW CASTLE – Per capita healthcare spending in Delaware increased 9.1% in Calendar Year (CY) 2023, outpacing the spending benchmark set at a 3.1 percent growth rate for the CY 2023 performance period. The State of Delaware’s fifth annual Health Care Benchmark Trend Report was presented today by the Department of Health and Social Services (DHSS) to members of the Delaware Health Care Commission, the public/private policy-setting body created to develop a pathway to basic, affordable healthcare for all Delawareans.

The spending benchmark is the target value annual percentage change in the State-level per capita value of Total Health Care Expenditures (THCE) for all Delaware residents based on data submitted by Delaware payers. Delaware is one of eight states, including neighboring New Jersey and Maryland, to establish statewide health care cost growth targets, ranging from 3.0 to 3.4%.

Delaware’s THCE was approximately $10.9 billion for the CY 2023 performance period, The per capita amount was $10,588, which represents a 9.1 percent year-over-year increase from CY 2022. During this same period, Delaware’s population increased 1.3%.

There have been significant inflationary increases on health care costs and services, driving larger-than-expected increases nationally, as well as locally within the State. While Medicare is the largest bucket for THCE, at about one-third of State health care spending, all markets showed an increase in per capita spending, most significantly in Medicaid and the Veterans Health Administration markets.

Total Medical Expenditures (TME) totaled $9.9 B in CY 2023, an increase of approximately 10.4% from CY 2022. Hospital Inpatient (Not Pharmacy) and Prescription Drug Benefits (Net of Rebates) were the largest TME service categories, each at $2.0B, followed by Hospital Outpatient at $1.7B, Physician at $1.4B, and Long-Term Care at $1.3B.

“The benchmark trend report is an important tool for raising awareness and spurring dialogue regarding the level and type of health care spending occurring in Delaware,” said DHSS Cabinet Secretary Josette Manning. “A billion dollar increase in total health care expenditures in just one calendar year is significant, concerning, and unsustainable, especially in a time when states can no longer rely on federal healthcare funding. The Diamond State Hospital Cost Review Board will play a critical role in monitoring hospital expenses as we continue to work to ensure the greatest possible value in both cost and quality of care for the people of Delaware.”

Quality benchmarks

In addition to the spending benchmark, Delaware also tracks several quality measures against an established annual quality benchmark.

Delaware did better than the benchmark in two quality measures in CY 2023:

• Use of Opioids at High Dosage improved by 0.8 percentage points in CY 2023 and was 0.4 percentage points below the benchmark for this measure where lower is better.
• Breast Cancer Screening exceeded the CY 2023 benchmark by 1.0 percent among patients covered by Delaware’s commercial market. However, in this measure where a higher number is better, among patients covered by the Medicaid market, screenings were 2.9 percent below the CY 2023 benchmark.

Results improved in both the adult obesity and opioid-related overdose deaths per 100,000 measures, although neither measure met the CY 2023 benchmark.

• Adult Obesity decreased by 2.3% in CY 2023 and was 4.4 percentage points above the benchmark (lower result is better).
• Opioid-Related Overdose Deaths decreased by 2.7 deaths per 100,000 in CY 2023 but were 14.5 deaths per 100,000 higher than the CY 2023 benchmark (where a lower number is better).

The State failed to meet the benchmark in other quality measures:

• Emergency Department Utilization increased by 1.1 visits per 100,000 and trended 11.1 visits per 100,000 higher than the CY 2023 benchmark (lower is better).
• Persistence of Beta Blocker Treatment after Heart Attack in the commercial market was 14.9 percentage points lower than the CY 2023 benchmark (higher number better); the Medicaid market for this measure remained consistent from Cy 2021 to CY 2022, but was 20.8 percentage points lower (worse) than benchmark in CY 2023.
• Stain Therapy for Patients with Cardiovascular Disease increased from CY 2022 in the commercial market (higher better), but not enough to exceed the CY 2023 benchmark. The Medicaid market was 6.1 percentage points lower (worse) than the CY 2023 benchmark.
• Colorectal Cancer Screening improved from CY 2022 in the commercial market, but did not meet the CY 2023 benchmark. This measure was added for the Medicaid market after the benchmarks were set and will be included in the next benchmarking cycle.

Set by the Delaware Economic and Financial Advisory Committee (DEFAC) Health Care Spending Benchmark Subcommittee, the spending benchmark is a target value for the change from the prior calendar year in state-level per capita total health care expenditures. The methodology incorporates both healthcare and macroeconomic trends. For this report, DHSS collected final/refreshed CY 2022 and new CY 2023 data from commercial, Medicaid and Medicare insurers, as well as from the Veterans Health Administration and the Net Cost of Private Health Insurance.

An interactive quality and spending dashboard updated to include the CY 2023 trend report data released today is available at https://dhss.delaware.gov/dhcc/global.html.

NEW CASTLE – The Delaware Department of Health and Social Services (DHSS) announced today enhancements to the CostAware website, designed to help Delawareans understand how their health care dollars are spent by comparing the variation of average costs for different episodes of care and medical services based on actual medical claims in Delaware.

In early 2020, DHSS and the Delaware Health Care Commission (DHCC) began working with Delaware Health Information Network (DHIN) to develop and implement various health care cost and quality analyses. These analyses leverage data in the Delaware Health Care Claims Database (HCCD), established through legislation passed by the General Assembly in 2016. DHIN manages the HCCD and DHSS uses it to inform and support a variety of health care policy initiatives.

The newest CostAware updates include the addition of data for calendar year 2022 and Medicare Fee For Service (FFS) beneficiaries, an enhanced report comparing costs for brand and generic prescription drugs by drug class and payer category (commercial insurance, Medicaid, Medicare), and new reports for treatment of psychosis and cervical cancer screening.

• New Data: This CostAware release includes results based on analysis of 2022 claims data. Results for 2023 claims data will be added before the end of this calendar year.
• Prescription Drug Costs compares the average daily cost of brand and generic drugs in Delaware by drug class and payer category based on 2022 pharmacy claims data. The enhanced report adds the ability to view results by gender and age group. Prescription drugs are identified by National Drug Code (NDC) and grouped into classes assigned based on the condition the drug is intended to treat.
• Psychosis is a new report that compares the average cost to treat psychosis episodes grouped by diagnosis (report in development, more details soon).
• Cervical Cancer Screening is a new quality focused report that highlights variation in the rate of cervical cancer screening (report in development, more details soon).

“Delawareans can now view additional data and compare costs for brand and generic prescription drugs to help make better decisions around their health care,” said DHSS Cabinet Secretary Josette Manning, who is also a member of the Delaware Health Care Commission. “CostAware continues to be a valuable tool to provide transparency around the health care dollars that are spent by Delawareans and their insurers.”

The most recent version of CostAware (last updated in September 2023) also includes:

• Average costs for episodes of care including C-section births, emergency department visits, knee and hip replacement, and vaginal delivery reported for Delaware hospitals.
• Average costs of imaging procedures including head CT, lumbar spine MRI, and screening mammography by care setting and for Delaware imaging centers.
• Average cost per visit for medical services including child wellness visits, mental and behavioral health services, diabetes care, cardiac procedures, adult doctor visits, and lab tests (blood and urine tests).
• Results reported by care setting including hospital outpatient facility, outpatient lab, professional office, urgent care facility, and telehealth.
• Multiple years of data: Results are reported for calendar years 2019 through 2022.
• Filtering of results by insurance category (commercial insurance, Medicaid, Medicare) and patient age group and gender (as appropriate)

Early in his administration, Governor John Carney said one of the most important things he could do as Governor is to slow the growth of health care spending. The State health care spending benchmark—an annual per-capita-rate-of-growth benchmark for health care spending and multiple health care quality measures that are to be evaluated and adjusted every three years – was established through Executive Order 25 signed by Governor Carney in November 2018 and codified in August of 2023 through House Amendment 1 for House Bill 442. In the most recent benchmark trend report released May 2024 for calendar year 2022, the per capita health care spending in Delaware increased 6.3% to $9,657, outpacing a 3% growth rate benchmark.

The CostAware website was developed by DHSS and DHCC in collaboration with DHIN.

NEW CASTLE (May 7, 2024) – Per capita health care spending in Delaware increased 6.3% in 2022 to $9,657, outpacing a 3% growth rate benchmark, according to the State of Delaware’s fourth annual Benchmark Trend Report presented Thursday May 2 to the Delaware Health Care Commission (DHCC) by Department of Health and Social Services (DHSS) Secretary Josette Manning.

Along with tracking the year-over-year percentage change in total health care expenditures expressed on a per capita basis, the benchmark report also reflects data trends on nine health care quality measures and offers insight on health disparities to guide efforts to improve health equity throughout the State.

Annual trend reports dating back to the initial release in 2019 reflect continued per-capita growth in health care spending beyond established benchmarks. That year, spending grew at a rate of 5.8%, exceeding a 3.8% spending benchmark. While a 3.5% benchmark was met in calendar year 2020, in 2021, reflecting the rebound from the COVID-19 pandemic, health care spending grew at a rate of 11.2% compared to a benchmark of 3.25%.

The 6.3% per capita increase in 2022 is significant, but there was an expectation of some continuing health care spending rebound effect in the post-pandemic period. Moving forward into 2023 and beyond, DHSS expects Delaware’s health care market to be in a steadier state.

“We recognize the economic burden of the rising costs of health care and the benchmark continues to be a valuable tool for the State to compare health care spending year over year, and drive targeted initiatives to improve health care delivery,” Secretary Manning said. “This report shows us there is still significant work to be done to improve the health outcomes of Delawareans.”

Quality benchmark results

The 2022 Trend Report also provides insight into Delaware’s health care quality on nine quality measures with data able to be analyzed by age, gender, and race/ethnicity for greater insight on health disparities. While the most recent report does show some improvement in use of opioids at high dosages, as well as the use of statin therapy for patients with cardiovascular disease, and both breast and colorectal cancer screenings for patients with commercial coverage, opportunities to meet benchmark continue to exist in most areas. Of note given recent reports of a concerning spike in drug overdoses in Sussex and Kent counties, the quality measures underscore urgency regarding Substance Use Disorder/Opioid Use Disorder Outcomes in Delaware.

Three of the measures – Breast Cancer, Cervical and Colorectal Cancer Screening – are new to the 2022 cycle of quality benchmarking.

Overview of Quality Results:

• Adult obesity: The benchmark for 2022 was to reduce the percentage of Delaware adults who are obese to 31.9%. The 2022 result: 37.9%; an increase from 2021, and still 6.0 percentage points higher than the benchmark.
• Use of opioids at high dosages: The 2022 benchmark: 10.8%; the 2022 result: 10.4%. This is a positive observation.
• Opioid-related overdose deaths: The benchmark for 2022 was to reduce the mortality rate to 38.0 deaths per 100,000. The 2022 result: 50.2 deaths per 100,000. This is an increase from 2021 and is well-above the benchmark.
• Emergency department utilization: The benchmark for 2022 was to reduce Emergency department utilization to 160.7 visits per 1,000. The 2022 result: 168.4 visits per 1,000. The 2022 result is worse than 2021 and is higher (worse) than the benchmark.
• Persistence of beta-blocker treatment after a heart attack: The benchmark rate for 2022 was to increase the percentage of patients who receive beta-blocker treatment to 86.8% of commercial insurance patients and to 83.0% for Medicaid patients. The 2022 results: 76.5% for commercial insurance patients and 80.6% for Medicaid patients. Neither the commercial nor Medicaid results met the benchmark; however, Medicaid results remain consistent between 2021 and 2022.
• Statin therapy for patients with cardiovascular disease: The benchmark rate for 2022 was to increase the percentage of patients who receive statin therapy to 83.1% of commercial insurance patients and 73.1% for Medicaid patients. The 2022 results: 82.0% for commercial insurance patients; 64.5% for Medicaid patients. Neither market met the benchmark, but there was improvement in the commercial results from 2021.
• Breast Cancer Screening: The new benchmark rate for 2022 was to increase the percentage of patients who receive breast cancer screening to 75.7% of commercial patients and 57.9% for Medicaid patients. The 2022 results: 77.0% for commercial insurance patients; 53.8% for Medicaid patients. The commercial results exceeded the 2022 benchmark.
• Cervical Cancer Screening: The new benchmark rate for 2022 was to increase the percentage of patients who receive cervical cancer screening to 76.2% of commercial patients and 55.1% for Medicaid patients. The 2022 results: 74.1% for commercial insurance patients; 52.6% for Medicaid patients. Neither market met the benchmark in the first year of reporting.
• Colorectal Cancer Screening: The new benchmark rate for 2022 was to increase the percentage of patients who receive cervical cancer screening to 61.0% of commercial patients. The 2022 results: 62.3% for commercial insurance patients. This is a positive observation.

The State health care spending benchmark—an annual per-capita-rate-of-growth benchmark for health care spending and multiple health care quality measures that are to be evaluated and adjusted every three years—was established through Executive Order 25 signed by Governor John Carney in November 2018 and codified in August of 2023 through House Amendment 1 for House Bill 442.

To learn more about the health care spending and quality benchmarks, visit the Health Care Commission website.

NEW CASTLE (February 12, 2024) – The Delaware Department of Health and Social Services and the Delaware Health Care Commission have launched the Benchmark Trend Report Dashboard to further support the State’s efforts to improve health care quality for all residents, while simultaneously working to monitor and reduce the economic burden of health care spending.

This dashboard allows an interactive view of Delaware’s health care spending and quality data comparing across multiple years. Users can directly interact with the data and visualizations, allowing a customizable journey through the dashboard. Information is broken down by state-, market- and insurer -level spending as well as type of insurance and total healthcare enrollment.

The spending and quality benchmarks were originally developed to support Governor John Carney’s vision for the State. In November 2018, Governor Carney signed Executive Order 25, establishing a state health care spending benchmark, an annual per-capita-rate-of-growth benchmark for health care spending, and multiple health care quality measures that are to be evaluated and adjusted every three years. The benchmarks were subsequently codified in August of 2022 through House Bill 442.

“Our goal of ensuring that Delawareans can access and afford quality health care is only possible when agencies across the State work collectively to pursue answers and solutions,” said DHSS Cabinet Secretary Josette Manning. “The benchmarks are a means to continue the conversation about how to decrease the cost of care and improve quality for the individuals we serve.”

To learn more about Delaware’s health care spending and quality benchmarks, visit the Delaware Health Care Commission website at https://dhss.delaware.gov/dhcc/.

NEW CASTLE – The Delaware Department of Health and Social Services (DHSS) announced today enhancements to the CostAware website, designed to help Delawareans understand how their health care dollars are spent by comparing the variation of average costs for different episodes of care and medical services based on actual medical and pharmacy claims in Delaware.

The newest CostAware enhancements include cost comparisons for brand and generic prescription drugs by drug category and payer type (commercial insurance, Medicaid, Medicare Advantage). Also added in this update are average cost comparisons for imaging procedures (head CT, lumbar spine MRI, and screening mammography) by provider organization.

• Prescription Drug Costs compares the average daily cost of brand and generic drugs in Delaware by category and payer type based on 2021 pharmacy claims data. Prescription drugs are identified by National Drug Code (NDC) and grouped into categories assigned based on the condition the drug is intended to treat.
• Imaging by Provider Organization shows the average cost of imaging procedures by payer type, claim year and provider organization. Estimates reflect both the facility cost (taking the image) and professional cost (reading and interpreting the image).

“Delawareans can now compare costs for prescription drugs by drug category and imaging procedures by provider organization to help them make better decisions around their health care,” DHSS Secretary Josette Manning said. “CostAware has served as a valuable tool for Delawareans since its launch in April 2022. These additional data enhancements will bring another layer of transparency around the health care dollars being spent by Delawareans and their insurers.”

In addition to the prescription drug and imaging procedure cost reports, the most recent version of CostAware includes:

• Average cost estimates for episodes of care including C-section births, emergency department visits, knee and hip replacement, and vaginal delivery reported for Delaware hospitals.
• Estimates of the average cost per visit for medical services including child wellness visits, mental and behavioral health services, diabetes care, cardiac procedures, adult doctor visits, and lab tests (blood and urine tests).
• Results reported by care setting including hospital outpatient facility, outpatient lab, professional office, urgent care facility, and telehealth.
• Multiple years of data: Results are reported for 2019, 2020 and 2021.
• Filtering of results by insurance category (Commercial insurance, Medicaid, Medicare Advantage) and patient age range and gender (as appropriate).

The CostAware website was developed by DHSS and the Delaware Health Care Commission (DHCC) in collaboration with Delaware Health Information Network (DHIN).

In early 2020, DHSS and DHCC began working with DHIN to develop and implement various health care cost and quality analyses. These analyses leverage data in the Delaware Health Care Claims Database (HCCD), which was established through legislation passed by the General Assembly in 2016. DHIN manages the claims database and DHSS uses it to inform and support a variety of policy initiatives.