CostAware Compares Health Care Costs Based on Delaware Medical Claims

NEW CASTLE (March 3, 2023) – The Delaware Department of Health and Social Services (DHSS) announced today the launch of a new version of its 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 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), 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.

The initial version of CostAware, launched in April 2022, compared hospital costs for several common episodes of care at six unnamed hospital systems: cardiac procedures, C-section birth, emergency department visits, knee and hip replacement, and vaginal delivery. The costs across five accountable care organizations (ACOs) are also compared for seven common services: blood count, colonoscopy, doctor visits, hemoglobin A1c, head CT, lumbar spine MRI and screening mammography.

In addition to the above data, this version of CostAware includes the following enhancements:

• Average cost estimates for episodes of care reported for named Delaware hospitals.
• Estimates of the average cost per visit for additional medical services, including child wellness visits, mental and behavioral/health services, diabetes care, cardiac investigations and procedures, doctor visits by complexity, and lab tests (blood and urine tests).
• Results reported by type of care setting (e.g., hospital outpatient facility, outpatient lab, professional office, urgent care facility, and telehealth) to facilitate additional comparisons.
• Additional years of data included – 2020 and 2021 were added to the 2019 data used for CostAware 1.0.
• Trend visualizations, with multiple years of data, show changes over time in average cost, quality, and other measures.
• Improved filtering of results by insurance category (Commercial, Medicaid, Medicare Advantage) and patient age range and gender (as appropriate).

“Since its launch last year, CostAware has served as a valuable tool in highlighting the variation in the cost, utilization, and quality of health care in Delaware,” said DHSS Secretary Molly Magarik, who is also a member of the Delaware Health Care Commission. “We are excited for these additional data enhancements, as they add yet another layer of transparency and awareness around the health care dollars that are spent by Delawareans and their insurers.”

CostAware also includes quality measures, including the readmission and utilization rates, and patient satisfaction scores, all from the Centers for Medicare and Medicaid Services (CMS) as part of its Hospital Compare and Medicare Shared Savings Program initiatives. Each episode of care and service can be filtered further by the type of insurance: commercial, Medicare Advantage and Medicaid.

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. In late 2018, the Governor signed Executive Order 25, establishing a state health care spending benchmark, a per-annum rate-of-growth benchmark for health care spending, and several health care quality measures. The first spending benchmark went into effect on Jan. 1, 2019, and was set at 3.8%, with the target expected to decrease gradually to 3% over the following three years. The first benchmark report measured the growth rate at 7.8% for 2019, or more than twice the 3.8% target. This has proven to be an invaluable initiative, which lead to it being codified in 2022 through House Amendment 1 for House Bill 442.

The CostAware website was developed by DHSS and the Health Care Commission in collaboration with DHIN.

NEW CASTLE (April 7, 2022) – The Department of Health and Social Services (DHSS) has launched a new website called CostAware 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.

Hospital costs are compared for five common episodes of care at six hospital systems: cardiac procedures, C-section birth, emergency department visits, knee and hip replacement, and vaginal delivery. The costs across five accountable care organizations (ACOs) are also compared for seven common services: blood count, colonoscopy, doctor visits, hemoglobin A1c, head CT, lumbar spine MRI and screening mammography. The rates are based on 2019 medical claims in the Delaware Health Care Claims Database and reflect the cost that consumers and their insurers actually paid for the care.

In addition, quality measures are provided, including the readmission and utilization rates, and patient satisfaction scores, all from the Centers for Medicare and Medicaid Services (CMS) as part of its Hospital Compare and Medicare Shared Savings Program initiatives. Each episode of care and service can be filtered further by the type of insurance: commercial, Medicare Advantage and Medicaid.

“This kind of transparency and public awareness of health care spending is important for everyone in the system – consumers, health care providers, taxpayers, insurers and businesses,” said DHSS Secretary Molly Magarik, who is also a member of the Delaware Health Care Commission. “We all want good value for the health care dollars we do spend. CostAware offers a glimpse into the actual costs that Delawareans and their insurers are paying, and the quality measures associated with that care.”

In this initial version of CostAware, the Delaware hospital systems and accountable care organizations are not identified. Secretary Magarik said she hopes to include that information in future versions of the website.

The site also breaks down the average monthly cost of care for each member of an accountable care organization and the top procedures for several age and gender groups based on overall volume and dollar volume.

In early 2020, DHSS and the Delaware Health Care Commission began working with the 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), 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.

CostAware is the result of goals from that partnership that include expanding the claims database analysis, measurement and reporting capabilities to increase transparency; highlighting variation in health care system performance; adding to consumers’ knowledge base; and identifying opportunities to improve quality and reduce costs for Delaware residents.

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. In late 2018, the Governor signed Executive Order 25, establishing a state health care spending benchmark, a per-annum rate-of-growth benchmark for health care spending, and several health care quality measures. The first spending benchmark went into effect on Jan. 1, 2019, and was set at 3.8%, with the target expected to decrease gradually to 3% over the following three years. The first benchmark report measured the growth rate at 7.8% for 2019, or more than twice the 3.8% target.

The CostAware website was developed by DHSS and the Health Care Commission in collaboration with DHIN.

NEW CASTLE (Sept. 7, 2021) – The Biden Administration has awarded Delaware $10,831,203 through the Centers for Medicare & Medicaid Services (CMS) to improve access to affordable, comprehensive health insurance coverage through its section 1332 state-based reinsurance waiver. Delaware is one of 13 states to receive these funds, also known as “pass-through funding,” which are available to states with approved section 1332 waivers that also have lowered premiums in implementing their waiver plans.

“We are grateful to the Biden Administration for acknowledging the progress of our reinsurance program in making health insurance more affordable and more accessible on the individual market,” Governor John Carney said. “During the COVID-19 pandemic, it is even more important that Delawareans have access to affordable coverage.”

In June 2019, Governor John Carney signed enabling legislation to create a reinsurance plan in Delaware, and in August 2019, CMS authorized the program. Under Delaware’s reinsurance program, which began Jan. 1, 2020, a portion of high-cost health care claims that drive up insurance rates for everyone on the individual market are reimbursed through a fund. The fund uses a mix of federal funding and assessments collected by the Delaware Department of Insurance from health insurance carriers. The Delaware Health Care Commission administers the program.

Delaware’s reinsurance plan, which is authorized by the federal government through 2024, has lowered premiums on the Health Insurance Marketplace on average more than 19% in the first two years. In addition to reducing premiums on the marketplace, the reinsurance program benefits anyone who buys coverage on the individual market, including people who are not eligible for coverage at their workplace, those who are too young for Medicare or make too much money to be eligible for Medicaid, young people who have aged off their parents’ plans, or those who are self-employed.

As a result of changes made in the American Rescue Plan Act of 2021 (ARP), residents in Delaware and the other 12 states implementing reinsurance waivers may have access to more affordable health insurance coverage. States will also have more pass-through funding to implement their waiver, and they may also have their own state funding—that otherwise might have been spent on 2021 reinsurance costs–available to pursue innovative state strategies to further improve affordability.

These funds, also known as “pass-through funding,” are determined on an annual basis by the Department of Health and Human Services and the Department of the Treasury.

The additional funds announced by CMS range from $2.5 million to $139 million per state – varying based on factors such as the size of the state’s reinsurance program. The funds are the result of expanded subsidies provided under the ARP, which will result in new individuals enrolled, and will cover a portion of the states’ costs for these reinsurance programs.

“This investment is a testament to our Administration-wide commitment to making health care more accessible and affordable,” said HHS Secretary Xavier Becerra. “This funding from the American Rescue Plan will reduce monthly health care costs for consumers, increase coverage, and provide more options. We will continue to work with states to strengthen the health care system as we respond to the COVID-19 pandemic.”

“Reducing a family or individual’s average monthly health coverage costs frees up that money for other needs,” said CMS Administrator Chiquita Brooks-LaSure. “The Biden-Harris Administration continues to work with states to reduce costs and deliver more affordable health coverage options. This is another example of how the American Rescue Plan is helping more people meet their health care needs.”

States with approved section 1332 state-based reinsurance waivers have experienced reduced premiums in the individual market. Delaware’s next open enrollment on the Health Insurance Marketplace will be Nov.1-Dec. 15 for coverage beginning in 2022.

Beyond reduced premiums, section 1332 state-based reinsurance waivers may help states maintain and increase issuer participation, and may increase the number of qualified health plans (QHPs) available from year to year.

NEW CASTLE (March 26, 2021) – The Department of Health and Social Services (DHSS) has updated its guidance to Delaware’s long-term care facilities following recent federal recommendations that allow for expanded indoor visitation during the COVID-19 pandemic.

The guidance was updated last week and was sent to the state’s 86 long-term care (LTC) facilities; it can be found here. The updated guidelines follow the release earlier this month of revised visitation recommendations by the Centers for Medicare & Medicaid Services in response to reductions in COVID-19 infections and transmission and increased vaccination rates in the nursing home population.

“As COVID-19 cases and hospitalizations decrease in Delaware and our vaccinations increase, we know that families and close friends of residents of nursing homes and assisted-living facilities are eager to have in-person indoor visitation with their loved ones once again,” DHSS Secretary Molly Magarik said. “We are pleased that our Division of Health Care Quality and Division of Public Health have come up with a reopening and visitation plan that supports long-term care facilities in making that happen.”

Highlights of the guidance include:

Indoor visitation

• LTC facilities should allow and support indoor visitation for all residents regardless of vaccination status, with certain exceptions when visitation should be limited for the following residents because of a high risk of COVID-19 transmission:
  • Unvaccinated residents, if the nursing home’s COVID-19 county positivity rate is greater than 10 percent and fewer than 70 percent of residents in the facility are fully vaccinated;
  • Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue transmission-based precautions;
  • Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.

• LTC facilities should use the COVID-19 county positivity rate as additional information to determine how to facilitate indoor visitation.
• LTC facilities should consider how the number of visitors per resident at one time and the total number of visitors in the facility at one time (based on the size of the building and physical space) will affect the ability to maintain the core principles of infection prevention consistent with CDC guidance. If necessary, facilities should consider scheduling visits for a specified length of time to help ensure all residents are able to receive visitors.
• Visitors should go directly to the resident’s room or designated visitation area, and visitor movement in the LTC facility should be limited.
• Visits for residents who share a room should not be conducted in the resident’s room, if possible. For situations where there is a roommate and the health status of the resident prevents leaving the room, facilities should attempt to enable in-room visitation while adhering to the core principles of COVID-19 infection prevention.
• If a resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after. Regardless, visitors must physically distance from other residents and staff in the facility.

Required visitation

• An LTC facility may not restrict visitation without a reasonable clinical or safety cause, consistent with federal and state regulations regarding rates of COVID-19 positivity in the county and the facility, and the rate of immunization among residents.
• Residents who are on transmission-based precautions for COVID-19 should only receive visits that are virtual, through windows, or in-person for compassionate care situations, with adherence to transmission-based precautions.

Outdoor visitation

• Outdoor visits are preferred even when the resident and visitor are fully vaccinated against COVID-19. Visits should be held outdoors whenever practicable.
• Aside from weather considerations or an individual’s health status, outdoor visitation should be routinely facilitated.
• LTC facilities should have a process to limit the number and size of visits simultaneously to support safe infection prevention practices.

Compassionate Care Visits

• Compassionate care visits should be allowed at all times regardless of a resident’s vaccination status, the county’s positivity rate, or an outbreak.
• The term “compassionate care visit” does not exclusively refer to end-of-life situations. Examples of other types of compassionate care situations include, but are not limited to:
  • A resident, who was living with their family before recently being admitted to a LTC facility, is struggling with the change in environment and lack of physical family support.
  • A resident who is grieving after a friend or family member recently passed away.
  • A resident who needs cueing and encouragement with eating or drinking, previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration.
  • A resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).
• In addition to family members, compassionate care visits can be conducted by any individual that can meet the resident’s needs, such as clergy or lay persons offering religious and spiritual support.
• Compassionate care visits should be conducted using social distancing; however, if a visitor and facility identify a way to allow for personal contact, it should only be done following all appropriate infection prevention guidelines, and for a limited amount of time.
• Fully vaccinated residents can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after.
• Visitors must physically distance from other residents and staff.
• LTC facilities should work with residents, families, resident representatives, and the state’s Long Term Care Ombudsman program through a person-centered approach, to identify the need for compassionate care visits.

Visitor Testing and Vaccinations

• Visitors should not be required to be tested or vaccinated (or show proof of such) as a condition of visitation.
• Although not required, facilities in medium- or high-positivity counties are encouraged to offer testing to visitors, if feasible.
• Facilities may encourage visitors to be tested on their own prior to coming to the facility (e.g., within 2–3 days).

The updated plan also includes sections on communal dining and activities and on indoor visitations during a COVID-19 outbreak. The state defines an outbreak as a single new COVID-19 infection in a facility staff or any LTC facility onset COVID-19 infection in a resident. A resident admitted to the facility with COVID-19 does not constitute a facility outbreak.

If members of the public find the visitation is not occurring as per the guidance, complaints can be filed with the Division of Health Care Quality:

• Phone: 1-877-453-0012
• Fax: 1-877-264-8516
• Online: https://dhss.delaware.gov/dhss/dhcq/mailform.html

To protect residents and staff, visitation was discontinued at Delaware’s long-term care facilities beginning in mid-March 2020, when the state’s first positive COVID-19 case was announced. Starting in June 2020, when positive COVID-19 cases and hospitalizations had declined in Delaware, eligible nursing homes and assisted-living facilities were able to submit plans for outdoor visitation. And in September 2020, eligible facilities could submit plans to resume indoor visitation. With the COVID-19 surge that began in December 2020, visitation was once again restricted until the end of February 2021.

NEW CASTLE (Sept. 26, 2019) – The Centers for Medicare and Medicaid Services (CMS) recently awarded the Delaware Department of Health and Social Services a $3.58 million planning grant to increase the treatment capacity of Medicaid providers to deliver substance use disorder treatment and recovery services to Delawareans in need.

Delaware was one of 15 states to receive the 18-month planning grants to increase addiction-related services through:

• An ongoing assessment of the SUD treatment needs of the state.
• Recruitment, training and technical assistance for Medicaid providers who offer SUD treatment or recovering services.
• Improved reimbursement for and expansion of the number or treatment capacity of Medicaid providers.

“We are grateful to the Centers for Medicare and Medicaid Services for providing this technical assistance to Delaware during the ongoing opioid crisis,” Gov. John Carney said. “We also appreciate the members of our congressional delegation supporting this critical work to increase our treatment capacity of Medicaid providers statewide.”

“With one in every four Delawareans being a Medicaid recipient, the need for treatment and recovery support is critical to stem this epidemic,” said Lt. Gov. Bethany Hall-Long. “The Behavioral Health Consortium is pleased we have our congressional delegation partnering with us to get more boots on the ground to save lives and expand care.”

“As our country continues to grapple with a deadly opioid epidemic, it is critical that we continue working to ensure that all those suffering from addiction have access to the life-saving treatment they need,” U.S. Sen. Tom Carper said. “By providing additional training and resources to Medicaid providers for substance use disorder treatment, we can help ensure that more Delawareans, regardless of their means or what community they live in, receive high-quality care.”

“As opioid-related deaths reach epidemic levels in Delaware and across the country, we need an all-hands-on-deck approach to stop this crisis. Already this year, we’ve lost over 200 Delawareans to suspected overdose deaths,” Sen. Chris Coons said. “This grant will allow the Department of Health and Social Services, along with Medicaid providers throughout the state, to focus on keeping our communities safe and bolstering our substance abuse treatment workforce.”

“Expanding treatment capacity and increasing resources to Medicaid providers is one of the most effective ways to combat the opioid epidemic in Delaware,” said U.S. Rep. Lisa Blunt Rochester. “These resources from CMS will be crucial in continuing to improve our addiction treatment and ultimately, save lives.”

The Medicaid planning grant helps to meet priorities for Delaware’s treatment system outlined in 2018 recommendations from researchers and clinicians at the Johns Hopkins Bloomberg School of Public Health. In April 2017, DHSS Secretary Dr. Kara Odom Walker had asked Johns Hopkins to conduct a review of Delaware’s addiction treatment system. In July 2018, the Johns Hopkins team issued a 33-page report that proposed four main strategies:

• Increase the capacity of the treatment system.
• Engage high-risk populations in treatment.
• Create incentives for quality care.
• Use data to guide reform and monitor progress.

“Across our country, Medicaid is the largest payer of addiction treatment services,” Secretary Walker said. “In Delaware, this planning grant will help us increase the capacity for Medicaid-provided treatment and recovery services for vulnerable people who are suffering from this chronic and complex brain disease.”

Dr. Elizabeth Brown, Medical Director for the Division of Medicaid and Medical Assistance, said the funding will be used for data analysis, a rate review and reimbursement redesign, expanding the provider pool, and stakeholder engagement.

If you or a loved one is struggling with substance use disorder, please call DHSS’ 24/7 Crisis Services Helpline to be connected to trained crisis professionals who can discuss treatment options. In New Castle County, call 1-800-652-2929. In Kent and Sussex counties, call 1-800-345-6785. Individuals and families also can visit DHSS’ website, www.HelpIsHereDE.com, to find addiction treatment and recovery services in Delaware and nearby states.

As of Sept. 24, the Division of Forensic Science has reported a total of 209 suspected overdose deaths in Delaware this year. There is always a lag in terms of both toxicology analyses and death determinations. In 2018, there were 400 overdose deaths across the state, an increase of 16 percent from the 2017 total of 345 deaths.

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The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.