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 (April 6, 2023) – Department of Health and Social Services (DHSS) Secretary Molly Magarik presented the State’s third annual Benchmark Trend Report at today’s Delaware Health Care Commission (DHCC) meeting. This report displays trends in Delaware’s health care spending and quality, comparing new 2021 data against a set benchmark, as well as baseline data from 2019 and 2020. This report continues 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.

In November 2018, Governor John 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. This Benchmarking program was codified in August of 2023 through House Amendment 1 for House Bill 442.

The first spending benchmark went into effect on Jan. 1, 2019, and was set at 3.8%. That spending benchmark was not met, as the finalized health care spending for 2019 grew at a rate of 5.8%. For calendar year 2020, the spending benchmark was set at a more ambitious target of 3.5%, which was met as the Total Health Care Expenditures (THCE) per-capita change from the prior year was estimated at -1.2%. Delaware’s spending benchmark is the year-over-year percentage change in total health care expenditures (THCE) expressed on a per capita basis.

For Calendar Year 2021, the spending benchmark was set at a 3.25 percent growth rate. Delaware’s total Calendar Year 2021 THCE was approximately $9.1 billion. The per capita amount was $9,088, which represents a 11.2% year-over-year increase.

The 11.2% per capita increase is significant, but this figure reflects Delaware’s health care market rebounding from the reduction in health care spending and utilization in Calendar Year 2020 caused by the COVID-19 pandemic.

“While the increase in per capita health care spending is significant, it was not surprising as this figure reflects Delaware’s health care market rebounding from the reduction in health care spending and utilization in 2020 caused by the COVID-19 pandemic,” said Secretary Magarik. “We know many Delawareans delayed preventive health care services or procedures at the height of the pandemic in 2020. As individuals started to return to schedule those services in 2021, we anticipated that the spending growth would increase as well. While we must continue to view these data in context of the extraordinary circumstances faced during the

pandemic, the benchmark will continue to be a valuable tool in comparing health care spending year over year, and driving targeting initiatives to improve health care delivery.”

The 2021 Trend Report also provides insight into Delaware’s health care quality by presenting data on six quality measures.

The quality results for 2021 were similar to 2020. While Delaware made progress in some important measures, the report shows us there is still significant work to be done to improve the health of Delawareans in other areas. For the 2021 Trend Report, additional quality data stratifications and demographic information related to age, gender, and race/ethnicity were requested from the carriers. The request for additional stratifications came from Commissioner feedback during last year’s Trend Report presentation and has since been incorporated into the process and will continue to be shared as data is available. It is the hope of the Commission that this additional data will help provide more insight in health disparities and improve health equity throughout the State.

Overview of Quality Results

• Adult obesity: The benchmark for 2021 was to reduce the percentage of Delaware adults who are obese to 28.7%. The 2021 result: 33.9%; a decrease from 2020, but still 5.2 percentage points higher than the benchmark.
• Use of opioids at high dosages: The 2021 benchmark: 11.6%; the 2021 result: 9.6%. This is a positive observation.
• Opioid-related overdose deaths: The benchmark for 2021 was to reduce the mortality rate to 14.7 deaths per 100,000. The 2021 result: 48.1 deaths per 100,000. This is an increase from 2020.
• Emergency department utilization: The benchmark for 2021 was to reduce Emergency department utilization to 178 visits per 1,000. The 2021 result: 163 visits per 1,000. This is a positive observation.
• Persistence of beta-blocker treatment after a heart attack: The benchmark rate for 2021 was to increase the percentage of patients who receive beta-blocker treatment to 87.2% of commercial insurance patients and to 83.1% for Medicaid patients. The 2021 results: 88.5% for commercial insurance patients and 80.7% for Medicaid patients. While the Medicaid patients did not reach the benchmark, this is an improvement from the 2020 results of 78.1%.
• Statin therapy for patients with cardiovascular disease: The benchmark rate for 2021 was to increase the percentage of patients who receive statin therapy to 81.0% of commercial insurance patients and 63.8% for Medicaid patients. The 2021 results: 81.8% for commercial insurance patients; 66.1% for Medicaid patients. For both markets, results were better than the respective benchmark.

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

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 (May 5, 2022) – Department of Health and Social Services (DHSS) Secretary Molly Magarik presented the State’s second annual Benchmark Trend Report at today’s Delaware Health Care Commission (DHCC) meeting. This report displays trends in Delaware’s health care spending and quality, comparing new 2020 data against a set benchmark, as well as baseline data from 2019. This report continues 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.

In November 2018, Governor John 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 first spending benchmark went into effect on Jan. 1, 2019, and was set at 3.8%. That spending benchmark was not met, as the finalized health care spending for 2019 grew at a rate of 5.8%. For calendar year 2020, the spending benchmark was set at a more ambitious target of 3.5%. This benchmark was met as the 2020 Total Health Care Expenditures (THCE) per-capita change from the prior year was estimated at -1.2%. Total expenditures encompass health care spending associated with Delaware residents from private and public sources. Total Health Care Expenditures increased by $39 million in calendar year 2020, totaling $8.1 billion. However, with Delaware’s population increasing by 1.7% from 2019 to 2020, the per-capita total decreased from $8,268 in 2019 to $8,173 in 2020.

“While the decreases in per-capita health care spending and the spending growth rate appear at first glance as a positive change, it is important to note that the COVID-19 pandemic had a significant impact on preventative health care services, health care facility utilization, service delivery, and payer/provider finances,” Secretary Magarik said. “These benchmark findings need to be viewed in the context of the extraordinary circumstances we faced in 2020. And that makes equitable comparisons with previous calendar years extremely difficult.”

“The report continues to showcase the need to lower costs and improve quality in Delaware,” said Steven Costantino, DHSS’ Director of Health Care Reform. “We need to continue to move toward a more value-based care system so that health care is more affordable for all Delawareans. The benchmark has proven to be a useful tool in driving reform and targeting initiatives to improve health care delivery.”

The 2020 Trend Report also provides insight into Delaware’s health care quality by presenting data on six quality measures.

“Unfortunately, the results of the quality measures are mixed,” Secretary Magarik said. “While Delaware made progress in some important measures, the report shows us there is still significant work to be done to improve the health of Delawareans in other areas. At DHSS, we look forward to working with health care providers, insurers, legislators, businesses, other government leaders and, most importantly, consumers to help build a healthier Delaware.”

Overview of Quality Results:

• Adult obesity: The benchmark for 2020 was to reduce the percentage of Delaware adults who are obese to 29.4%. The 2020 result: 36.5%; an increase from 2019 and 7.1 percentage points higher than the benchmark.
• Use of opioids at high dosages: This is a new benchmark for 2020, which used the Delaware Prescription Monitoring Program to observe the rate at which high-dose opioids were prescribed. The 2020 benchmark: 12.4%; the 2020 result: 11.1%. This is a positive observation.
• Opioid-related overdose deaths: The benchmark for 2020 was to reduce the mortality rate to 15.5 deaths per 100,000. The 2020 result: 43.9 deaths per 100,000. This is an increase from 2019.
• Emergency department utilization: The National Committee for Quality Assurance (NCQA) significantly changed the methodology for this quality measure, so it was given first-year status and no calendar year 2020 data was reported.
• Persistence of beta-blocker treatment after a heart attack: The benchmark rate for 2020 was to increase the percentage of patients who receive beta-blocker treatment to 84.9% of commercial insurance patients and to 80.1% for Medicaid patients. The 2020 results: 91.7% for commercial insurance patients and 78.1% for Medicaid patients. While the Medicaid patients did not reach the benchmark, this is a significant improvement from the 2019 results of 73.5%.
• Statin therapy for patients with cardiovascular disease: The benchmark rate for 2020 was to increase the percentage of patients who receive statin therapy to 80.5% of commercial insurance patients and 61.5% for Medicaid patients. The 2020 results: 83.6% for commercial insurance patients; 72.6% for Medicaid patients. For both markets, results were better than the respective benchmark.

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

Latest Step in Effort to Reduce Cost, Improve Quality of Care in Delaware

DOVER (April 1, 2021) – Department of Health and Social Services (DHSS) Secretary Molly Magarik presented the state’s first Benchmark Trend Report at today’s Delaware Health Care Commission (DHCC) meeting, summarizing health care spending and quality data collected for calendar year 2019. The report is the latest step in the state’s effort to reduce health care spending and improve quality of care for Delawareans.

The Benchmark Trend Report details total health care spending for 2019 and compares it to baseline data collected for 2018. In late 2018, Governor John Carney 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.

For calendar year 2019, the report found overall health care spending in Delaware totaled $8.2 billion vs. $7.6 billion for 2018. The per-capita cost increased from $7,814 in 2018 to $8,424 in 2019, or 7.8% – more than twice as high as the 3.8% target. Spending in 2019 increased across all spending categories, including the five largest:

• Hospital inpatient: $1.8 billion (up from $1.6 billion in 2018)
• Hospital outpatient: $1.6 billion (up from $1.4 billion in 2018)
• Physician: $1.3 billion (up from $1.2 billion in 2018)
• Pharmacy: $1.2 billion (up from $1.1 billion in 2018)
• Long-term care: $1.1 billion (up from $1 billion in 2018)

“This kind of transparency and public awareness of health care spending is important for everyone in the system – health care providers, consumers, taxpayers, insurers and businesses,” said Secretary Magarik, a member of the Health Care Commission. “The next step is to work with health care providers, insurers, government agencies and consumers to transform the delivery of health care away from volume-based case to value-based care to be consistent with the overall economic growth of the state.”

The report also provided results on six health care quality measures; Delaware improved on two measures, split on one measure, and worsened on three others:

Improved

Adult tobacco use: The benchmark rate for 2019 was to reduce the percentage of Delaware adults who smoke to 17.1%. The 2019 result: 15.9%.
Statin therapy for patients with cardiovascular disease: The benchmark rate for 2019 was to increase the percentage of commercial insurance patients who receive statin therapy to 79.9% and for Medicaid patients to 59.2%. The 2019 results: 85.3% for commercial insurance patients; 65.1% for Medicaid patients.

Split

Persistence of beta-blocker treatment after a heart attack: The benchmark rate for 2019 was to increase the percentage of commercial insurance patients who receive beta-blocker treatment to 82.5% and to 78.8% for Medicaid patients. The 2019 results: 93.9% for commercial insurance patients, but 73.5% for Medicaid patients.

Worsened

Adult obesity: The benchmark for 2019 was to reduce the percentage of Delaware adults who are obese to 30%. The 2019 result: 34.4%.
Opioid-related overdose deaths: The benchmark for 2019 was to reduce the mortality rate to 16.2 deaths per 100,000. The 2019 result: 43 deaths per 100,000.
Emergency department utilization: The benchmark for 2019 was to reduce the rate to 190 visits per 1,000. The 2019 result: 193.2 visits per 1,000.

“While we made progress as a state in reducing adult tobacco use and increasing the use of statins for patients with heart disease, we have much more work to do reduce the adult obesity rate, deaths from opioid overdoses and emergency department utilization,” Secretary Magarik said. “Working together, I know we can make more progress in improving the overall health of Delawareans.”

The Delaware Health Care Commission previously collected spending data from calendar year 2018 to provide a preliminary basis for calculating the state’s health care spending performance and to serve as a baseline for the 2019 spending growth calculations. The 2018 baseline data collection also allowed the state’s health insurers and the DHCC to test payers’ data-submission methods and identify areas for improvement.

The release of the 2019 spending and quality data is another step along the state’s “Road to Value” initiative to improve access to affordable, quality health care for all Delawareans. That effort remains critically important even as Delaware responds to the COVID-19 crisis, Secretary Magarik said.

“As our state continues to respond to the global pandemic, we will need to support the health care system with value-based goals, knowing that too many Delawareans have put off their health care needs,” Secretary Magarik said. “The Benchmark Trend Report will help us to focus those goals.”

The Heath Care Commission is accepting written public comments on the Benchmark Trend Report through Friday, April 9, at: DHCC@delaware.gov. To learn more about Delaware’s health care spending and quality benchmarks, visit the Delaware Health Care Commission website.