Benchmark initiative will limit spending growth, improve quality of care

NEW CASTLE, Del. – The Delaware Economic and Financial Advisory Council (DEFAC) on Wednesday issued a recommended Benchmark Index that set the state’s health care spending growth target at 3.8 percent for 2019 – the initial year of Delaware’s newly created Health Care Spending Benchmark. This move furthers the state’s goals of managing the growth of future health care spending, increasing transparency into how health care is delivered and paid for, and improving the quality and cost of health care for the citizens of Delaware.

DEFAC set the target based on Executive Order 25 signed by Governor John Carney in November. The order called for the initial benchmark to be equivalent to the advisory Benchmark Index for overall State budget growth established under Executive Order 21 signed by the Governor in June 2018.

“We know that the rising cost of health care crowds out other important state investments, keeps companies from hiring, and makes it harder for families to manage their household budgets,” said Governor Carney. “This benchmark initiative is about providing Delawareans with more transparency around their own health care spending, and making sure that Delawareans are getting the quality of health care that they’re paying for. At the state level, Delaware taxpayers rightly expect us manage their money wisely. This initiative will help us do just that.”

“Establishing the health care spending benchmark is an important step forward in learning more about how health care dollars are spent in our state,” said Dr. Kara Walker, Secretary of the Delaware Department of Health and Social Services. “In order to meet the current and future health care needs of Delawareans, our system of providing and paying for care has to change in order to be sustainable. We look forward to working with health care providers, insurers, businesses and consumers as we move forward in improving the patient and provider experience, while improving the overall health of Delawareans and doing it at a lower cost.”

“Establishing the Health Care Spending Benchmark is a vital step in establishing realistic economic measures that provide meaningful insight toward producing optimal outcomes with the limited health care dollars available to the state, our citizens and the private sector,” said Rick Geisenberger, Secretary of the Delaware Department of Finance.

In subsequent years, Executive Order 25 requires the health care spending benchmark to be calculated based on long-term projections for growth in Potential Gross State Product (PGSP). Currently, long-term PGSP is forecast at 3 percent. The target approved today provides a transitional market adjustment with the benchmark starting at 3.8% and then gradually expected to decline to 3% over the next three years.

A Health Care Spending Benchmark Subcommittee of DEFAC will monitor PGSP forecasts and health care spending trends and make annual recommendations for the Benchmark in future years.

The path to creating the health care spending benchmark began in the summer of 2017, when the General Assembly passed House Joint Resolution (HJR) 7 authorizing the Department of Health and Social Services (DHSS) to develop a spending benchmark. The Governor signed HJR 7 in September 2017, just months after an analysis by the Centers for Medicare and Medicaid Services (CMS) indicated that Delaware had the third-highest per-capita health care spending rate in the country, and a rate that was 27 percent above the U.S. average.

That fall, DHSS and Secretary Dr. Kara Odom Walker, a board-certified family physician, began a series of summits to explore how a spending benchmark could work for Delaware. In February 2018, Governor Carney signed Executive Order 19 creating an Advisory Group to provide feedback to Secretary Walker on the health care spending and quality benchmarks. While the overall health of Delawareans has been improving – Delaware is now ranked 30th among the states, according to America’s Health Rankings ¬– the pace of that improvement is trailing the growth of health care spending in the state.

Delaware has historically ranked among the top 10 states in per-capita health care spending, including in 2014, when the state ranked behind only Alaska and Massachusetts. The 50-state analysis by the Centers for Medicare and Medicaid Services (CMS) released in 2017 found that Delaware’s per-capita rate was $10,254. Without changes, the analysis estimated that Delaware’s total health care spending would more than double from $9.5 billion in 2014 to $21.5 billion in 2025.

Click here to learn more about the health care spending benchmark.

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Related news:
Governor Carney Signs Executive Order Establishing Health Care Spending and Quality Benchmarks
Governor Carney Signs Executive Order on Budget Smoothing

NEW CASTLE (Dec. 4, 2018) – As part of the State Innovation Model (SIM) initiative, the Delaware Health Care Commission has awarded eight additional value-based payment reform mini-grants to Delaware health care providers in order to facilitate data integration, improve the coordination of patient care or increase readiness to integrate into an Accountable Care Organization (ACO) or operate through an Alternative Payment Method (APM)

The awards, through the Value-Based Payment Reform Fund, range from $25,000 to $250,000 for work that must be completed by Jan. 31, 2019. The commission received a total of 45 applications from primary care providers, behavioral health providers, hospitals, Accountable Care Organizations (ACOs), Federally Qualified Health Centers (FQHCs) and clinically integrated networks, all of which must be licensed in the State of Delaware. The commission expects to award a few more additional grants for small projects (up to $50,000) and large projects (up to $250,000), based on the scope of the project.

This round of awards went to:

• Nanticoke Hospital ($250,000): To conduct a study on global budgeting and how it could be implemented by Nanticoke and the State of Delaware.

• MedNet ($200,230): To speed up development of a population health management platform through expedited integration of clinical data from the Electronic Medical Records (EMR) platforms represented across the MedNet network.

• Nemours/A.I. duPont Hospital for Children ($200,000): To increase readiness to integrate into an Accountable Care Organization (ACO) or Clinically Integrated Network (CIN) or operate through an Alternative Payment Method (APM), as well as to ensure data integration/infrastructure analytics and improve coordination of patient care.

• Westside Family Healthcare ($179,190): To improve the Federally Qualified Health Center’s ability to thrive into Alternative Payment Methods (APM) by focusing on utilization of Health Information Technology (HIT) to identify and coordinate care of high-risk/cost patients, identify barriers limiting patients from utilizing the appropriate level of care and develop improved data integration with one of its Medicaid Managed Care (MMC) payers to allow use of clinical data for pay-for-value program performance. Part of the work will involve integration of Westside’s Allscripts Electronic Health Records (EHR) system with the Delaware Health Information Network (DHIN).

• Brandywine Counseling and Community Services ($111,716.50): To implement a data integration project that will reorganize its institutional structure to accommodate value-based payments and improve the coordination of patient care, especially for those clients with co-occurring disorders.

• Stoney Batter Family Medicine ($73,000): To upgrade its Allscripts system to facilitate better data-sharing required for participation in value-based programs, conversion to electronic billing and training sessions for employees.

• Delaware Health Net ($34,375): To develop “cost of care” analytics tool to adequately define the cost of a chronic condition population historically when cared that population has been cared for at a health center.

• Stoney Batter Family Medicine ($20,000): To design a training program for care coordinators/providers on how to prevent emergency department and hospital readmissions utilizing hospital-based admission information from DHIN, its ACO practice dashboard for Medicare patients, and its EHR stem to optimize communication.

“We are excited to announce this next round of mini-grant awards in the area of value-based payment reform,” said Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker, a board-certified family physician. “These grants reflect a diversity of ways that providers, hospitals, health centers and health systems are embracing payment reform.”

The first award ($62,168), to Christiana Care Health System’s CareLink Behavioral Health Medical Home Pilot, was announced in November. Applications, which were received during the summer, fell into one of three areas:

• Data integration: Project must enhance the applicant’s data integration, clinical informatics or population-based analytics capabilities. Examples include data exchange infrastructure and analytics projects or support; data warehousing and reporting capacity; and development of data-sharing agreements.
• Improve the coordination of patient care: Project must enhance the applicant’s clinical integration. Examples include conducting data analytics and developing care guidelines for a primary care-based system of complex care management for high-risk population(s); implementing improvements in care transitions such as new business processes or mutual agreements with partner providers; and implementing a practice support call center.
• Increase readiness to integrate into an Accountable Care Organization (ACO) or operate through an Alternative Payment Method (APM): Project must develop, expand or enhance the applicant’s shared governance structures and organizational integration strategies, linking the applicant with ACO leadership and across the continuum of care with providers already contracted with an ACO. An example would be support to model costs of care in preparation for participation in value-based payment arrangements with multiple payers.

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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.

Order will create subcommittee focused on bettering health care spending, quality across the state

WILMINGTON, Del. – Governor Carney on Tuesday signed Executive Order #25 establishing health care spending and quality benchmarks. This Executive Order will form a subcommittee of the Delaware Economic and Financial Advisory Council to focus on reducing the cost of health care for Delaware families, taxpayers, and businesses. The subcommittee will advise DEFAC and other relevant state agencies on spending, and will work closely with the Delaware Health Care Commission (DHCC) on improving the quality of health care in Delaware.

“Delaware has consistently ranked among the highest-spending states for health care, but we have not traditionally been a leader in health care outcomes. That needs to change,” said Governor John Carney. “This Executive Order reaffirms our commitment to lowering costs for Delaware families and improving the quality of care that Delawareans receive. We’ll do that, first and foremost, by improving transparency around the cost of health care services.”

In addition to setting the State’s health care spending benchmark for 2019 and beyond, the new subcommittee will consistently review its methodology and provide the public and interested stakeholders an opportunity to provide input and consider their recommendations.

This Executive Order also lays out quality benchmarks for the State for calendar years 2019 through 2021 for the Delaware Health Care Commission to follow in the categories of:

• Emergency Department Utilization Rate,
• Opioid-Related Overdose Deaths,
• Overlapping Opioid and Benzodiazepine Prescriptions,
• Adult Obesity,
• Adult Tobacco Use,
• High School Students Who Were Physically Active,
• Statin Therapy for Patients with Cardiovascular Disease, and
• Persistence of Beta-Blocker Treatment After a Heart Attack.

These quality benchmarks will be reviewed every three years, starting after 2022, to reflect improved health care performance in the state.

“I am grateful to all of the health care stakeholders for the work they have done to change how care is delivered and paid for in our state,” said Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker, a board-certified family physician. “As a state, we must address the cost of health care and the outcomes we are getting for that spending. The Executive Order that Governor Carney signed adds transparency and attention to our health care system, both from a spending and a quality standpoint. Today is an important milestone in moving toward a health care system that is financial sustainable for families, employers, providers and insurers, and one that rewards providers for keeping Delawareans healthy.”

This Executive Order was based on recommendations from Secretary Walker in August of this year, after a year of outreach and feedback from health stakeholders. Secretary Walker will publish a manual that contains the methodology for the health care spending and quality benchmarks no later than January 31, 2019.

“For more than four decades, the Delaware Economic and Financial Advisory Council has played a vital, non-partisan role in tracking national and state economic trends and preparing credible and trusted state revenue and expenditure estimates,” said Rick Geisenberger, Secretary of Finance. “This Executive Order creates a DEFAC Health Care Spending Benchmark Subcommittee that will solicit public and stakeholder input toward recommending a credible and trusted annual target for per capita growth of total health care costs in Delaware.”

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NEW CASTLE (Nov. 15, 2018) – As part of the State Innovation Model (SIM) initiative, the Delaware Health Care Commission has awarded the first value-based payment reform mini-grant to Christiana Care Health System to test a new reimbursement model that will also improve the coordination of patient care.

Christiana Care Health System’s CareLink Behavioral Health Medical Home Pilot was awarded $62,168 to test a reimbursement model to foster behavioral health integration within primary care practices focusing on a subset of AmeriHealth Medicaid members with chronic behavioral health conditions as a primary diagnosis.

The Health Care Commission is prepared to award up to multiple applicants in amounts ranging from $25,000 to $250,000 through the Value-Based Payment Reform Fund for work that must be completed by Jan. 31, 2019. The commission has received a total of 45 applications from primary care providers, behavioral health providers, hospitals, Accountable Care Organizations (ACOs), Federally Qualified Health Centers (FQHCs) and clinically integrated networks, all of which must be licensed in the State of Delaware. The commission expects to award grants for small projects (up to $50,000) and large projects (up to $250,000), based on the scope of the project.

“We are pleased to announce the first mini-grant award to Christiana Care as a way for a prominent health care provider in our state to conduct a pilot project in the area of value-based payment reform,” said Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker, a board-certified family physician. “This is a significant step forward in terms of how health care will be delivered and paid for in Delaware. Additional awards are going through the review and approval process, and we look forward to making those announcements soon.”

“As our work with the State Innovation Model nears its conclusion, the mini-grants are an important milestone for health care providers in our state as they embrace change in health care delivery and plan for long-term sustainability in terms of innovation,” said Dr. Nancy Fan, Chair of the Delaware Health Care Commission. “Along with ongoing work through our practice transformation vendors, the mini-grants will give providers a practical way to facilitate change in the health care landscape.”

Applications, which were received during the summer, fell into one of three areas:

• Data integration: Project must enhance the applicant’s data integration, clinical informatics or population-based analytics capabilities. Examples include data exchange infrastructure and analytics projects or support; data warehousing and reporting capacity; and development of data-sharing agreements.
• Improve the coordination of patient care: Project must enhance the applicant’s clinical integration. Examples include conducting data analytics and developing care guidelines for a primary care-based system of complex care management for high-risk population(s); implementing improvements in care transitions such as new business processes or mutual agreements with partner providers; and implementing a practice support call center.
• Increase readiness to integrate into an Accountable Care Organization (ACO) or operate through an Alternative Payment Method (APM): Project must develop, expand or enhance the applicant’s shared governance structures and organizational integration strategies, linking the applicant with ACO leadership and across the continuum of care with providers already contracted with an ACO. An example would be support to model costs of care in preparation for participation in value-based payment arrangements with multiple payers.

“The Delaware Center for Health Innovation (DCHI) is a public/private partnership that was created after Delaware received a four-year State Innovation Model grant from the Centers for Medicare and Medicaid Innovation,” said Julane Miller-Armbrister, executive director of DCHI. “We support innovative changes in health care delivery and payment in our state in order to drive quality and better health for the people of Delaware. The mini-grants are another step forward in achieving lasting change.”

NEW CASTLE (Oct. 23, 2018) – Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker, a board-certified family physician, is reassuring Delawareans that a proposed change to the public charge rule by the U.S. Department of Homeland Security does not affect current eligibility for health care and social services in Delaware, and that DHSS will work with community providers to address fears in the immigrant community about the proposed change.

The proposed rule seeks to change how the U.S. Department of Homeland Security (DHS) determines whether immigrants – when seeking admission to the United States, an extension of their stay or a status change to become a legal permanent resident – are likely to become a public charge, or dependent on government services in the future. If individuals are determined to be a public charge, it may put their immigration status at risk.

Secretary Walker issued this statement on the proposed public charge rule, which is open for public comment on the Federal Register until Dec. 10, 2018:

“Along with Governor Carney’s office and the congressional delegation, DHSS is closely monitoring the proposed change to the U.S. Department of Homeland Security’s federal public charge rule, which could impact access to such essential services as health care and social services for people in Delaware’s immigrant communities. Eligibility criteria for such services as Medicaid, food benefits and the Children’s Health Insurance Program have not changed.

“We know that there are families – whether their children are U.S. citizens or not – who are afraid to access benefits for fear of what could happen to their immigration status later. The Department of Health and Social Services will work with local health care providers, advocates, community leaders and elected officials to address those fears.

“To build a healthier Delaware, we must reach people where they are and meet their needs, including prenatal care and birth delivery, pediatric care, childhood and adult nutrition, and immunizations, and by reducing emergency department visits and hospitalizations. We want everyone in our state to feel safe when they interact with the health care or social services system. We are here to serve all of the people of Delaware.”

The proposed changes would expand the list of programs that could impact public charge determinations to include non-emergency Medicaid, Supplement Nutrition Assistance Program (food benefits) and housing assistance. The U.S. Department of Homeland Security is also considering including the Children’s Health Insurance Program (CHIP).

Reaction from Delaware Officials

“The Trump Administration’s recent ‘public charge’ proposal would go against American values by seeking to penalize immigrants who receive non-cash benefits for which they are eligible, including Medicaid, SNAP, or Section 8 housing,” Sen. Tom Carper said. “I have already joined a number of my colleagues in the Senate, including Sen. Coons, in expressing my grave concern regarding this proposal. Immigrants are indispensable to our continued economic growth – and we ought not to penalize these hardworking families for receiving short-term assistance while they pursue the American dream. I am grateful to Governor Carney and Secretary Walker for clarifying that immigrants remain eligible for these benefits until the rule goes into effect. In the meantime, I will continue to work with my colleagues to push back against this harmful proposal.”

“I thank Secretary Walker and Governor Carney for seeking to clarify some of the confusion surrounding the public charge proposal,” Sen. Chris Coons said. “It’s important to remember that the proposed rule has not been finalized and that eligibility criteria for programs like Medicaid, CHIP, and food benefits have not changed. I recently joined a number of my colleagues in the Senate, including Sen. Carper, in sending a letter to the Trump Administration, in which we expressed our grave concerns with the proposal that they put forward. We are hopeful that the Administration will heed our calls and know that we will be monitoring the situation closely.”

The Department of Health and Social Services will join with Governor John Carney’s office and other state agencies to monitor the proposed rule, study its potential impacts and work with community partners to support those populations affected in Delaware.

“Access to affordable health care provides families most in need with the opportunity to contribute to their community, thrive and reach their full potential, “ said Lolita Lopez, President & CEO of Westside Family Healthcare. “The proposed rule will likely result in Delawareans being deterred from addressing their health care needs, ultimately leading to worse health outcomes and increased costs for Delaware. As a patient-centered community health center serving 31,000 Delawareans each year, we seek to provide appropriate and meaningful access to care for all those who come through our doors. We fear this rule works in contrast to this longstanding goal.”

The public may submit comments to the Federal Register on the proposed rule change until Dec. 10, 2018. You can comment on the Federal Register website:
https://www.federalregister.gov/documents/2018/10/10/2018-21106/inadmissibility-on-public-charge-grounds

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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.