Delaware one of 11 participating states vetting strategies around crises such as Hepatitis C and opioid use disorder

WILMINGTON, Del. — Delaware was one of 11 states that vetted potential strategies through the National Governors Association (NGA) Center for Best Practices to address public health crises such as Hepatitis C and opioid use disorder by improving access to evidence-based pharmaceutical interventions while ensuring the fiscal sustainability of public programs. The NGA released the report on the strategies today.

“Working with other states and the NGA, our Delaware team has found ways to address these public health crises that are having such a devastating impact on the people of our states, while still being able to effectively manage the cost of the medications we use to provide effective and life-saving interventions,” said Governor John Carney. “Giving states more options helps us make the right decisions on behalf of people in need.”

Across all states, specialty medicines – including treatments for Hepatitis C – have been a key driver in Medicaid spending, accounting for 0.9 percent of claims and 32 percent of Medicaid drug spending. A national study found that naloxone use in Medicaid increased 66 percent from 2013 to 2014, as compared with 12 percent for all drugs, and 101 percent from 2014 to 2015, compares with 10 percent for all drugs.

Delaware joined teams from 10 other states in coming up with the strategies: California, Louisiana, Massachusetts, New Mexico, New York, Ohio, Oregon, Rhode Island, Virginia and Washington. Beginning in November 2017, the NGA Center supported the states in generating ideas for governors across the country to consider as they balance access and cost concerns. The strategies include:

• Establish a Medicaid spending cap for pharmaceuticals.
• Pursue alternative payment mechanisms such as a subscription model with a pharmaceutical manufacturer.
• Consider options for excluding select drugs from Medicaid coverage.
• Engage in bulk and pooled purchasing.
• Determine and pay value-based prices for drug treatments by incorporating value assessments.
• Explore whether the federal government would allow nominal pricing for correctional facilities.

In Delaware, health care spending – including Medicaid, the Department of Correction and state employee health benefits – account for about 30 percent of the state’s total budget. About 225,000 Delawareans are served by Medicaid, the shared state and federal health insurance program for people from low-income households, seniors eligible for long-term care and individuals with disabilities.

Department of Health and Social Services Secretary Dr. Kara Odom Walker, who represented Delaware in the NGA vetting, said the strategies complement the work Governor Carney and she are leading to advance a health care spending benchmark and value-based care in Delaware. In February, Governor Carney signed Executive Order 19 creating a 13-member Advisory Group to make recommendations to Secretary Walker on health care cost and quality benchmarks across Delaware’s health care system, including employer-based coverage, Medicare and Medicaid. Secretary Walker will provide her formal recommendations to the Governor this summer. Beginning in 2019, Delaware will measure the total cost of health care, the first step in increasing transparency in how health care dollars are spent.

“Our Medicaid team has launched several initiatives to improve the quality of care for our Medicaid clients, to address the social determinants of health and to encourage value-based payments,” said Secretary Walker. “These NGA strategies involving evidence-based pharmaceutical interventions offer us options in balancing health care innovations, where appropriate, with the affordability of making those innovations available to the people we serve.”

The full report can be found here.

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WILMINGTON, Del. – In support of a movement to transform how health care is delivered and paid for in the state, Delaware was one of eight states chosen to participate in a National Governors Association initiative to harness data systems to inform health policymaking. Joining Arkansas, Colorado, Indiana, Iowa, Minnesota, Vermont and Washington, Delaware’s team will receive guidance in creating a strategic plan for data analytics in support of policy and decision-making in its Medicaid program.

Over the course of the 16-month project, Delaware’s team will receive technical assistance and engage in cross-state learning to help advance its capacity to use and analyze data in the Medicaid program within the Department of Health and Social Services (DHSS). About 230,000 Delawareans are served by Medicaid, the shared state and federal health insurance program for people from low-income households, seniors eligible for long-term care and individuals with disabilities.

“This NGA data initiative will help us grow our ability to analyze how Medicaid dollars are spent, the health of the populations we serve and how well the health care system is doing in meeting the care needs of our clients,” said Governor John Carney. “Harnessing data is an important way to measure and evaluate our progress as we shift from a health care system that is based on volume of care to one that this based on health outcomes of patients.”

In January, DHSS’ Division of Medicaid and Medical Assistance (DMMA) signed value-based purchasing contracts with its two managed care organizations (MCOs) – Highmark Health Options Blue Cross Blue Shield Delaware and AmeriHealth Caritas Delaware. As part of the contracts, seven key client care measures will be monitored, including management of diabetes cases, asthma management, cervical and breast cancer screenings, obesity management, timeliness of prenatal care and 30-day hospital readmission rates.

Medicaid data also will be an important component of Delaware’s work on health care spending and quality benchmarks. In February, Governor Carney signed Executive Order 19 creating a 13-member Advisory Group to make recommendations to DHSS Secretary Dr. Kara Odom Walker on health care cost and quality benchmarks across Delaware’s health care system, including employer-based coverage, Medicare and Medicaid. Secretary Walker will provide her formal recommendations to the Governor this summer. Beginning in 2019, Delaware will measure the total cost of health care, the first step in increasing transparency in how health care dollars are spent.

“Our Medicaid team has launched several initiatives to improve the quality of care for our Medicaid clients, to address the social determinants of health and to encourage value-based payments,” said DHSS Secretary Walker. “The NGA assistance will offer us support as we plan, implement and evaluate these special efforts. We need data to develop baselines, track progress and analyze the results.”

Staff from the National Governors Association will provide in-state visits and ongoing technical assistance throughout the project including research, consultations, facilitating meetings with experts, sharing examples from other states and reviewing state plans.

The Delaware team is led by Elizabeth Brown, Medical Director for the Division of Medicaid and Medical Assistance, and includes Steve Groff, Director of DMMA; Steven Costantino, Director of Health Care Reform for DHSS; Troy McDaniel, Director of Information Systems for DMMA; and Joe Bryant, Health Policy Advisor for Governor Carney.

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Op-ed by Rick Geisenberger, Secretary of the Delaware Department of Finance

Over the next several weeks, as we complete another budget debate in Dover, we should not lose sight of Delaware’s long-term challenges and of one issue in particular: the rising cost of health care.

The projected growth rate for state spending on health care services will more than double our expected growth rate in available revenue over the next two years. Next year alone, Delaware taxpayers will spend more than $1.3 billion on health care — primarily on state employee benefits and Medicaid, the state-federal program that provides insurance for low-income Delawareans, those with disabilities, and older residents that require long-term care.

In January, Governor Carney proposed a 2019 budget plan focused on investing in Delaware’s economy, in high-needs schools, and communities across our state. The governor’s budget proposal limits spending growth to 3.5 percent — an increase far below available revenue this year, and one that is sustainable over the long term.

But if we hope to continue making investments that matter, we cannot continue on our current path.

State spending on health care now accounts for more than 30 percent of the state’s budget. Simply put, the growth of state spending on health care crowds out investments in schools, communities, infrastructure, and our economy that would move our state forward.

And this is not an issue unique to state government. Health care spending severely strains the budgets of Delaware families and businesses up and down our state, limiting household spending and making it harder for companies to invest and create jobs.

A few statistics tell the tale:

Delaware’s health care spending per person exceeds the national average by more than 27 percent. Among states, only Alaska and Massachusetts spend more. And we’re not getting our money’s worth. Delaware ranks 30th in terms of overall health quality.

Workers’ contributions for health care have increased 40 percent since 2010, while Delaware wages have increased only 25 percent.
Health care spending per person has increased every year since 1991, even as our economy has grown and contracted through recession and recovery.

To be clear, health care is an important sector of Delaware’s economy, accounting for 12.5 percent of the state’s workforce, and thousands of jobs. But we cannot ignore concerns that health care costs are growing dramatically faster than other measures of economic growth.

To address these issues last year, the General Assembly enacted and Governor Carney signed House Joint Resolution 7, authorizing the Department of Health and Social Services (DHSS) to establish a benchmark, with a growth rate for health care spending linked to growth in our overall economy. DHSS will select the methods to measure and report on the total cost of health care and identify metrics to measure and track spending and quality across our health care system.

Governor Carney established the Health Care Delivery and Cost Advisory Group to assist in this process and provide feedback to DHSS Secretary Dr. Kara Odom Walker.

The good news is that there is a great deal of consensus and energy about the importance of this work among Delaware’s purchasers and providers of health care services. But, understandably, some providers are concerned that, in the future, a benchmark might be used to set price controls or create spending caps on private health care spending.

To be clear, this is not at all the purpose for the benchmark.

Our goal is to provide additional price transparency and attention to the underlying costs and quality of health care delivery across the state. Delaware families and businesses deserve to know how much they are paying for health procedures, and what they’re getting for their money.

With better information, we can analyze and report on variations in cost and quality. We can make this data available to policymakers and health care providers so that everyone better understands the sources of cost growth. Most importantly, we can use this information to work collaboratively to address unwarranted variations in costs and quality.

As the state’s chief financial officer, I’m keenly aware of the importance of bending the health care cost curve to more closely align with public and private resources available to cover these costs. At the Delaware Department of Finance, we believe it’s critical that the process for setting health care benchmarks be verifiable, transparent, and independently generated. Dr. Walker already has engaged the health care community significantly in this effort and this commitment will continue.

The challenge presented by the growth of health care spending is a national problem. But many solutions will need to be local. Delaware’s size — and our history of working together to solve difficult problems — means we are uniquely equipped to bring all stakeholders to the table to address this challenge.

As Governor Carney has said, lowering health care costs while improving quality is the most important thing we can do for the future health of our economy, our citizens and our finances.

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

NEW CASTLE (Feb. 26, 2018) – Medicare beneficiaries, caregivers and others can find out more the new Medicare Card and other senior and consumer-focused topics and programs at the Medicare Roadshow, on Thursday, March 8, from 9 to 11:30 a.m. at the Newark Senior Center, 200 Whitechapel Drive, Newark.

The free event is being offered in conjunction with National Consumer Protection Week, which runs from March 4 through 10.

The Medicare Roadshow will feature representatives from a variety of federal, state and local agencies, and consumer organizations who will offer information and provide assistance to attendees with the focus on programs and services for seniors. Organizations represented will include the Centers for Medicare & Medicaid Services, the Social Security Administration, Wilmington Veterans Medical Center, Delaware Medicare Assistance Bureau, the Delaware Department of Health and Social Services Adult Protective Services, Home and Community Based Ombudsman, and Senior Medicare Patrol, KEPRO, Quality Insights, Delaware Attorney General Fraud and Consumer Protection Division, and staff from Delaware’s U.S. House and Senate delegation, among others.

Starting in April 2018, and continuing through April 2019, new Medicare Cards will be mailed to beneficiaries. The new cards will feature a unique new number instead of the beneficiary’s Social Security number. More detailed information about the new Medicare card, and tips for beneficiaries and caregivers, will be available at the Medicare Roadshow. Information is also available on the Medicare website at https://www.medicare.gov/forms-help-and-resources/your-medicare-card.html

The Medicare Roadshow is open to the public.

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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.

Advisory group will advance health care benchmark initiative to reduce costs, improve outcomes

WILMINGTON, Del. – Taking the next step in implementing a health care spending benchmark for Delaware, Governor John Carney has signed an executive order establishing the Health Care Delivery and Cost Advisory Group to provide feedback to the Secretary of the Department of Health and Social Services (DHSS) on how to measure and report the total cost of health care in Delaware and how to determine metrics across the health care system to create quality benchmarks.

The creation of the advisory group to implement the spending benchmark comes five months after the Governor signed House Joint Resolution 7 granting authority to DHSS to establish a benchmark with a growth rate for health care spending linked to the overall economy of the state. In June, the Centers for Medicare and Medicaid Services (CMS) released a 50-state analysis of per-capita health care spending showing Delaware had the third-highest rate in 2014 behind only Alaska and Massachusetts.

The CMS analysis of all insurance payers – Medicare, Medicaid and commercial – found that Delaware’s per-capita rate was $10,254, or more than 27 percent above the U.S. average of $8,045. Without changes, the analysis estimates that Delaware’s total health care spending will more than double from $9.5 billion in 2014 to $21.5 billion in 2025.

“Delaware has consistently ranked among the states that spend the most on health care, yet we’re not seeing the best results,” said Governor Carney. “High costs present a barrier to quality health care, squeeze family budgets, crowd out other important state investments, and prevent businesses from investing in innovation and job creation. We’re committed to addressing this issue, to bringing providers to the table, reducing costs, and improving health outcomes for Delawareans across our state.”

“We have the talent and the capacity in our Delaware health care community to move to better value in our health care system and deliver better outcomes for the people of our state,” said DHSS Secretary Dr. Kara Odom Walker, a board-certified family physician. “The advisory group gives us the unique opportunity to continue progress in a collaborative forum and gather input on how to best to track the trend lines in the total cost of health care over time.”

The advisory group will provide feedback to the DHSS Secretary on the selection of methodologies to measure and report on the total cost of health care in Delaware, and on the establishment of a spending growth target that will become Delaware’s cost benchmark. Advisory group members also will help identify which metrics should be used to create quality benchmarks across our healthcare system to reduce costs, and recommend changes to the Delaware Health Care Commission.

The advisory group will include the DHSS Secretary; Director of the Office of Management and Budget; Chair of the Delaware Health Care Commission; Chair of the Delaware Center for Health Innovation; hospital representatives; representatives from the insurance industry, a licensed physician; a health economist; and a business community representative.

A full list of members is available in the text of the Executive Order. The advisory group will dissolve on June 30, unless the period is extended.

Click here to watch a video message from Dr. Kara Odom Walker, Secretary of the Delaware Department of Health and Social Services, on the benchmark initiative.

To learn more about the health care spending benchmark, visit:
https://www.choosehealthde.com/Health-Care-Spending-Benchmark

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Related news:
Governor Carney Signs Legislation to Limit Growth in Health Care Spending
Op-Ed: Let’s Get Control of Health Care Spending
Secretary Walker Issues Report on Progress Toward Implementing a Health Care Spending Benchmark