Advances in Primary Care Reform Made Possible by Legislature

General Assembly sent key bill to the Governor

The Delaware General Assembly passed legislation to increase Delawareans’ access to high quality, affordable health care through a series of reforms that will refocus Delaware’s healthcare system on primary care and improvements in value.

Senate Substitute 1 for Senate Bill 120 requires commercial health insurance companies to make meaningful increases in their primary care investment, limits price increases for hospital and other non-professional services, and compels health insurance companies and health systems to work together to improve healthcare value. By implementing these reforms simultaneously, models show that the increases in primary care investment do not result in unsustainable increases in total cost of care.

“Informed by data and the perspectives of Delaware consumers, physicians, employers, health insurance companies and hospitals, the Delaware Department of Insurance created a road map aimed at ensuring residents have access to high-quality, affordable health care, and that the primary care provider community would be strengthened in the process,” stated Insurance Commissioner Trinidad Navarro. “Through this legislation, the General Assembly has put these plans into action. We look forward to working with those stakeholders and the General Assembly to implement this important legislation that will improve the health and wellbeing of Delawareans while bending the healthcare cost curve.”

The types of reforms included in SS 1 for SB 120 were first contemplated in a report by the Delaware Department of Insurance and its Office of Value-Based Health Care Delivery, which was created by the General Assembly in 2019. Those same agencies would be tasked with implementing the legislation, creating necessary regulations, and enforcing its measures. To inform this work, the Office of Value-Based Healthcare Delivery embarked on an extensive data collection and stakeholder engagement process in 2020, which included data from Delaware health insurers, the Delaware Health Information Network Health Care Claims Database, publicly available sources, and perspectives shared during more than two dozen stakeholder interviews.

Research by the Office of Value-Based Health Care Delivery found that primary care spending in Delaware is low relative to the national average and about half of what is spent in leading states. This low investment in primary care services has likely contributed to declining numbers of primary care providers and poor access to primary care statewide. Increased numbers of primary care providers have been associated with improvements in health and decreases in mortality, as well as lower rates of emergency department visits and hospital admissions. Though many states face similar trends, the research also found primary care access problem in Delaware is particularly acute. The state’s population is among the oldest in the nation, a trend that will continue to grow.

“With one in five Delawareans are over the age of 65 and two in five of our neighbors living in an area with a shortage of primary care doctors, we have to do more to ensure our communities have access to the frontline providers they need to improve the quality of their health and keep them out of the hospital,” said Senate Majority Leader Bryan Townsend, the prime sponsor of SS 1 for SB 102. “Even as costs continue to rise for us all, the current system is simply providing positive results for too few Delawareans,” he said. “After three years of careful study and consideration, I am confident the legislation that Rep. David Bentz and I passed through the General Assembly will result in more primary care providers serving our state and better healthcare outcomes for our neighbors.”

“The primary care industry in Delaware is facing substantial challenges. Physicians are retiring or leaving the state, creating a shortage that means poor access to care for residents. Factor in the low levels of investment and we have an unsustainable system. We need to tackle this crisis head-on immediately,” said Rep. David Bentz, the bill’s lead House sponsor. “SS 1 for SB 120 will modernize and enhance primary care services in Delaware by directing the Health Care Commission to monitor and promote compliance with alternative payment models that promote value-based care. Primary care is critical in our efforts to improve public health outcomes and reduce long-term costs. It is, without question, where we get the best return on investment with our healthcare spend both financially and in-terms of the health of our population. I look forward to Governor Carney signing this bill into law to reverse the losses we’ve seen in recent years.”


Commissioner Navarro Signs Health Policy Letter to President-Elect Biden

Joins ten Insurance Commissioners in providing short- and long-term recommendations to the incoming administration

A group of the nation’s state insurance commissioners joined together in a pledge to work with President-elect Joe Biden by providing health policy recommendations to the incoming administration.

The commissioners share President-elect Biden’s vision that no American should have to go without health care coverage. They believe comprehensive and progressive health care is essential to addressing urgent public health priorities, such as the COVID-19 and opioid crises, addressing racial disparities in the health care system, and ensuring enforcement of mental health parity.

“President-elect Biden knows the healthcare needs of Delaware residents first-hand. So many of the healthcare challenges we face are being felt across the country, and I am proud to join Insurance Commissioners from coast to coast in recommending short and long-term policy solutions,” said Delaware Insurance Commissioner Trinidad Navarro.

A letter sent by the group of commissioners detailed six immediate or critical policy recommendations and six longer-term recommendations for the Biden administration to consider.

Immediate policy recommendations

  • Ensure immediate access to the federal marketplace, Healthcare.gov, through a special enrollment period.
  • Provide immediate relief from Affordable Care Act (ACA) subsidy clawbacks created by COVID-19 uncertainty.
  • Provide clarity on COVID-19 testing coverage requirements, especially in regard to tests that are ordered as part of state-based contact tracing efforts.
  • Partner with states in actively focusing on programs and practices that address the needs of historically marginalized communities.
  • Address problematic elements of the recently proposed Notice of Benefit and Payment Parameters (NBPP) for Plan Year 2022.
  • Allow flexibility for states aiming to pursue progressive policy aims by empowering them to apply for ACA innovation waivers beyond reinsurance.

Longer-term policy priorities

  • Reverse policies, such as the weakening of non-discrimination protections and the public charge rule, that undermine the ACA and deny health care coverage to many people.
  • Encourage both people and small businesses to enroll in ACA programs, and stop encouraging enrollment in insurance plans that do not provide the ACA’s most critical consumer protections.
  • Improve income counting rules to allow consumers greater flexibility.
  • Extend premium tax credits to Deferred Action for Childhood Arrivals (DACA) recipients so that legally present noncitizens have access to health care coverage.
  • Modernize Department of Labor oversight of the Employee Retirement Income Security Act to ensure all health insurance coverage is held to similar standards.
  • Consider a national reinsurance program to stabilize health insurance markets and improve affordability of health insurance coverage.

Enacting these policy recommendations will provide immediate relief to many Americans affected by the COVID-19 crisis, provide states with flexibility to strengthen health insurance markets, remove discriminatory barriers to health coverage, protect the coverage needs of Americans with pre-existing conditions, and ensure comprehensive health insurance access is available to all Americans.

The following state insurance commissioners developed these recommendations and are committed to working with the Biden administration on its national health care plan:
Commissioner Ricardo Lara, California
Commissioner Michael Conway, Colorado
Commissioner Trinidad Navarro, Delaware
Commissioner Colin M. Hayashida, Hawaii
Director Anita G. Fox, Michigan
Temporary Commissioner Grace Arnold, Minnesota
Commissioner Andrew R. Stolfi, Oregon
Commissioner Jessica K. Altman, Pennsylvania
Health Insurance Commissioner Marie Ganim, Rhode Island
Commissioner Mike Kreidler, Washington
Commissioner Mark Afable, Wisconsin

View the Commissioners’ Letter


New Report Outlines Plan for Strengthening Primary Care in Delaware

Provisional Affordability Standards aim to strengthen primary care in Delaware through increased investment

Insurance Commissioner Trinidad Navarro announced the release of the Office of Value-Based Health Care Delivery’s initial provisional Affordability Standards as part of a new report, Delaware Health Care Affordability Standards: An Integrated Approach to Improve Access, Quality and Value, which includes plans to more than double primary care spending in the commercial fully-insured market by 2025.

The Affordability Standards announced today also include decreasing price growth for certain healthcare services and expanding the use of payment models that aim to improve healthcare value. The Affordability Standards and targets were informed by data from Delaware health insurers, the Delaware Health Information Network Health Care Claims Database, publicly available sources, and the perspectives shared during more than two dozen stakeholder interviews.

“An effective healthcare environment requires a strong primary care system, but it also requires shared standards that define success and progress. The multi-pronged approach announced today aims to increase primary care investment without increasing the total cost of healthcare or health insurance premiums,” Commissioner Navarro said. “We are grateful to our many partners who shared their data and experience during the process of building these guidelines. Now we ask the public as a whole to share their feedback on this report.”

The department will be accepting public comment on the report until January 25, 2021. Anyone may submit comments via email to DOI-legal@delaware.gov.

The Office of Value-Based Health Care Delivery was created through the passage of Senate Substitute 1 for Senate Bill 116 in 2019. The General Assembly recognized the importance of a strong system of primary care and the need to help bend the healthcare cost growth curve, directing the department to establish the office in order to “reduce health-care costs by increasing the availability of high quality, cost-efficient health insurance products with stable, predictable, and affordable rates,” and charged the office with three tasks:

1. Establish Affordability Standards for health insurance premiums based on recommendations from the Primary Care Reform Collaborative and annually monitor and evaluate these standards;
2. Establish targets for carrier investment in primary care to support a robust system of primary care by January 1, 2025; and
3. Collect data and develop annual reports regarding carrier investments in health care, including commercial reimbursement rates for primary and chronic care services.

The Office is meeting these directives by conducting extensive research on Delaware’s healthcare market, and used that research to inform the development of the interim Affordability Standards, including targets for increased investment in primary care.


The Mezzanine Gallery to Exhibit “The Pandemic Paintings” by Theresa Walton

On view from June 12 – July 24, 2020
Visit the Gallery in-person or view it online

Wilmington, Del. (June 10, 2020) – The Pandemic Paintings, an exhibition of watercolor portraits of health care workers and scenes that represent hope to them by Theresa (Terre) Walton, will be on view in the Mezzanine Gallery from June 12-July 24, 2020. For those unable to visit in-person, an online gallery will be available on our main website on June 12. Walton, a retired art educator with over 25 years of experience, paints in both watercolors and acrylics and has exhibited in various venues in the Newark and Wilmington area.

The Pandemic Paintings started with Walton’s commitment to paint every day during the quarantine, and a spontaneous watercolor painted from a photo of her son’s fiancé in a mask before work. After posting the watercolor on Facebook, Walton received an avalanche of requests from family and friends to paint their loved ones working in health care. For over a week she painted up to four portraits a day to keep up with the demand. The result is a collection of over 35 portraits of people “connected to her by five degrees of separation.”

Self-portrait, 2020, watercolor, 5″ x 7″

Moving on from the portraits, hope became the theme of the next phase of the quarantine watercolors. Walton requested from that same sphere of friends to send her a photo of something “that represents hope or a photo of what you hope to do when this whole thing is over.” Walton received many images of nature (walks, wildlife, and gardens) and water.

Most recently she is painting a series of loose, spontaneous images of her own choosing. Walton said, “I am still getting portrait requests and still fulfilling those requests, but primarily have moved on to the loose, relaxed work of the final phase, and hope.”

Images from Health Workers/ Five Degrees of Separation, 2020, watercolor, all images 5″ x 7″

The Mezzanine Gallery is open to the public weekdays from 8:00 a.m. to 4:30 p.m. and is located in the Carvel State Office Building, 820 N. French Street, Wilmington. Visitors must wear face coverings and maintain 6 feet distance from other individuals not in their household.

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Contact: Leeann Wallett, Program Officer, Communications and Marketing
302-577-8280, leeann.wallett@delaware.gov


The Delaware Division of the Arts, a branch of the Delaware Department of State, is dedicated to cultivating and supporting the arts to enhance the quality of life for all Delawareans. Together with its advisory body, the Delaware State Arts Council, the Division administers grants and programs that support arts programming, educate the public, increase awareness of the arts, and integrate the arts into all facets of Delaware life. For more information about the Delaware Division of the Arts, visit arts.delaware.gov or call 302-577-8278.


New Bulletin Provides Recommendations to Insurers During COVID-19

Insurers asked to waive prior authorization requirements, cease cancellations and nonrenewals due to missed or delayed payments

Insurance Commissioner Trinidad Navarro and the Delaware Department of Insurance today issued a bulletin with recommended actions for the insurance industry. Requests included asking health insurers waive all prior authorization constraints for lab testing and future treatment of COVID-19, and that insurers consider ceasing cancellations or nonrenewals of insurance policies due to nonpayment throughout the duration of the declared Delaware State of Emergency.

“The insurance industry has the opportunity to help tens of thousands of Delaware residents, businesses, and healthcare providers during this state of emergency,” said Insurance Commissioner Trinidad Navarro. “Waiving prior authorization requirements would help the entire healthcare system to run more efficiently and allow providers to focus on patient outcomes rather than paperwork.”

Prior authorization is a process that requires certain tests, medications, or other health services to be pre-approved by an insurance company before a medical provider serves an insured consumer, which can at times result in delays. Should prior-authorization be voluntarily waived by insurers, that would not mean that residents should not be in contact with their primary care provider prior to visiting a COVID-19 testing site.

The bulletin also asked insurance carriers to voluntarily freeze cancellations and nonrenewals of policies that might have otherwise occurred due to delays in payments through the duration of the state of emergency.

“Throughout Delaware’s State of Emergency, many companies have had to close or reduce their business, and employees have been laid off or fired as a result,” Commissioner Navarro explained. “After hearing from businesses and residents who were concerned about the choices they will have to make with limited finances, we ask insurers to help alleviate some of that stress and ensure that residents and business owners in this difficult situation can have the peace of mind that insurance provides throughout the duration of the emergency.”

Business interruption coverage will vary policy to policy, and some business interruption coverage may explicitly exclude viral infections. Companies are urged to review their related insurance policies and contact their insurance company with questions about coverage. Hospitality small businesses and nonprofits may be able to apply for no-interest loans from the Division of Small Business Hospitality Emergency Loan Program (HELP). Organizations can receive a $10,000 maximum loan per month for rent, utilities, and other unavoidable, non-personnel bills.

On March 18, Governor Carney’s updated State of Emergency Declaration waived certain telemedicine regulations to expand access to these services. The Governor clarified that residents do not need to see a provider in-person before receiving telemedicine services, and that if a Delaware resident is out-of-state, they can still receive telemedicine services. To increase availability of these services, out-of-state providers who are licensed to provide telemedicine in other jurisdictions will also be able to serve Delaware residents through the duration of the emergency declaration. Telehealth and telemedicine can be provided via phone, webcam, facetime, and a myriad of other easily accessible options, as the department recently reminded insurers via bulletin.

Department of Insurance March 20 Bulletin

National Association of Insurance Commissioner’s COVID-19 and Insurance Brief

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