Cristine Vogel Named Director of Value-Based Health Care Delivery

Experienced healthcare management strategist hired after lengthy national search

Insurance Commissioner Trinidad Navarro welcomed Cristine Vogel to the Delaware Department of Insurance as its Director of Value-Based Health Care Delivery this week after a lengthy national search to fill the role. As the inaugural Director, Vogel will lead efforts that relate to value-based care, primary care, pharmaceuticals and pharmacy benefit managers, affordability, and other health-policy initiatives including grant programs.

“It is more important than ever before to ensure the accessibility and affordability of healthcare and prescriptions,” said Commissioner Navarro. “Hospital prices, the cost of medications, and low-quality services all raise the price of consumer care and insurance coverage. With Cristine’s expertise on board, we can keep making progress toward higher-quality care at a lower cost.”

Director Vogel has been involved with healthcare management for over 25 years, with experience in hospitals and medical practices, state government, insurance, and consulting. Leading the Office of Value-Based Health Care Delivery, Vogel will establish, implement, and monitor Affordability Standards such as those to increase primary care investment, and manage the reporting of carrier investments in health care. This will include assessing commercial reimbursement rates for primary and chronic care services, the role of price and utilization in healthcare spending, and prescription drug spending as a driver of total cost of care.

“Delaware is taking on innovative efforts to address care quality and cost, and I’m proud to work with Commissioner Navarro to make these projects a success,” said Director Vogel.

Vogel most recently served as the Director of Population Health Initiatives for Nuvance Health System in Connecticut, where she developed solutions to improve clinical outcomes, increase quality of care, and control healthcare costs through implementing a nurse care management program, a clinical pharmacy program, and through integrating behavioral health within primary care practices. Her experience in healthcare reform also includes leading the State of Connecticut’s Office of Healthcare Access and evaluating Certificates of Need. The position, funded by the department, was made necessary by several legislative mandates related to healthcare affordability and pharmacy benefits.


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.”


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.


Delaware Issues RFP for Office of Value-Based Health Care Delivery

Delaware’s Department of Insurance is pleased to announce that it is actively recruiting for a qualified independent contractor to staff and run its new Office of Value-Based Health Care Delivery. The Office will assist the Insurance Commissioner and Delaware’s Primary Care Reform Collaborative in evaluating primary care accessibility and affordability statewide.

“Reducing health care costs in Delaware is a key priority of my administration,” said Insurance Commissioner Trinidad Navarro. “The team leading our Office of Value-Based Health Care Delivery needs to possess a high level of expertise in health care transformation and innovation. Together with the Primary Care Reform Collaborative, we intend to identify quantitative tools that will help increase the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates.”

Earlier this year, members of the General Assembly passed Senate Substitute 1 for Senate Bill No. 116, in order to create the Office. The Office was a recommendation of the Primary Care Reform Collaborative, which is tasked with evaluating the high costs of care in Delaware. In the months since passage, the Collaborative has been working hard to develop recommendations to strengthen Delaware’s primary care system.

“The legislature’s consideration of pro-consumer bills has allowed us to continue to foster an environment where residents are prioritized over profits,” said Leslie W. Ledogar, Esq, the Commissioner’s representative within the working group. “The Office of Value-Based Health Care Delivery epitomizes that vision, and we are grateful for everyone who spent time working on this effort.”

The Request for Proposal may be downloaded from the Office of Management and Budget website. Applicant questions should be directed to the Department’s Regulatory Specialist Leslie W. Ledogar, Esq.