Another banner year for consumer protection and insurer competition

In 2023, the Delaware Department of Insurance’s 101 team members served Delaware residents and seniors, attracted new companies, oversaw expansions of coverage and enhanced competition, and contributed substantial funds to the state. Today’s data release details how each team contributed to Delaware’s strong insurance environment.

“Each year, our team gathers and reports data on our efforts to give residents a look at our daily work,” said Insurance Commissioner Trinidad Navarro. “And while the numbers themselves are impressive, within them are tens of thousands of stories. Stories of finding affordable coverage for the first time, stories of storms and fires, stories of injustice, investigation, and resolution, and above all, a story of change. Our state is changing, and our department is changing with it to ensure we continue to protect our consumers and offer them a robust, affordable, competitive insurance market.”

The year began with the announcement of a record-setting Open Enrollment on the Delaware Health Insurance Marketplace, where 35,000 residents got covered, and 6,000 were eligible for plans costing $10 or less per month. As recently as 2022, Delaware consumers only had one insurer and 12 plans to choose from – but during 2023 enrollment, they had four carriers and more than 50 plans offering coverage. Premiums in the individual market have decreased roughly 12% since 2019.

DOI welcomed yet another new carrier to the Marketplace in 2023, and indications are that enrollment for 2024 has again broken enrollment records with likely more than 40,000 enrollees.

Health insurance rates are submitted alongside affordability standards data to the department’s Office of Value-Based Health Care Delivery, which endeavors to support a robust, high-quality primary care environment. As a result of this work, annual primary care investment is projected at over $40 million, an increase of nearly $13 million or 44% year over year. This includes a projected $7 million in direct, prospective payments to more than 775 providers engaged in care transformation.

In addition to supporting healthcare providers, the work of the department also provides substantial funding to the state. For the 2023 calendar year, the department’s work resulted in about $189 million in funds for the state and its funds, including $113 million for the General Fund, and $44.7 million for fire companies.

Strong results were again reported by resident-facing programs. Consumer Services staff processed a total of 4,228 complaints and inquiries. The Medicare Assistance Bureau hosted and participated in 66 public events, and held more than 5,000 one-on-one counseling sessions. Medicare beneficiaries saved an estimated $2.08 million dollars because of the free assistance offered by this team, an increase of over half a million dollars from last year. Helping residents address claim settlement issues outside of court, the Legal Division reported that of 419 cases, 236 settled pre-hearing. Completed arbitration cases resulted in awards totaling more than $611,000. The department also moved to a new office in New Castle County, which offers much improved accessibility to consumers, while also saving the department over $200,000.

Delaware continued to be a national presence in insurance regulation, with Commissioner Navarro being elected Chair of the Northeast Zone of the National Association of Insurance Commissioners. His tenure chairing the National Anti-Fraud Task Force, and Delaware’s leadership on the Improper Marketing of Health Plans Working Group has resulted in improved coordination of efforts across states, and progress in the drafting of an improved model law related to producer licensing. Locally, the Commissioner and staff participate in numerous committees, including the Behavioral Health Crisis Services Board, Delaware Health Care Commission, Foster Youth Drivers’ License and Insurance Working Group, EARNs Board, Non-Acute Long Stay Task Force, Plans Management Board, Primary Care Reform Collaborative, Retiree Healthcare Benefits Advisory subcommittee, and the State Employee Benefits Committee (SEBC).

In 2023 the seventh consecutive decrease in workers’ compensation insurance rates was approved, a double-digit average drop of 13.85% in the residual market and 10.03% in the voluntary market. These lower rates are just one component of several department efforts to help businesses. Nearly 1,000 employers are saving even more on their premiums by participating in the department’s Workplace Safety Program, saving approximately $5.6 million on premiums through safety credits.

Market Conduct staff completed 61 insurer interrogatories, 72 Level 1 market analyses, and 5 exams including 3 introductory PBM examinations. 13 examinations remain in progress.

The most recent data available from the Bureau of Examination, Rehabilitation and Guaranty shows oversight of the financials of 149 domestic companies that manage $769 billion in assets, and more than 2,149 other companies operating in the state. This represents 8 new domestics, 76 new licenses, and an increase of one billion dollars in assets managed. The team completed 34 financial examinations and have 22 exams in progress.

The Fraud Bureau processed 631 referrals, closing 12 criminal cases with 44 charges. They collected $15,525 in civil penalties last year and closed 574 cases. 607 cases are open.
Life and Health staff reviewed 5,782 filings, rates, forms, and advertisements. The Property and Casualty team reviewed 26,915 filings, rates, forms, and rules. In addition, the department issued 57,216 licenses in 2023, bringing total licensees to 253,438.

This past year, the Captive Bureau announced the launch of Delaware Captives 2.0 in conjunction with the Delaware Captive Insurance Association to continue to innovate and compete with other domiciles. 43 new captives were licensed in 2023, for a total of 670 licensed captives.

The department led and engaged with dozens policy efforts with partners in the legislature. Legal staff processed 15 new bulletins and 10 revised or reissued bulletins, 5 new regulations, and 4 exempt orders to regulations.

Staff also participated in outreach events, including the Positively Dover African American Festival, Clayton Fire Prevention Open House, Dover Days, Down Syndrome Walk, Middletown Peach Festival, Milford Freedom Walk Festival, New Castle Ice Cream Festival, the 55+ Expo, and of course, the Delaware State Fair. In addition to robust contributions to the Delaware Employees’ Charitable Campaign, the Department also participates in charitable events including blood drives, food insecurity donations, and breast cancer awareness.

NEW CASTLE (May 4, 2022) – The Department of Health and Social Services (DHSS) has launched a state-sponsored Health Care Provider Loan Repayment Program (HCPLRP). Under the new loan repayment program, eligible clinicians may receive up to $50,000 per year in loan repayment for a maximum of four years of employment in Delaware.

Governor John Carney signed House Bill 48 with House Amendment 1 on Aug. 10, 2021, establishing the loan repayment program administered by the Delaware Health Care Commission (DHCC). The program is a valuable tool to incentivize providers to practice in Delaware, in addition to attracting more providers to the state’s primary care workforce.

“We are grateful to Governor Carney and to the General Assembly for their support of the Health Care Provider Loan Repayment Program,” said DHSS Secretary Molly Magarik. “It’s clear that we need to find ways to attract more primary care providers to practice in Delaware, and this state-sponsored program is a strategic way to do that.”

“When it comes to health care, Delawareans deserve to be treated by highly trained professionals at medical facilities statewide,” said Rep. David Bentz, the lead sponsor of House Bill 48. “However, we are facing a shortage of doctors as the demand for them grows. That’s why we passed HB 48, which offers an attractive incentive to Delaware students in residency programs here, as well as establishes an education loan repayment program for medical professionals who currently work in Delaware. With this law, we can work toward recruiting and retaining top primary care doctors. I’m grateful to the Delaware Health Care Commission for taking a leadership role in running the grant program and ensuring that we have more health care workers throughout the state, including in underserved communities.”

In Fiscal Year 2022, the General Assembly allocated $1 million in state funds to support the loan repayment program. The Delaware Health Care Commission also received, in December 2021, a $1 million one-time contribution from Highmark Blue Cross Blue Shield Delaware. For Fiscal Year 2023, beginning July 1, 2022, the Governor’s Recommended Budget has proposed an additional $1 million in state funds to support the program.

“The Delaware Health Care Commission is excited to be able to implement HB48 and offer health care providers, who are interested in practicing in Delaware, worked to address this crisis through the development of the Health Care Workforce Subcommittee; supporting education through Delaware Institute of Medical Education and Research (DIMER) and (Delaware Institute of Dental Education and Research (DIDER); providing practice sustainability through the Primary Care Reform Collaborative; and now incentivizing providers to practice in Delaware with the State Health Care Provider Loan Repayment Program,” said Dr. Nancy Fan, Chair of the Delaware Health Care Commission and a practicing OB/GYN. “We are excited to be able to implement HB48 and offer primary care providers, who will be practicing in Delaware, meaningful financial relief, so they can build a sustainable practice and increase access for our patients to quality, affordable care.”

Qualifying clinicians must be a new primary care provider in an ambulatory or outpatient setting and completed graduate education within six months of the application for HCPLRP being submitted. Eligible health care providers include physicians practicing family medicine, internal medicine, pediatrics, obstetrics/gynecology, geriatrics, and psychiatry as well as Nurse Practitioners, Certified Nurse Midwives, Clinical Nurse Specialists, and Physicians Assistants practicing adult medicine, family medicine, pediatrics, psychiatry/mental health, geriatrics, and women’s health.

Employers may apply on behalf of their affiliated, qualifying clinicians for education loan repayment grants. These sites may include:
• Hospital primary care practices
• Private practices
• Federally Qualified Health Centers
• Community outpatient facilities
• Community mental health facilities
• Free medical clinics

For awards issued to practitioners employed by Delaware health care facilities, hospitals and health systems must provide a 50% match for loan repayment awards.

Priority consideration will be given to Delaware Institute of Medical Education and Research (DIMER)-participating students and participants in Delaware based residency programs. Delaware is one of four states that does not have its own medical school. To accommodate the growing demand for primary care physicians across the state, the General Assembly created DIMER to support affiliated agreements with two medical schools in Philadelphia: Philadelphia College of Osteopathic Medicine (PCOM) and Thomas Jefferson, Sidney Kimmel Medical College (SKMC). A minimum of 120 academic seats are reserved annually (80 at Sidney Kimmel and 40 at PCOM) for Delaware residents applying to an allopathic or osteopathic degree program. New DIMER graduates are eligible for HCPLRP.

Delaware’s Health Care Provider Loan Repayment Program application is available online.

Applications are now accepted on a rolling basis and will be reviewed on the following schedule:
June 1, 2022*
Aug. 1, 2022*
Oct. 1, 2022

* Applicants in the June 1 and August 1 review cycles must have completed their graduate medical education by July 2021 or sometime thereafter. Applicants in the Oct. 1 review cycle must complete their graduate education by 2022 or sometime thereafter.

In addition to the state-sponsored Health Care Provider Loan Repayment Program, Delaware has operated a federal state loan repayment program (SLRP) supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services. SLRP offers similar incentives: up to $200,000 for four-year contractual agreements to provide services in federally designated Health Professional Shortage Areas. Where SLRP differs from HCPLRP is in designated areas of need, eligible professional disciplines, types of health care employment facilities that qualify, and date of graduation in respective disciplines.

To learn more about Health Care Provider Loan Repayment Program and the federal state loan repayment program, visit the Health Care Commission’s website.

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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.

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.”

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.