Heart 2 Heart Hugs Spreading Love Across Delaware

DOVER — Valentine’s Day is not just for sweethearts. Thursday, February 14 is the day that Schools and Foster Care Programs throughout Delaware will be able to pick up all the warm winter clothes collected by GACEC in their Heart 2 Heart Hugs annual campaign. Donations can still be dropped off at the GACEC office located in the old train station at 516 Loockerman Street in Dover.

Sue O’Day from Fleece for Keeps of Wilmington donated 65 blankets. (see photo and cutline below) Project Warm donated 800 winter coats and people from the community and other state agencies donated new store bought and handmade items for distribution.

This years distribution is on Valentines day with distribution to schools and foster care programs across Delaware. Some claim that this is too late for such a campaign. Wendy Strauss responded, “ Some of the items do go to students this winter. Mostly the schools need their inventory restocked so they have it when the need arises at the beginning and throughout the school year. Right now, retail stores are reducing their winter wear so it is a good time to buy and donate to the campaign.”

There is still time to donate! Staff will be at the office today until 4 p.m. if you would like to drop off donations. For additional information please contact Kathie Cherry by calling 302-739-4553 or email her at Kathie.cherry@gacec.k12.de.us and if you would like to donate items for Delaware’s homeless children.


DHSS Releases 2018 Study Showing a Continuing Decline in Primary Care Physicians Across the State

NEW CASTLE (Jan. 2, 2019) – The number of full-time equivalent primary care physicians providing direct patient care in Delaware in 2018 declined about 6 percent from 2013, a trend that resulted in a slightly lower percentage of physicians statewide who are accepting new patients, according to a new University of Delaware study of the primary care physician workforce commissioned by the Department of Health and Social Services (DHSS).

The study, done by UD’s Center for Applied Demography & Survey Research, also found that the reduction in primary care physicians likely will continue, with a declining percentage of primary care physicians expecting to be active in five years, especially in Kent County. Kent has the highest percentage (25 percent) of physicians 65 and older, compared with Sussex County (16 percent) and New Castle County (13 percent). Only 60 percent of primary care physicians in Kent County reported that they will be active in five years, compared to 70 percent in Sussex County and 78 percent in New Castle County.

Despite the workforce trends, the UD study found that there are a sufficient number of primary care physicians in Delaware, “although their location and specialty is probably not optimal.” In 2018, there were 815 individual primary care physicians practicing in Delaware, down from 862 in 2013, and a full-time equivalent of 662 physicians statewide in 2018 vs. 707 in 2013. The study found that the 2018 numbers are at the upper range of what is desirable. Both Kent County – 2,069 patients per primary care physician – and Sussex County – 2,014 patients per physician – are above the 2,000-to-one ratio used by the U.S. Health Resources and Services Administration (HRSA) to designate shortage areas.

DHSS Secretary Dr. Kara Odom Walker, a board-certified family physician, said the trends point to the need to strengthen the dwindling primary care workforce in Delaware.

“The best preventive care and the most cost-effective care is provided by a strong and coordinated primary care workforce,” Secretary Walker said. “Primary care providers know their patients and their medical histories best and can provide the most effective, high-value, longitudinal care for chronic health conditions and other preventable diseases. As state government officials, our priority is to find ways to incentivize front-line care to perform as coordinated teams that are ultimately accountable for population health. We also need more primary care physicians to remain in practice and find ways to encourage new doctors, including those from minority and rural backgrounds, to choose primary care as their specialty.”

State Sen. Bryan Townsend and Dr. Nancy Fan, Chair of the Delaware Health Care Commission, are Co-Chairs of the Primary Care Collaborative, which is working on long-term solutions to support primary care in the state. The collaborative was created through Senate Bill 227, which aimed to strengthen primary care through a series of changes, including requiring insurers to reimburse primary care physicians and other front-line practitioners at the Medicare rate for the next three years. The collaborative, which has been meeting since September, is expected to issue its long-term recommendations by Jan. 8.

“It is vital that the State of Delaware, for the sake of Delawareans’ health, take steps to promote and strengthen primary care,” said Sen. Bryan Townsend, who sponsored Senate Bill 227 with Rep. David Bentz. “The declining rates of primary care providers practicing in Delaware or offering access to new patients are alarming. We have implemented immediate measures, and we have developed long-term solutions. The health and well-being of Delawareans, and the Delaware economy, cannot afford for us to delay in implementing those solutions, or for us to lack the courage to tackle complex policy and political issues.”

“This survey is very timely and demonstrates with supporting data the primary care physician crisis currently in Delaware,” said Dr. Nancy Fan, Chair of the Delaware Health Care Commission and an obstetrician/gynecologist in Wilmington. “Recognizing that primary care is foundational to effective, quality health care, the Health Care Commission is working through the Primary Care Collaborative to develop policy recommendations that will strengthen and maintain the current workforce and increase attractiveness of practice in Delaware for the future physician workforce. If something is not done immediately, these numbers will only get worse.”

“This DHSS study illustrates the poor access to primary care experienced by Delawareans,” said Dr. James Gill, a family medicine physician in Wilmington and a member of the Medical Society of Delaware who advocated for Senate Bill 227. “Increasing access to primary care will require increasing payment for primary care services by commercial payers in our state, which is currently 40 percent to 50 percent below the rest of the country. Senate Bill 227 has begun to move Delaware in that direction, and the Primary Care Collaborative is working to continue the work necessary to reduce the cost of care and improve the quality of care and the health of Delawareans.”

Among the other findings in the Primary Care Physicians in Delaware 2018 Survey:

  • In 2018, accounting for the time that primary care physicians offer direct patient care, the estimated full-time equivalent (FTE) was 662 physicians, with 461 FTEs in New Castle County, 89 in Kent and 112 in Sussex.
  • About 60 percent of Delaware’s physicians went to high school in the region; over half graduated from a medical school in the region; and about 80 percent completed their medical residency in the region.
  • The breakdown by gender statewide is 52.9 percent male and 47.1 percent female.
  • Delaware has a disproportionately low percentage of African-American (6.6 percent) and Hispanic (4.3 percent) primary care physicians statewide, compared with the state’s general population of 22.8 percent African-American and 18.1 percent Hispanic/Latino.
  • About 82 percent of physicians were accepting new patients in 2018, compared with 86 percent in 2013, but the proportion accepting new Medicare patients (72 percent) and new Medicaid patients (78 percent) was lower.
  • Average wait times statewide for new patients was 23 days in 2018, compared with 32 days in 2013, and six days for established patients in 2018 vs. 17 days in 2013.
  • The percentage of primary care physicians who employed non-physician services – advanced practice nurses, physician assistants and others – climbed to about 62 percent in 2018, up from 56 percent in 2013.
  • About 80 percent of physicians participated in a pay-for-performance reimbursement model including shared savings (34 percent), shared risk (19 percent), capitation model (14 percent), and concierge model (6 percent).

Data collection for the Primary Care Physician in Delaware 2018 Survey was done during the spring and summer of 2018, with 2,533 physicians contacted by mail who have an active license with a Delaware address or an address with a ZIP code adjacent to Delaware. Of those contacted, 957 responded and provided usable data. Primary care physicians practice in one of five specialties: family practice, general practice, internal medicine, pediatrics or obstetrics/gynecology.

Download the study here from the DHSS website.


Health Care Commission Awards First Value-Based Payment Reform Mini-Grant to a Christiana Care Behavioral Health Pilot

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.”


Health Care Commission Seeks Applications from Delaware Health Care Providers for One-Time Mini-Grants Related to Payment Reform

NEW CASTLE (July 26, 2018) – As part of the State Innovation Model (SIM) initiative, the Delaware Health Care Commission is seeking applications from Delaware health care providers for one-time, value-based payment reform mini-grants to grow their capacity to integrate data, improve the coordination of patient care or increase their readiness to integrate into a total cost of care or Alternative Payment Model (APM).

The Delaware Health Care Commission is prepared to award up to 10 applicants in amounts ranging from $25,000 to $250,000 through the Value-Based Payment Reform Fund for work that must be completed or services procured by Jan. 31, 2019. Mini-grant applicants must be primary care providers, behavioral health providers, hospitals, Accountable Care Organizations (ACOs), Federally Qualified Health Centers (FQHCs) or clinically integrated networks, and must be licensed in the State of Delaware. Bidders may apply for multiple projects. The Health Care 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. Applications are due no later than Aug. 30.

“These one-time mini-grants offer a great opportunity for health care providers in Delaware to conduct pilot projects 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. “To embrace this change, we urge providers to test out collaborations or partnerships in the areas of data integration, care coordination or readiness to integrate into an ACO or an Alternative Payment Method.”

“In our continuing work with the State Innovation Model, the Health Care Commission has embraced innovative ways to help practices succeed in the changing health care delivery environment,” said Dr. Nancy Fan, Chair of the Delaware Health Care Commission. “These mini-grants, along with the ongoing work through our practice transformation vendors, give us practical ways to help facilitate that change.”

Applications must be made in 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, supporting innovative changes in the way health care is delivered and paid for in order to drive quality and better health for all in our state,” said Julane Miller-Armbrister, executive director of DCHI. “We encourage Delaware health care providers to apply for these mini-grants as a way to pilot their ideas for comprehensive reform.”

Applications will be evaluated and considered as they are received, with the final notifications of award coming by Sept. 30. For potential applicants, the Health Care Commission will host a Q&A session via conference call at 2 p.m. Aug. 9. Please email DHCC@delaware.gov for call-in information. All questions and final applications also must be submitted by email to DHCC@delaware.gov.


Delaware Falls Four Spots in Commonwealth Fund’s 2018 State Health Scorecard; Secretary Walker Says Health Care Spending and Better Outcomes Must Be Aligned

NEW CASTLE (May 3, 2018) – Ranking in the bottom half of states in a variety of health measures, including adults who smoke, annual diabetes treatment testing, and adults who are obese, Delaware fell four spots in The Commonwealth Fund’s 2018 Scorecard on State Health System Performance released today.

Delaware ranked 22nd among all the states on the more than 40 measures, which are divided among access to health care, quality of care, efficiency in care delivery, health outcomes and income-based health care disparities. Delaware’s worst trend was in deaths from suicide, alcohol and drug use increasing from 38.2 deaths per 100,000 population in 2013 to 49 deaths per 100,000 in 2016. Delaware ranked 31st in that category among the states.

On the positive side, Delaware ranked in the top five in three categories, including the top ranking for the lowest rate of deaths within 30 days of hospital discharge among Medicare beneficiaries. The state ranked third for the lowest rate of adults with a mental illness reporting an unmet need and fourth for the lowest rate of children ages 19-35 months who did not receive all recommended vaccines.

“This is another national health scorecard that indicates we are not a top state for overall health, despite being one of the top-ranked states in terms of per-capita health care spending,” said Delaware Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker, a board-certified family physician. Last June, a Centers for Medicare and Medicaid Services (CMS) analysis found that Delaware ranked third among the states for per-capita health care spending in 2014 at $10,254, or 27 percent above the U.S. average of $8,045. If that rate is maintained, CMS estimated that Delaware’s overall health care spending could double by 2025.

In September, Gov. John Carney signed House Joint Resolution 7 authorizing DHSS to develop a health care spending benchmark to bring transparency to how Delaware’s health care dollars are spent across the system – commercial insurers, Medicare and Medicaid. In February, Gov. Carney signed an Executive Order creating the Health Care Delivery and Cost Advisory Group to advise Secretary Walker on the creation of statewide health care spending and quality benchmarks.

“Across the health care spectrum, our goal is to examine health care costs and how to slow the growth of those costs, while improving the overall health of Delawareans at the same time,” Secretary Walker said. “The Commonwealth Fund rankings provide us with valuable insights into the areas where we need improved health outcomes.”
Dr. Karyl Rattay, director of DHSS’ Division of Public Health, said the rankings show there is more work to do to improve population health across the state. In a note of caution, Dr. Rattay said The Commonwealth Fund appeared to report Delaware’s infant mortality rate incorrectly at 9.1 deaths per 1,000 live births in 2015. Dr. Rattay said Delaware’s rate peaked at 9.3 deaths per 1,000 live births for the five-year time period ending in 2005 and has declined to 7.5 deaths per 1,000 live births for the five-year time period ending in 2016. “Our rate is still significantly higher than the U.S. average of 5.9 deaths, with higher disparities among populations and in specific geographic areas,” she said.

“While we are pleased to see Delaware ranked sixth among the states in the broad category of prevention and treatment,” Dr. Rattay said, “the Commonwealth Fund’s results indicate the areas where we must seek further improvement, especially in the healthy lives and disparity indicators.”

In another national health scorecard released earlier this year, Delaware ranked 30th in United Health Foundation’s 2017 America’s Health Rankings Annual Report, exceeding the national average in drug deaths per 100,000 population, obesity and physical inactivity rates among adults, cancer deaths per 100,000, diabetes rate among adults and violent crime offenses per 100,000. Delaware’s 2017 ranking improved one spot from 2016.

To read The Commonwealth Fund’s 2018 Scorecard on State Health System Performance:
http://www.commonwealthfund.org/interactives/2018/may/state-scorecard/

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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.