The Impact of Health Care

Innovation in Delaware

Council of State Governments Eastern Regional Conferences

Annual Meeting and Regional Policy Forum: Aug. 18, 2015
Rita Landgraf, Secretary, Delaware Department of Health and Social Services
Delaware Health and Social Services

Health care is confusing for

Patients, and premiums are rising

Employers are facing

increasing costs, an unhealthy
workforce, and complex
decisions

Providers

State of
Delaware
The

lack time and

resources to
proactively
coordinate care

Delaware Health and Social Services

faces health care

costs that consume
approximately 25%
of the state budget

1 in 5
4.3% of

Per capita costs

Health care costs

growing at

6%

25%
higher than U.S.
average

per year

historically

11.1%

25% of state budget

Delawareans are
smokers

adults
considered
suicide in 2011

Diabetes
incidence rate of

Health care costs consume

More than

$8B
annual spend on
healthcare in Del

Delaware Health and Social Services

31.1%
of Delawareans
are obese

HEALTH CARE INNOVATION

Stakeholders Come Together to Embrace the Triple Aim,
Plus One

Delaware Health and Social Services

Our Vision for 2018

All Delawareans will have a primary care provider, and it will be easy for
them to access care when they need it.

When patients from a primary care practice need to go to the ER, the
office will be notified on arrival or check-in (if not by the patient before).

Care coordination will be integrated with primary care rather than a

remote system disconnected from care delivery.

When a mother needs help caring for her child with asthma, she will
know where to turn.

Doctors offices will be paid for care coordination in between office

visits, and rewarded for quality and efficiency of care.

Providers will work more closely together so that patients will feel as
though the individuals caring for them, including behavioral health
providers, are part of a team.

Employers will be able to continue providing health insurance to their

employees.
Delaware Health and Social Services

Payers and other

purchasers

Governor

Department of
Health & Social
Services

Health Care
Commission
(HCC)

Providers

Consumers and
patients

Delaware
Center for Health
Innovation (DCHI)

Delaware Health
Information
Network (DHIN)

Payment Model
Monitoring
Committee

Healthy
Neighborhoods
Committee

Clinical
Committee

Patient/Consumer
Advisory
Committee

Workforce and
Education
Committee

Technical
Advisory Group

State of Delaware
Public-private
Private sector

Delaware Health and Social Services


Clinical
Workforce
and
Education
Payment

Transformation of primary care through Patient-Centered Medical

Homes (PCMHs) and Accountable Care Organizations (ACOs)
Support for primary care practice transformation & care coordination
Innovative two-year learning and development program with common
curriculum on team-based, integrated care
Development of the health professional residency consortium
Multi-payer value-based payment models offered statewide: Pay-4-Value
(P4V) and Total Cost aligned with CMS models
QHP standards, Medicaid MCO RFP, & state employees driving adoption

First in the country multi-payer performance scorecard

Nationally leading HIE to enable integrated clinical and claims data
over time

Healthy
Neighborhoods

Integration of community-based health initiatives with delivery

system focused on priority health needs
Scorecard, tools, data, and resources to support neighborhoods

Patient /
Consumer
Advisory

HIT

Patient at center of everything Delaware does

Patient engagement tools to support individuals to engage in their
own health

Delaware Health and Social Services

Aspirations
and Goals
Aspirations for Triple Aim

Become 1 of the 5 healthiest

states in the U.S.

Achieve top performance for

Specific Goals Reflected in Plan

Create >$1 billion in total savings to the

system through 2020

Reinvest about half of savings in care

delivery to ensure sustainability for
providers

Pass about half of savings on to consumers

and purchasers to preserve affordability

quality/patient experience

Bring health care spending

growth more closely in line
with growth of economy

PLUS ONE: Achieve high

provider experience

Goals for Adoption to Achieve Plan

Participation by all payers: Commercial,

Medicaid, Medicare by 2016

Participation by >70% of self-insured

employers by 2018

Total investment: $130

million over 4 years

Adoption by >90% of PCPs by 2018

Meaningful changes in capabilities/processes

Delaware Health and Social Services

Two Types of Value-Based Payment Models

Total cost of care models look at the overall spending as a
Total Cost
of Care

key metric, and look to reduce wasted healthcare spend

(with the savings shared between payer and provider)

These models also have a requirement to meet quality and

patient experience goals

Pay-for-value enables providers to earn bonuses for meeting

Pay for Value

both a set of quality measures and managing resource

utilization

As a common goal, pay-for-value models look for a decrease

in the growth of overall costs
Delaware is targeting to have 80% of payments and 90% of primary care
providers going through these models in the next 4 years
Delaware Health and Social Services

Work Ahead in Innovation

Common Scorecard for
providers. Measures include:
Diabetes care
High blood pressure
Screening for clinical
depression
Tobacco use
Influenza immunization
Patient hospitalization
admissions per 1,000
patients
ER visits per 1,000 patients

Sampling of Timeline:
2015: Test and refine
scorecard; begin practice
transformation; engage
consumers and providers
2016: Funding for care
coordination more widely
available; Healthy
Neighborhoods initiatives
launched; workforce strategy
implemented.

Delaware Health and Social Services

Segmentation of Population
NON-MEDICARE, EXCLUDING LTSS1

Percentage of population, and spending

Severe chronic

10%

Multiple chronic

20%
65%

Single chronic

Healthy
Non-Claimants2

30%

30%

20%
10%
Population

Those focused on
maximizing ROI from care
coordination may focus on
the 10% highest-risk
patients who account for
60-70% of spending.
Some may argue that wellexecuted care coordination
can deliver positive ROI for
a broader share of the
population.

10%
10%
5%
0%
Spending

1 LTSS: Long term services and supports of Medicaid

2 May have some associated spend (e.g. cap rates paid), however no medical claims
Source: AHRQ Chart Book, Delaware Medicaid Claims data analysis by McKinsey Health Care Value Analytics

Delaware Health and Social Services

INNOVATIONS IN MEDICAID
New Ways to Serve Vulnerable Populations, Resulting in Better Outcomes

Delaware Health and Social Services

Serving Vulnerable Seniors

Transitioned Medicaids long-term care
seniors to MCOs in April 2012 to better
coordinate care and supports.
Began reimbursing for telemedicinedelivered services in July 2012, including
wellness checks for individuals with
Parkinsons, telepsychiatry and hospital
trauma cases.
Partnered with St. Francis Hospital to open
LIFE Center in Wilmington in 2013 under
Program for All-Inclusive Care for the
Elderly. Exploring 2nd center in Sussex.
Delaware Health and Social Services

Another Impact: Aging Population

400000

350000
300000
250000

Age 60+

200000

Age 75+

150000

Age 85+

100000
50000

0
2000 2005 2010 2015 2020 2025 2030 2035 2040

Delaware Health and Social Services

** By 2030,
Delaware is
projected to
have the
9th-highest
proportion
of people
age 65 and
older in the
U.S.

Serving Vulnerable Populations

Pathways to Employment: Brings together
state agencies, including Medicaid, to
increase options in support of low-income
individuals with disabilities who want to
work.
PROMISE (Promoting Optimal Mental
Health for Individuals through Supports and
Empowerment): In additional to
employment, the goal is to improve clinical
and recovery outcomes, reduce
unnecessary institutional, and reduce
growth in overall program costs.
Delaware Health and Social Services

Delaware Health and Social Services