Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker sent her recommendations for establishing health care spending and quality benchmarks to Gov. John Carney.
The work on the benchmarks began last summer when the General Assembly passed House Joint Resolution 7 authorizing DHSS to develop the benchmark. Gov. John Carney signed that legislation in September 2017, after an analysis by the Centers for Medicare and Medicaid Services (CMS) showed Delaware had the third-highest per-capita health care spending rate in the country.
DHSS and Walker began a series of summits to explore how a spending benchmark could work in Delaware. While the overall health of Delawareans has been improving – Delaware is ranked 30th among the states, according to America’s Health Rankings – the pace of that improvement is trailing the growth of health care spending across the state.
Carney signed Executive Order 19 in February, creating an advisory group of health care leaders and other key stakeholders to provide feedback to Walker on strategies for developing spending and quality benchmarks. The advisory group provided its summary report in June.
Based on months of feedback, research and deliberations, Secretary Walker’s recommendations to Governor Carney include:
– The healthcare spending benchmark should be expressed as a rate using a calculated measure of the per-capita potential gross state product (PGSP) growth, that the Governor should set the initial benchmark for 2019 and that the initial benchmark should remain in place for five years.
– The Delaware Finance Advisory Committee (DEFAC) should establish a new Health Care Spending Benchmark Subcommittee to review the inflation component of the benchmark and the methodology of calculating the benchmark for 2024 and beyond.
– The Health Care Commission should be responsible for setting the health care spending benchmark in the future and consider changes to the benchmark target between 2020 and 2023 if the DEFAC Health Care Spending Benchmark Subcommittee so recommends.
– The Health Care Commission should collect timely and accurate data from licensed health insurers – using the Health Care Claims Database – to inform setting the spending and quality benchmarks, and assessing performance.
– The quality benchmarks should be established to “monitor and establish accountability for improved health care quality that bends the health care cost growth curve.”
– The quality benchmarks should be focused on high-priority areas, including ambulatory care-sensitive emergency department visits; opioid-related overdose deaths and co-prescribed opioid and benzodiazepine prescriptions; and cardiovascular disease prevention.
– That there should be aspirational benchmarks along with more incremental annual benchmarks, and that the Health Care Commission (HCC) should convene a time-limited advisory group to inform the HCC on whether the quality measures should change to reflect new priorities or improved performance.
