Delaware Governor Announces Health Care Spending; Quality Benchmarks

December 2018 ~

Delaware Governor, John Carney, signed an executive order establishing state health care spending and quality benchmarks beginning in calendar year 2019.

The order lists eight policies established to help improve state healthcare and decrease costs by improving the quality of care provided as well as streamlining care to reduce wasteful procedures or services.

1. The Delaware Economic and Financial Advisory Council (DEFAC) Health Care Spending Benchmark Subcommittee (hereinafter “Subcommittee”) is hereby established.
2. The Subcommittee shall be responsible for setting the health care spending benchmark for the State of Delaware (hereinafter “Spending Benchmark”) and shall advise DEFAC, the Governor and relevant state agencies on the Spending Benchmark.
3. For calendar year 2019, the Spending Benchmark shall be set equivalent to the Benchmark Index submitted to the Governor and General Assembly in December 2018 as established pursuant to Executive Order Twenty-One dated June 30, 2018. For calendar years 2020, 2021, 2022 and 2023, the Spending Benchmark shall be set at 3.5%, 3.25%, 3.0%, and 3.0% per capita spending growth respectively, unless the Subcommittee determines, in its annual review (outlined below) that the Spending Benchmark should be adjusted, using the formula in 2.b.
   b. The Spending Benchmark shall be the per capita Potential Gross State Product (PGSP) growth rate which shall be calculated as follows:
4. The sum of: the expected growth in national labor force productivity; plus the expected growth in Delaware’s civilian labor force; plus the expected national inflation;
   ii. Minus Delaware’s expected population growth;
   iii. Plus a transitional market adjustment set at 0.5% for calendar year 2020, 0.25% for calendar year 2021, and 0% for calendar year 2022 and beyond.
5. The Subcommittee shall:
6. Review annually all components of the PGSP methodology and recommend to DEFAC for its approval whether the forecasted PGSP growth rate has changed in such a material way that it warrants a change in the Spending Benchmark, and if so, how and why the Spending Benchmark should be modified.
   b. Review the methodology of the Spending Benchmark periodically for possible updates or modifications to the methodology for the performance year starting January 1, 2024 and beyond, and make recommendations to DEFAC no later than March 2023 and each March thereafter, on whether, and, if so, why the Spending Benchmark methodology and/or the PGSP growth rate should change.
   c. Provide the public and interested stakeholders an opportunity to provide input and consider their recommendations.
   d. Advise the Governor and DEFAC on current and projected trends in health care and the health care industry, particularly as they affect the expenditures and revenues of the State of Delaware, its citizens, and its major industries.
7. The Subcommittee shall consist of the following:
8. A Chair and a Vice-Chair, both of who shall be members of DEFAC and have health care expertise appointed by the DEFAC Chair;
   b. Three existing members of DEFAC appointed by the DEFAC Chair;
   c. Two members representing health economists, appointed by the Governor; and
   d. Two members representing quality improvement experts from two health care systems or hospitals which operate in the state, appointed by the Governor.
9. All members of the Subcommittee shall be appointed by and serve at the pleasure of the appointing authority. All meetings shall be called by the Chair of the Subcommittee. The Vice-Chair shall chair any meetings of the Subcommittee in the absence of the Chair.
10. DEFAC shall report no later than May 31 of each year to the Governor and the Delaware Health Care Commission (DHCC) any changes to the Spending Benchmark approved by DEFAC pursuant to Sections 2 and 3 of this Order.
11. Recognizing the importance of coordination between the Subcommittee and the DHCC in the creation of spending and quality health care benchmarks, and as part of its ongoing efforts to serve as the policy body to advise the Governor and the General Assembly on strategies to promote affordable quality health care to all Delawareans, the DHCC is encouraged to accomplish the following:
12. Set health care quality benchmarks for the State of Delaware (hereinafter “Quality Benchmarks”) and advise the Governor and relevant state agencies on the Quality Benchmarks. For calendar years 2019 through 2021, the Quality Benchmarks shall be as follows:
13. Emergency Department Utilization Rate (risk-adjusted rate), as defined by the National Committee for Quality Assurance, measured for commercial populations:
14. 2019: 190 visits per 1000
    b. 2020: 184 visits per 1000
    c. 2021: 178 visits per 1000
    d. Aspirational benchmark for longer term attainment: 166 visits per 1000
15. Opioid-Related Overdose Deaths, as defined by the Centers for Disease Control and Prevention:
16. 2019: 16.2 deaths per 100,000
    b. 2020: 15.5 deaths per 100,000
    c. 2021: 14.7 deaths per 100,000
    d. Aspirational benchmark for longer term attainment: 13.3 deaths per 100,000
17. Residents per 1,000 with Overlapping Opioid and Benzodiazepine Prescriptions, as defined by the Pharmacy Quality Alliance, measured for commercial and Medicaid populations:
18. 2020, 2021 and aspirational benchmarks to be defined and published by the Secretary of DHSS during 2019
19. Adult Obesity, as defined by the Centers for Disease Control and Prevention:
20. 2019: 30.0%
    b. 2020: 29.4%
    c. 2021: 28.7%
    d. Aspirational benchmark for longer term attainment: 27.4%
21. Adult Tobacco Use, as defined by the Centers for Disease Control and Prevention:
22. 2019: 17.1%
    b. 2020: 16.4%
    c. 2021: 15.8%
    d. Aspirational benchmark for longer term attainment: 14.6%
23. High School Students Who Were Physically Active, as defined by the Centers for Disease Control and Prevention:
24. 2019: 44.6%
    b. 2020: no survey performed
    c. 2021: 46.8%
    d. Aspirational benchmark for longer term attainment: 48.7%
25. Statin Therapy for Patients with Cardiovascular Disease – Statin Adherence 80%, as defined by the National Committee for Quality Assurance, measured for commercial and Medicaid populations:
26. 2019 (commercial): 79.9%
    b. 2019 (Medicaid): 59.2%
    c. 2020 (commercial): 80.5%
    d. 2020 (Medicaid): 61.5%
    e. 2021 (commercial): 81.0%
    f. 2021 (Medicaid): 63.7%
    g. Aspirational benchmark for longer term attainment (commercial): 82.1%
    h. Aspirational benchmark for longer term attainment (Medicaid): 68.3%
27. Persistence of Beta-Blocker Treatment After a Heart Attack, as defined by the National Committee for Quality Assurance, measured for commercial and Medicaid populations:
28. 2019 (commercial): 82.5%
    b. 2019 (Medicaid): 78.8%
    c. 2020 (commercial): 84.9%
    d. 2020 (Medicaid): 80.1%
    e. 2021 (commercial): 87.2%
    f. 2021 (Medicaid): 81.3%
    g. Aspirational benchmark for longer term attainment (commercial): 91.9%
    h. Aspirational benchmark for longer term attainment (Medicaid): 83.9%
29. Review the methodology of the Quality Benchmarks in 2022, and every three years thereafter, to determine whether changes should be made to the values used to establish the Quality Benchmarks to reflect changes in new population health or health care priority opportunities for improvement, and/or whether the Quality Benchmarks’ values should be changed to reflect improved health care performance in the state. Should such determinations be made, the DHCC shall change the values used for the Quality Benchmarks, but only after providing the public and interested stakeholders an opportunity to provide feedback, and considering their recommendations.
30. Report annually during the fourth quarter on performance relative to the Spending and Quality Benchmarks during the prior Calendar year, including variation in costs and quality of high-volume, high-cost and high-value episodes of care (identifying the causes of variation, including mix of services used, unit price variation and provision of low-value care) at:
31. State, health insurance market (e.g., commercial Medicaid, Medicare, Medicare Advantage) and individual payer levels; and
    2. Medical group and accountable care organization (ACO) levels for entities of a sufficient size, using clinical risk adjustment methodologies.
32. Engage providers and community partners in a regular and ongoing forum, with the State and with each other, to develop strategies to reduce variation in cost and quality and to help the State perform well relative to the Spending Benchmark and Quality Benchmarks, relying on data and, to the extent practicable, evidence-based solutions to address identified opportunities through the variation analysis.
33. No later than January 31, 2019, the Secretary of DHSS shall publish a technical manual that contains the methodology for the Spending Benchmark and the Quality Benchmarks, including where to obtain data to calculate the values of the benchmarks and how to assess performance.

“Delaware has consistently ranked among the highest-spending states for health care, but we have not traditionally been a leader in health care outcomes. That needs to change,” Governor John Carney. “This Executive Order reaffirms our commitment to lowering costs for Delaware families and improving the quality of care that Delawareans receive. We’ll do that, first and foremost, by improving transparency around the cost of health care services.”

Source(s): Delaware.gov; Delaware Online; Delaware 105.9; American Hospital Association;