NEWS

Delaware gets federal grant to test health care plan

Beth Miller, and Jen Rini

Federal officials announced Tuesday that Delaware has won a $35 million grant to test its health care innovation plan, part of a $665 million pot of money meant to improve the quality of care and lower costs.

More than 100 people – doctors, hospital officials, insurance companies, patient advocates and policy analysts – have worked on the state plan, using $2.5 million in planning grants provided by the federal government in early 2013. The Delaware Health Care Commission has steered the effort.

Now the state will start to test the model to see if it achieves the "triple aim" – improving health, making the health care system work better and lowering costs.

"This is a big win for Delaware – a lot of money for a small state," said Wayne Smith, president and chief executive officer of the Delaware Healthcare Association, which represents medical facilities. "It will enable us to be an active laboratory for trying some of the new ideas that are out there in health care delivery and population health improvement."

Wayne A. Smith, president and chief executive officer of the Delaware Healthcare Association

With the money, health care officials have planned an ambitious agenda in the next four years that includes lowering health care costs so they align with natural gross domestic product growth, developing 10 healthy neighborhoods throughout the state and establishing that 80 percent of health care costs are value-based.

"It's ambitious, but certainly it's feasible," said Bettina Riveros, Gov. Jack Markell's health care policy adviser and lead on the state innovation plan.

Though the grant is $5 million shy of the $40 million grant the state requested, Riveros says it is a large award given the size of Delaware's population. The state will "trim around the edges" and adjust its timeline instead of cutting out proposals completely, she said. But new payment models, technology innovation and physician standards will go forward, Riveros said.

"I think we are going to have to work harder and work more efficiently," she said. "We will make it work.

Delaware is among 28 states to receive grant money for this testing phase. Also included are three territories and the District of Columbia. The money comes from appropriations authorized by the 2010 Affordable Care Act.

According to Health Care Commission figures, Delaware spends $8 billion on health care each year – 25 percent more per capita than the national average. That above-average spending has not translated to above-average results, however.

And Dr. Christopher Casscells, an orthopaedic surgeon who reviews health policy for the Caesar Rodney Institute, said Delaware's plan is more stale "rah-rah" than real change.

"These are ideas that have failed consistently, resurfacing from the old HMO model," he said. "I applaud the fact that they got a $35 million grant. Something good can come of it. But you're not going to improve quality or lower cost until everybody has some skin in the game."

Tort reform is needed to reduce unnecessary testing and procedures, he said. And he sees no real incentives in the plan. Incentives, he said, drive people toward any goal.

He can see that now in his schedule, as patients try to fit every possible procedure into 2014 before their insurance plan's deductible resets on Jan. 1. Where he otherwise might have one patient on Dec. 29 – maybe for emergency treatment – he has nine surgeries scheduled that day and no room to add more.

"Regular folks have done the math," he said. "Give doctors incentives, give patients incentives. ... It's a complicated process, but everybody who thinks they have the holy grail is incredibly naive."

Smith said that incentive work is underway in the Delaware Health Innovation Center's payment model committee. But he agrees with Casscells that tort reform is essential if the state really wants the system to work more efficiently.

"Tort reform has its own political environment and players," said Smith, who was the House majority leader in the Delaware Legislature for more than a decade. "That would not get done in this state at this time."

Dr. Nancy Fan, president of the Medical Society of Delaware

There are transformative concepts in the works, added Dr. Nancy Fan, an OB-GYN with St. Francis and president of the Delaware Medical Society, but physicians' excitement has been measured.

"It's always concerning when the state is in charge of it. We never know what's going to be handled, what mandate comes out of it. You never know what's going to happen," she said.

Smaller, independent physicians in particular would like to maintain operational control of their own practices, while abiding by state guidelines.

"The devil's in the details," Fan said. "I think, when you are talking about health care innovation and reform, I really feel that for many physicians in practice, they definitely need to be aware that there's a lot of flux and change."

Riveros said Delaware wants to keep the focus on patients.

"How do things change for the patient?" Riveros added. "We've heard this from the insurers: They want to work together to make sure that all Delawareans have a primary-care provider."

With that goal comes the need to integrate behavioral health services – including mental health counseling and substance abuse treatment – into primary health visits. For example, the grant would fund technology advances to give behavioral health practices access to electronic health records so staff can better track patients from primary care to specialty visits. Riveros said primary-care providers also would receive electronic upgrades to improve follow-up care.

The plan is to organize "uncoordinated" care so a patient is not constantly repeating his or her health history to providers.

"We want people to feel like there is a team caring for them," she said. "Your team could be all in one place. That provides that one-stop-shop for information."

The "care" has to be put back into health care, said Joyce Rickards, Kent/Sussex County Chapter of Sisters on a Mission, a breast cancer support group for African-American women.

Rickards is intimately familiar with the ins and outs of the health care sector. Her father, mother and one of her brothers battled cancer, and she was diagnosed with gastric and breast cancer.

"There are some [providers] that just treat people as a number. I would rather see the care put into it," she said. "It's going to take everybody working together, and this grant is going to be a great start for making it happen."

However, she said that the focus shouldn't be on creating more new programs to alleviate that problem.

"I would actually like to see them focus more on the quality of care that a lot of the lower-income people don't see rather than quantity. I know that Delaware is second in the nation with the high cancer incidence, and I just feel that with more screenings being offered that people will benefit from it," she explained.

The cost of care will still be an obstacle, however.

"It seems to be continually increasing where there's no cost-of-living adjustments and salaries," Rickards said. Even so, she considers the grant a step in the right direction.

"With the economy being the way it is everywhere, everybody is struggling. This happening [award announcement] at this time of the year, it's like a Christmas blessing."

Riveros said the state has already started implementing the grant's "triple aim" into practice by changing the payment models to favor quality service. She said the commission worked with the state's Medicaid division to amend the state's 2015 Medicaid provider request to include those elements. Going forward she'd like to see funds flowing to primary-care providers to help them bring in the resources they need to delivery such quality care and increasing work with community groups to foster healthy neighborhoods.

"We want to be one of the healthiest states," she said.

Contact Beth Miller at (302) 324-2784 or bmiller@delawareonline.com. Follow on Twitter @BMiller57 or on Facebook. Contact Jen Rini at (302) 324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.