People are Solutions, Not Problems

The Institute for Healthcare Improvement has posted an interview with America Bracho, MD, MPH, President and CEO of Latino Health Access.

“Some people assume that addressing issues like unemployment, housing, food, and education makes things more complicated, but I’ve seen chronic illnesses become more manageable by addressing social determinants.”

Read the interview here.

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Health Alert Notice: Seasonal Influenza Activity and Treatment of Patients with Influenza in Delaware

The Delaware Division of Public Health (DPH) is issuing this health advisory to advise health care providers of increased influenza (flu) activity in Delaware, what precautions can be taken and recommendations that can be made for patients experiencing flu-like symptoms.

Summary
The level of influenza activity in Delaware is at record levels in the state. DPH urges providers to continue to vaccinate their patients against the flu and to start patients who have a clinical picture consistent with influenza on neuraminidase inhibitor antivirals (such as oseltamivir) as soon as possible and without waiting for results of laboratory testing.

Due to the ongoing strain on the hospitals, providers are encouraged to direct to the emergency room (ER) only those patients experiencing serious or life-threatening symptoms. Patients with less serious symptoms related to influenza can be cared for by primary care providers or at walk-in clinics.
Providers should also consider calling in prescriptions for antivirals for patients with flu like symptoms without waiting for an office visit, and communicate to patients the importance of staying home from work, or in the case of children – school, while sick to prevent further spread of the disease.

Influenza activity remains high

The number of Delaware laboratory-confirmed flu cases for the 2017-2018 season are at record high levels. Total laboratory-confirmed flu cases have now surpassed 4,100. The total for the entire 2016-2017 season was 4,590 laboratory-confirmed cases, which was a record high for the time. Additionally, for the week of Feb. 4 to Feb. 10, 2018, single week totals have exceeded 1,200 lab-confirmed cases, which is almost double the previous single week total record of 671 during the 2009-2010 flu season.

As of February 15, 2018, Delaware has seen 11 flu-related deaths for the 2017-2018 season, most of whom have been patients over 60 with chronic underlying health conditions. The latest reported death was to a 47-year old individual who had no underlying health conditions, and had not been vaccinated. To date, eight of the 11 deaths have been New Castle County residents and three have been Sussex County residents. There have not been any flu-related deaths in Kent County reported.

The age groups hit hardest with the flu this year have been persons aged 5 to 24 (875) – most of them in the 5 to 13 age range, as well as infants and children birth to 4 (461). To date, persons age 65 and older comprise 62.6 percent of the hospitalizations. 513 have been hospitalized this season due to flu complications – more than double the 199 at this time last year.

While there are signs that flu activity may be declining along the West coast, overall, influenza-like-illness increased again nationally. This is highest level of influenza-like illness recorded since the 2009 H1N1 pandemic

While H3N2 viruses continue to be predominant this season, the nation is seeing the proportion of H3N2 viruses begin to decline and an increase in the proportion of influenza B viruses and, to a lesser extent, H1N1 viruses as well.

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DHSS Moves Medicaid Managed Care Contracts to Value-Based Purchasing

DHSS Moves Medicaid Managed Care Contracts to Value-Based Purchasing to Accelerate Health Care Delivery Reforms

Thursday, January 25, 2018

Delaware’s health care delivery system, Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker announced today that DHSS has entered into a value-based purchasing care initiative through contracts in its Medicaid Managed Care Program. This initiative applies to all managed care organizations participating in the Delaware Medicaid program.

Beyond accelerating reforms, Secretary Walker said the purpose of the agreement is to transition the system away from traditional fee-for-service, volume-based care to a system that focuses on rewarding and incentivizing improved patient outcomes, value, quality improvements and reduced expenditures. DHSS seeks to align the incentives of the managed care organizations, providers and members through innovative value-based strategies.

“Through this historic initiative, we will reward our Medicaid managed care partners for embracing innovation and for providing our clients with high-quality care that focuses on improved outcomes and reduced expenditures,” Secretary Walker said. “Rather than paying solely for volume of care – hospital stays, tests and procedures, regardless of outcomes – we will pay for achieving optimal health for our Medicaid clients and give our MCO partners flexibility in meeting that goal.”

Steve Groff, director of DHSS’ Division of Medicaid and Medical Assistance (DMMA) said the initiative has a two-part approach: quality performance measures and value-based purchasing strategies. Through quality performance measures, Medicaid will select measures that relate to the following: quality, access, utilization, long-term services and supports, provider participation, spending and/or member/provider satisfaction, Groff said. Key measures build on the Common Scorecard created in collaboration with the Statewide Innovation Model (SIM) Award and through the Delaware Center for Health Innovation’s work. In the three years of this contract, seven key measures will be monitored including management of diabetes cases, asthma management, cervical cancer screening, breast cancer screening, obesity management, timeliness of prenatal care and 30-day hospital readmission rates.

These measures also will be tied to desired performance levels, with potential penalties being imposed if performance levels are not achieved. Through the value-based purchasing strategies, the managed care organizations will be required to implement provider payment and contracting strategies that promote value over volume and reach minimum payment threshold levels. If minimum threshold levels are not met, potential penalties could be imposed. The changes are subject to approval by the Centers for Medicare and Medicaid Services.

About 200,000 of the current 225,000 Medicaid clients in Delaware are served by Medicaid’s two managed care organizations, Highmark Health Options Blue Cross Blue Shield Delaware and AmeriHealth Caritas Delaware.

Secretary Walker said the value-based purchasing initiative within Medicaid’s Managed Care Program is another step forward in embracing Governor John Carney’s goal of lowering health care costs while improving patient outcomes. In last week’s State of the State, the Governor said we are spending too much money on health care and not getting the best results. He said now is the time to change the way we deliver health care.

In 2014, Delaware’s per capita health care costs were more than 27 percent above the U.S. average, ranking the state third-highest in the country, behind only Alaska and Massachusetts. The Centers for Medicare and Medicaid Services (CMS) analysis of all insurance payers – Medicaid, Medicare and private – found per-capita spending in Delaware was $10,254. Without changes, the analysis estimates Delaware’s total health care spending will more than double from $9.5 billion in 2014 to $21.5 billion in 2025. While Delaware ranks high in terms of health care spending, the state ranks in the bottom half – No. 30 – for overall health, according to the 2017 America’s Health Rankings.

To learn more about the work in Delaware to slow the growth of health care spending while improving the overall health of Delawareans, go to ChooseHealthDE.com

Categories: DHSS