Delaware Primary Care Update

On October 1, 2021, Delaware Governor John Carney signed into law Senate Bill 120, groundbreaking legislation designed to address how Delaware health care is delivered and paid for, with particular emphasis on primary care. The bill’s sponsor, state senator Bryan Townsend, described its primary theme:

It simply makes it clear the priority in Delaware is to keep people healthy in a health care system, and the way to do that is to invest more in primary care. Keep people healthy on the front‑end, rather than just waiting for people to be unhealthy on the back‑end.[i]

The law requires:

• The Delaware Healthcare Commission to monitor compliance with both value‑based care delivery and alternative payment methods;
• Limited price growth for inpatient, outpatient, and other medical services to specified percentage amounts;
• Insurers to spend a defined percentage of their total costs on primary care; and
• The Delaware Office of Value‑Based Health Care Delivery (“OVBHCD”) to establish mandatory minimums for payment innovations and alternate payment models, such innovations and models to be reviewed annually.[ii]

Department of Health and Social Services Secretary, Molly Magarik, noted:

When we’re talking about primary care, it really is the most trusted relationship in the health care system. From the patients’ trust of their pediatrician, to them being older and potentially having to manage multiple chronic conditions, it is the primary care clinician – by their experience, training, and their empathy and compassion – that really validates and creates a profound relationship that keeps patients healthy. And so this legislation validates that relationship, and invests in it, so that it can continue into the future.[iii]

With greater focus on their reimbursement, the law should help Delaware retain primary care physicians, who have been leaving the state at an “alarming rate” according to Delaware Insurance Commissioner, Trinidad Navarro.[iv] Commissioner Navarro emphasized:

We knew that the best way to help people stay healthy is to make sure they’re healthy, and that the importance of primary care is finding … illnesses in folks that we can treat early on, before they get to the ER. It’s about spending money now, and saving tremendously later on. So, with the signing of this bill, those plans will be put into action.[v]

Central to previous efforts to improve primary care was the establishment of the Delaware Health Care Commission’s Primary Care Reform Collaborative (“PCRC”).[vi] The PCRC was created to, “assist with the development of recommendations to strengthen Delaware’s primary care.” The PCRC collects input from stakeholders, including the health care and patient community. The collaborative is comprised of the following members:

• The Commission Chairperson;
• The Chair of the Senate Health, Children & Social Services Committee;
• The Chair of the House Health & Human Development Committee;
• Two members, appointed by the Medical Society of Delaware;
• Two members, appointed by the Delaware Nurses Association;
• Two members, appointed by the Delaware Health Care Association;
• Two members representing insurance carriers, appointed by the Governor;
• The Secretary, Department of Health and Social Services;
• The Director, Division of Medicaid and Medical Assistance;
• The Insurance Commissioner, Insurance Department;
• The Chair, State Employee Benefits Committee;
• One member representing large self‑insured employers, appointed by the Delaware State Chamber of Commerce; and
• One member representing a Federally Qualified Health Center, appointed by the Governor.[vii]

The PCRC has issued written recommendations regarding desired levels of primary care investment.[viii]  Additionally, the PCRC is tasked with developing plans to strengthen Delaware primary care.[ix]

During its most recent meeting on January 10, 2022, the PCRC received an OVBHCD policy objectives update which emphasized the need for greater participation in alternative payment models, increased utilization of value-based payment, and cost containment driven by primary care investment.[x] Similarly, the PCRC was advised that the law’s new draft regulations will focus upon required investment in primary care, strengthened insurance carrier programs, increased participation in the Medicare Shared Savings Program, and the proper balancing of predictability and flexibility in new payment models.[xi]

[i] “ Keeping Delaware Healthy, Carney Signs Bill into Law Strengthening Primary Care for Patients”, WDEL News, October 1, 2021.

[ii] “ Keeping Delaware Healthy, Carney Signs Bill into Law Strengthening Primary Care for Patients”, WDEL News, October 1, 2021.

[iii] “ Keeping Delaware Healthy, Carney Signs Bill into Law Strengthening Primary Care for Patients”, WDEL News, October 1, 2021.

[iv] “ Keeping Delaware Healthy, Carney Signs Bill into Law Strengthening Primary Care for Patients”, WDEL News, October 1, 2021.

[v] “ Keeping Delaware Healthy, Carney Signs Bill into Law Strengthening Primary Care for Patients”, WDEL News, October 1, 2021.

[vi] 16 DE Code § 9904 A (2019).

[vii] 16 DE Code § 9904 A (2019).

[viii] “Delaware Primary Care Legislation”, Primary Care Collaborative, August 29,2018.

[ix] “Delaware Primary Care Legislation”, Primary Care Collaborative, August 29,2018.

[x] “Primary Care Reform Collaborative Meeting Agenda”, January 10, 2022.

[xi] “Primary Care Reform Collaborative Meeting Agenda”, January 10, 2022.