Delaware Executive Order 25 to Address State’s High Per Capita Health Care Spending

On November 20, 2018, Delaware Governor John Carney signed Executive Order 25 (“Order”) establishing Delaware health care spending and quality benchmarks. The Order sets forth measures to address Delaware’s high per capita health care spending (top 10 nationally), which has been deemed unsustainable given the rate by which it outpaces Delaware’s recent economic growth. The Order set initial health care spending benchmarks for calendar years 2020 through 2023, which were respectively set at 3.5%, 3.25%, 3.0%, and 3.0% per capita spending growth. Delaware hospitals’ revenue will likely be adversely affected by the initiative as it is designed to address over reliance on the most costly forms of care, such as that rendered by emergency departments. Additionally, attainment of the quality standards will likely reduce the number of costly follow-up procedures and related care.

In an attempt to increase transparency and accountability, the Order also details the “establishment, monitoring, and implementation of annual health care cost and quality targets” and recommends that the Delaware Health Care Commission (“DHCC”) set the following health care quality benchmarks:

1. Emergency Department Utilization Rate (risk-adjusted rate), as defined by the National Committee for Quality Assurance, measured for commercial populations:

a. 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

2. Opioid-Related Overdose Deaths, as defined by the Centers for Disease Control and Prevention:

a. 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

3. Residents per 1,000 with Overlapping Opioid and Benzodiazepine Prescriptions, as defined by the Pharmacy Quality Alliance, measured for commercial and Medicaid populations:

a. 2020, 2021, and aspirational benchmarks to be defined and published by the Secretary of the Delaware Department of Health and Social Services (“DHSS”) during 2019

4. Adult Obesity, as defined by the Centers for Disease Control and Prevention:

a. 2019: 30.0%
b. 2020: 29.4%
c. 2021: 28.7%
d. Aspirational benchmark for longer term attainment: 27.4%

5. Adult Tobacco Use, as defined by the Centers for Disease Control and Prevention:

a. 2019: 17.1%
b. 2020: 16.4%
c. 2021: 15.8%
d. Aspirational benchmark for longer term attainment: 14.6%

6. High School Students Who Were Physically Active, as defined by the Centers for Disease Control and Prevention:

a. 2019: 44.6%
b. 2020: no survey will be performed
c. 2021: 46.8%
d. Aspirational benchmark for longer term attainment: 48.7%

7. 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:

a. 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%

8. Persistence of Beta-Blocker Treatment After a Heart Attack, as defined by the National Committee for Quality Assurance, measured for commercial and Medicaid populations:

a. 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%

The Order established a subcommittee of the Delaware Economic and Financial Advisory Council tasked with reducing health care costs. The subcommittee will advise state agencies regarding both cost containment and quality initiatives and work closely with the DHCC toward these aims. Additionally, the subcommittee will regularly review its cost and quality assessment methodologies and provide the means for the public to provide input relative to its recommendations. While the DHCC is tasked with designing the specific benchmarks, the subcommittee will oversee statewide education regarding, and implementation of, the cost containment and quality standards. The quality benchmarks are to be reviewed every three years beginning after 2022, as statewide health care performance changes. A manual was released by DHSS on January 31, 2019 containing the methodologies for both the health care spending and quality benchmarks.

For further information about Delaware’s health care spending benchmark, including the subcommittee’s minutes and agenda, please visit the site found here.