The Delaware Department of Health and Social Services (DHSS) has expanded its Medicaid managed care program by adding a Centene health plan. Centene’s Delaware Health First will join Highmark Health Options Blue Cross Blue Shield, which began operating in Delaware in 2015, and AmeriHealth Caritas, which began in 2018.
The three managed care organizations will provide integrated services for physical health, behavioral health, and long-term services and supports through the new contracts for the Division of Medicaid & Medical Assistance (DMMA) statewide Medicaid Managed Care programs, including Diamond State Health Plan and Diamond State Health Plan-Plus (DSHP-Plus).
Centene is the largest Medicaid managed care company in the United States. With the award of Delaware, Centene is entering its 30th Medicaid managed care state.
“It is a privilege to be selected by the state of Delaware to provide local healthcare services and programs that address social determinants of health and remove barriers to care for Medicaid members across the state,” said Brent Layton, president and chief operating officer of Centene, in a statement. “We are excited to work with the state and providers on proven models of value-based care to deliver transformative healthcare and improve the health of Diamond State Health enrollees across the state.”
DMMA’s statewide Medicaid Managed Care programs Diamond State Health Plan and Diamond State Health Plan-Plus (DSHP-Plus) are expected to commence on Jan. 1, 2023.
“We are pleased to reach agreement with Highmark, AmeriHealth and Centene to provide these vital services to the Medicaid members we serve,” DHSS Secretary Molly Magarik said in a statement. “These companies not only will offer more choice to our Medicaid members, but they also understand Delaware’s commitment to value-based care, and to the critical services that our Medicaid members need and deserve. We appreciate the commitment of Highmark, AmeriHealth and Centene to providing a connection to care and support that will help our Medicaid members achieve their optimal health.”
In 2017, Gov. John Carney signed House Joint Resolution 7, which gave DHSS the authority to develop health care spending and quality benchmarks. The spending benchmark – a spending target – is linked to the growth rate of Delaware’s economy and includes all health care spending, including through Medicaid, Medicare and commercial insurers. The quality benchmarks are established periodically to offer strategic goals to improve the health of Delawareans and the care they receive.
Delaware’s Medicaid program serves about 300,000 members. Division of Medicaid and Medical Assistance Director Steve Groff said members will receive information during the next several weeks about their options in choosing a new plan for 2023. Open enrollment will begin Oct. 1.
In September 2020 the state authorized its first four Medicaid accountable care organizations (ACOs). The ACOs are part of a larger plan to transform the way that healthcare is delivered and paid for in the state.
The four Medicaid ACOs are Aledade Delaware ACO; Delaware Care Collaboration, a partnership between Saint Francis Healthcare and the Medical Society of Delaware; Delaware Children’s Health Network, affiliated with Nemours Children’s Health System; and Delaware Medicaid Quality Partners ACO, affiliated with ChristianaCare.
The ACOs were authorized to negotiate and enter into agreements directly with Medicaid managed care organizations (MCOs). Those contracts began July 1, 2021, and run through Dec. 31, 2024, provided that the MCOs maintain their contracts with the Division of Medicaid and Medical Assistance (DMMA) for the term of the agreement.
Under Delaware’s Medicaid ACO program, contracts between the ACOs and MCOs require participation by at least 5,000 Medicaid and/or Children’s Health Insurance Program (CHIP) enrollees, excluding individuals in long-term care facilities, those eligible for both Medicaid and Medicare, and those receiving long-term services and supports. Enrollees voluntarily decide to participate in the ACO through their primary care provider or their managed care organization.
“The Medicaid ACO program advances our efforts to move Delaware’s healthcare system toward a model that is sustainable and that meets the ongoing needs of the patients we serve,” said Magarik, in a statement. “The program’s value-based purchasing model is a pillar of our work to change how healthcare is delivered and paid for in Delaware, with the goal of reducing the cost of healthcare in the state while improving the overall health of our clients.”
Medicaid ACOs operate in about a dozen states, several of which have reported promising results from their programs. Minnesota, which launched its Medicaid ACO program in 2012, reported that it saved $213 million in healthcare costs, reduced hospital readmissions by 14 percent and reduced emergency department visits by 7 percent in the program’s first four years.
“Our Medicaid beneficiaries typically are among our most vulnerable residents, those who are more likely to face certain challenges to good health than people who receive Medicare or commercial health coverage,” Secretary Magarik said in 2020. “These challenges include struggles with income, housing, food, and transportation, and a greater need for behavioral health support. The new Medicaid ACOs address these issues by promoting changes in how care is delivered and by fostering relationships among a variety of health-services organizations.”