Delaware’s Title V program aims to ensure access to quality health care and needed services for maternal and child health (MCH) populations across the state.  We have been successful at leveraging partnerships and resources to maximize services available to the MCH population.  Delaware’s Title V program is responsible for grants and cooperative agreements from numerous federal funders and generates revenues through the provision of services such as the Part C and Newborn Screening programs.

Delaware’s Title V program has mostly shifted away from a direct service delivery orientation to a preventive, population-based assurance role that could be responsive to new national programs and policies and the changing economic climate.  Our MCH partners typically refer uninsured pregnant women, women of childbearing age, children and adolescents to resources to access primary and preventive and reproductive health care services such as DPH clinics, FQHC and HWHB providers.

One of the most significant roles that our Maternal and Child Health program plays is supporting the implementation of the Affordable Care Act as it relates to preventive health services for women.  Specifically, many MCH partners, including the Division of Public Health is a lead partner in an initiative to increase access to the most effective methods of birth control (i.e. IUDs and implants), which involved reimbursement policy changes, building provider capacity through training and technical assistance, increasing awareness of family planning services, and removing barriers to same day access to long-acting reversible contraceptives (LARCs).  For more details on our accomplishments and planned activities to promote LARCS, please see the narrative for the domain of Women/Maternal Health.  Medicaid continues to be a strong partner in this work for LARC access as well as our sustainability efforts.

Healthy Communities Delaware (HCD) involves business, community, and organizational participants, and is managed as a collaboration among DPH, the University of Delaware Partnership for Healthy Communities, and the Delaware Community Foundation. HCD works in partnership with communities to address resident priorities around the social determinants of health - conditions in which we are born, live, learn, work and age.  The Division of Public Health (DPH) and the Healthy Communities Delaware (HCD) initiative announced collaborations with several communities throughout Delaware that have been significantly impacted by COVID-19 in 2020.  Many Delawareans lack the basic resources for health and well-being - safe and healthy homes, a quality education, meaningful employment, a healthy environment, access to healthy foods, financial stability and reliable transportation. Many of these inequities are a result of and perpetuated by structural racism and discrimination and are exacerbated by the COVID-19 pandemic.

Working with 12 community-based lead organizations, Healthy Communities Delaware is providing more than $720,000 in funding to nine communities across the state to reduce the impact of COVID-19 on Delaware's most vulnerable populations.  Descriptions on the can be viewed using the following link,  https://healthycommunitiesde.org/community-partners.   This funding will help communities address important fundamental needs by creating neighborhood hubs to serve as food pantries and provide prevention care and resources; hiring bilingual resource navigators; and replacing deteriorating buildings with affordable rental units. Projects will engage residents in identifying the needs of their communities, building trust, and directly providing food, education, and care resources.  These collaborative efforts will support nine communities working with 12 community-based organizations to navigate such challenges as food security, resource navigation, housing, job creation and workforce development.  Healthy Communities Delaware is collaborating with 8 organizations in New Castle County, 1 organization in Kent County and 3 in Sussex County.  

Senate Bill 227 and Executive Order 25 was passed/issued in 2018 which 1) requires the Delaware Health Care Commission to collaborate with the Primary Care Reform Collaborative to develop annual recommendations to strengthen the primary care system in Delaware 2) requires all health insurance providers to participate in the Delaware Health Care Claims Database. 3)require individual, group, and State employee insurance plans to reimburse primary care physicians, certified nurse practitioners, physician assistants, and other front-line practitioners for chronic care management and primary care at no less than the physician Medicare rate for the next 3 years. The scope of the Primary Care Reform Collaborative long-term recommendations would include payment reform, value-based care, workforce and recruitment, directing resources to support and expand primary care access, increasing integrated care (including for women and behavioral health), and evaluating system-wide investments into primary care using claims data. 

The Primary Care Reform Collaborative released their annual report in May 2020 and highlighted how the landscape of our health care delivery and life in general has been drastically altered since the last report. The necessary measures to ensure recovery from the health pandemic that has swept the globe has also paralyzed the normal rhythm and function of every aspect of life. For health care, it has starkly highlighted deficiencies, gaps and disparities but it has also accelerated innovation, partnerships and collaboration, which hopefully will drive the development of successful solutions for the former.

The crisis in primary care, which prompted the passage of SB 227, still exists in the shadow of the overall pandemic. While SB227 has provided a fragile stability for some aspects of primary care, there needs to be much more significant change in how primary care is delivered, including investments to help current practices thrive; enhancements for our existing and future workforce and bending the cost curve with alternative payment models. The expansion of the Primary Care Reform Collaborative invested all stakeholders in what it means for primary care to be foundational to health care delivery in Delaware. Aligning the stakeholders, including payors, providers, employers and the State on how to build primary care beyond survival and through sustainability into a successful “cornerstone” of health care delivery in Delaware will continue to be the bulwark of the Collaborative. The development of the Office of Value Based Health Care Delivery provides an essential framework for data collection, analysis and policy research that is crucial to the development of an overarching primary care policy.  How these proceeds in Delaware, post-pandemic, with concerns regarding funding, potential increases in loss of access and the general effect on overall health outcomes is difficult to determine.  However, even though the momentum of work has lagged with the pandemic, the stakeholders in the Collaborative are committed to developing and implementing policy recommendations that will improve the delivery of primary care and provide Delaware with adequate, quality access at lower costs.

Department of Health and Social Services (DHSS) Secretary Molly Magarik presented the state’s first Benchmark Trend Report at today’s Delaware Health Care Commission (DHCC) meeting, summarizing health care spending and quality data collected for calendar year 2019. The report is the latest step in the state’s effort to reduce health care spending and improve quality of care for Delawareans. The Benchmark Trend Report details total health care spending for 2019 and compares it to baseline data collected for 2018. The first spending benchmark went into effect on Jan. 1, 2019, and was set at 3.8%, with the target expected to decrease gradually to 3% over the following three years. For calendar year 2019, the report found overall health care spending in Delaware totaled $8.2 billion vs. $7.6 billion for 2018. The per-capita cost increased from $7,814 in 2018 to $8,424 in 2019, or 7.8% – more than twice as high as the 3.8% target. Spending in 2019 increased across all spending categories, including the five largest:

• Hospital inpatient: $1.8 billion (up from $1.6 billion in 2018)

• Hospital outpatient: $1.6 billion (up from $1.4 billion in 2018)

• Physician: $1.3 billion (up from $1.2 billion in 2018)

• Pharmacy: $1.2 billion (up from $1.1 billion in 2018)

• Long-term care: $1.1 billion (up from $1 billion in 2018)

The release of the 2019 spending and quality data is another step along the state’s “Road to Value” initiative to improve access to affordable, quality health care for all Delawareans. That effort remains critically important even as Delaware responds to the COVID-19 crisis, Secretary Magarik said.