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. We work in partnership with Delaware communities experiencing inequities.  HCD works on community-driven priorities around the vital conditions (social determinants of health)—conditions into which we are born, grow, live, learn, work and play that affect our health. They use a collaborative, place-based approach with the goal of collective impact.  From April 2020 through July 2022, over $3 million has been invested through Healthy Communities Delaware to our partnering communities statewide.  The statewide Healthy Communities Delaware network includes 14 geographic communities and 21 community-based organization/coalition partners. Each receives investment and support to advance the Vital Conditions goals that their neighborhoods have prioritized 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.   Healthy Communities Delaware invests in communities wherever they may be in the Community Transformation Process (right), and supports their journey with communications, evaluation, and grant-writing assistance.  The Healthy Communities Delaware Network began in 2020 with investments in 9 communities and 14 community-based organizations. Some of the progress they have made since June 2020 includes:

• 3 comprehensive community assessments and action plans
• 6 COVID assessments and action plans
• 1 vacant lot assessment and plan
• 5 community gardens maintained
• 531 home revitalizations services
• 3 parks/playgrounds revitalized
• 1 vacant lot revitalized

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.

Department of Health and Social Services (DHSS) Secretary Molly Magarik presented the State’s third annual Benchmark Trend Report at an April 2023 Delaware Health Care Commission (DHCC) meeting. The report displays trends in Delaware’s health care spending and quality, comparing new 2021 data against a set benchmark, and 2020 data. The report continues the State’s efforts to improve health care quality for all residents, while simultaneously working to monitor and reduce the economic burden of health care spending. In November 2018, Governor John Carney signed Executive Order 25, establishing a state health care spending benchmark, an annual per-capita-rate-of-growth benchmark for health care spending, and multiple health care quality measures that are to be evaluated and adjusted every three years. The first spending benchmark went into effect on Jan. 1, 2019, and was set at 3.8%. That spending benchmark was not met, as the finalized health care spending for 2019 grew at a rate of 5.8%. For calendar year 2020, the spending benchmark was set at a more ambitious target of 3.5%. This benchmark was met as the 2020 Total Health Care Expenditures (THCE) per-capita change from the prior year was estimated at -1.2%. THCE encompasses health care spending associated with Delaware residents from private and public sources. Total Health Care Expenditures increased by $39 million in calendar year 2020, totaling $8.1 billion. However, with Delaware’s population increasing by 1.7% from 2019 to 2020, the per-capita total decreased from $8,268 in 2019 to $8,173 in 2020. “While the decreases in per-capita health care spending and the spending growth rate appear at first glance as a positive change, it is important to note that the COVID-19 pandemic had a significant impact on preventative health care services, health care facility utilization, service delivery, and payer/provider finances,” Secretary Magarik said. “These benchmark findings need to be viewed in the context of the extraordinary circumstances we faced in 2020. And that makes equitable comparisons with previous calendar years extremely difficult.” The 2020 Trend Report also provides insight into Delaware’s health care quality by presenting data on six quality measures. “Unfortunately, the results of the quality measures are mixed,” Secretary Magarik said. “While Delaware made progress in some important measures, the report shows us there is still significant work to be done to improve the health of Delawareans in other areas. At DHSS, we look forward to working with health care providers, insurers, legislators, businesses, other government leaders and, most importantly, consumers to help build a healthier Delaware.”

To learn more about the health care spending and quality benchmarks, visit the Health Care Commission website.