In recent years, Delaware has acted to improve healthcare quality and bend the healthcare cost growth curve by:

• Implementing healthcare quality and spending benchmarks.
• Creating the Primary Care Reform Collaborative to make recommendations on payment reform, value-based care, workforce and recruitment, and primary care investment and access;
• Implementing a state reinsurance program under the federal 1332 waiver program to stabilize the health insurance marketplace
• Issuing regulations to require the registration of pharmacy benefit managers ; and
• Lifting payment and other barriers to ensure that providers could easily transition to providing telemedicine services including phone-based visits during the COVID-19 pandemic.

To further help bend the healthcare cost growth curve, in 2019, Senate Bill 116 of the 150th Delaware General Assembly directed the DOI to create the Office of Value Based Health Care Delivery to “reduce health-care costs by increasing the availability of high quality, cost-efficient health insurance products with stable, predictable, and affordable rates.” SB 116 charged the Office with three tasks:

1. Establish Affordability Standards for health insurance premiums based on recommendations from the Primary Care Reform Collaborative and annually monitor and evaluate these standards;
2. Establish targets for carrier investment in primary care to support a robust system of primary care by January 1, 2025; and
3. Collect data and develop annual reports regarding carrier investments in health care, including commercial reimbursement rates for primary and chronic care services.

By October 2021, Delaware’s Legislature passed Senate Substitute 1 for Senate Bill 120 and Governor Carney signed it into law. This legislation recognizes the benefits of effective primary care and aims to make it more accessible to all Delawareans. It is based on findings and Affordability Standards outlined in the Office’s inaugural report below. In 2021 the Office updated its report and published an Annual Review of Carrier Progress Towards Meeting Affordability Standards to provide a baseline with which to measure future progress. The report reinforces the need for the new law, and highlights opportunities for meaningful progress that will improve the physical, mental, and financial health of Delawareans.

Following this series of recent statutory and regulatory changes, the Office published the 2023 Annual Report which outlines carriers’ projected compliance with requirements for 2023 in the first year of implementation.

Spending on prescription drugs increased a cumulative 77% nationally from 2010 to 2020 . Prescription Drug Spending and Rebates in Delaware, prepared by the DOI Office of Value-Based Health Care Delivery, provides a baseline understanding of pharmaceutical spending in the state and will inform state policymakers, regulators, health care purchasers, and consumer advocates as they consider future efforts to improve consumers’ access to affordable prescription drugs while addressing unsustainable increases in their cost.

To further improve affordability and access to high value, evidence-based care, the Office was awarded a Center for Consumer Information and Insurance Oversight (CCIIO) Cycle II Grant. One component of the project is to evaluate three of the most commonly purchased individual and small group plan offerings in the Marketplace to monitor compliance with state and federal law. This Delaware EHB Health Plan Compliance Report provides an overview of these findings.

Additional reports prepared by the Office on primary care investment and health care affordability in Delaware can be found below:

• Achieving Value-Based Transformation for Delaware: Three Key Market Forces to Address highlights three key market dynamics to be addressed to improve healthcare value and move Delaware closer to its vision of high-quality, equitable and affordable healthcare for all residents.
• Investment in Comprehensive Primary Care: Unlocking the Savings in Delaware, outlines the potential impact on healthcare delivery and cost when increased primary care investment funds high value primary care capabilities.
• Delaware Primary Care Reimbursement: Evaluating Parity with Medicare Rates, discusses findings on carrier compliance with statutory requirements, outlined in Senate Bill 227 , to reimburse at least as much as Medicare for primary care and care management services and provides an analysis of commercial primary care spending reimbursement rates in Delaware.
• Delaware Health Care Affordability Standards: An Integrated Approach to Improve Access, Quality and Value, the Office’s inaugural report, provides extensive research on Delaware’s Healthcare Market and includes key findings and three Affordability Standards. Public comments and the Department’s responses to commentsare provided for context.

“Investing in Primary Care: Lessons from State-Based Efforts” is a national scan of state actions to increase primary care investment. The report, published in April 2022, features Delaware as an emerging national leader in this important work. The scan was released as part of Primary Care Matters , a new resource center developed by California Health Care Foundation.