Page 14 - Delaware Medical Journal - May/June 2018

Delaware Health Care Benchmark: Myths and Truths
Kara Odom Walker, MD, MPH, MSHS
On Sept. 7, 2017, Governor John Carney signed House Joint Resolution 7, granting authority
to the Department of Health and Social Services (DHSS) to study and plan for
a health care spending benchmark for Delaware linked to an overall economic measure for the state. Five months and Governor Carney issued Executive Order 19, creating an Advisory Group to make recommendations to me, as DHSS Secretary, on the creation of a health care spending benchmark and health care quality benchmarks to begin in 2019.
Independent primary providers are represented on the Health Care Delivery and Cost Advisory Group by James
M. Gill, MD, a family physician from Wilmington and a member of the Medical Society of Delaware. Dr. Gill also serves on the Quality Benchmark Subcommittee.
As Cabinet Secretary for the Department of Health and Social Services and as a to address some common myths about the benchmark.
MYTH: The benchmark is a cap on spending.
The benchmark is not a cap on spending. It is not a way to penalize any organization for its overall spending or any category of spending. It is not about limits on health care in Delaware, in terms of either quality or cost.
Simply, the benchmark is a target for health care spending growth and is about increasing the transparency and the dialogue about total health care spending in our state and deciding on the areas
where we have the opportunity to improve — both in cost and quality.
The Advisory Group will make recommendations to me on the methodologies and data sources to measure the total cost of care in our state. Once
we know the health care spending total,
we can track the spending year over year and determine the annual growth rate. From there, we can measure the growth of health care spending against an economic measure for the state. If the two rates are not in alignment, we will set a target — a benchmark — for the growth of health care spending and measure all of our health care spending against that rate.
If health care spending continues to grow faster than our state’s economy overall,
it will keep crowding out other priorities
— such as education, public safety, and infrastructure — that are essential to quality of life. Setting spending growth targets helps to ensure that we have the information needed to maintain the balance between direct health care services and creating an environment in the state that promotes health and quality of life for us and our patients.
MYTH: The benchmark will decrease physicians’ reimbursement rates and reduce their income.
The benchmark is about increasing transparency and improving the dialogue on health care spending in our state — understanding how we spend the more than $9.5 billion for health care that the Centers for Medicare and Medicaid Services calculated for Delaware in 2014 in a state- by-state analysis. That ranked Delaware No. 3 among the states for per-capita spending — a total that was 27 percent higher than the U.S. average.
As providers, insurers, consumers, and business owners, the benchmark would not only give us the transparency to understand where our health dollars are going, but also provide us up-to-date data
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Del Med J | May/June 2018 | Vol. 90 | No. 5