Almost three months after changing the way Delaware pays for Medicaid, state health officials say they’re encouraged by the response from managed care organizations.
Delaware announced at the start of the year it would pay for Medicaid based on health outcomes rather than the number of services provided. It’s part of a statewide effort to improve a health care system which is both more costly and less effective than most states.
Steve Groff is the director of Delaware’s Division of Medicaid. He says the First State’s two managed care organizations—Highmark Health Options Blue Cross Blue Shield Delaware and AmeriHealth Caritas Delaware—now must adhere to national standards or face a penalty.
“And we are expecting them to initially be in the top 50% of plans nationwide, and over time to improve that performance,” said Groff.
For example, in the case of diabetes, Delaware MCOs will be compared against national data setting the standard for manageable blood glucose levels. If Medicaid managed care plans don’t meet the criteria, the MCO is penalized. Before, payments were made based on the number of visits and tests performed.
Groff says it’s still too early to tell if the plan is improving health outcomes and reducing costs.
“It will take time. It will not be a dramatic reduction in what we actually spend. It will be a slowing of the cost trend,” said Groff.
Groff adds under the new system the MCOs are developing strategies to emphasize value over volume.
Recent data shows the cost of healthcare in Delaware is growing faster than the state’s economy.
