Delaware

The first statewide PCMH program, the Delaware Patient Centered Medical Home Initiative, is a pilot set up by the Medical Society of Delaware and Highmark Delaware (expanding from 20 practices to 90 practices heading into its second year). In September of 2013, Highmark Blue Cross Blue Shield Delaware (Highmark Delaware), MedNet (a subsidiary of the Medical Society of Delaware), and the four Physician Organizations (POs) in Delaware signed a Letter of Intent to establish an Accountable Care Organization (ACO) in Delaware.

Although there is no formal Medicaid PCMH program in the State, Delaware's Quaified Health Plan (QHP) requirements include that "Issuers are required to participate in state quality improvement workgroups intended to standardize QHP quality improvement strategies, activities, metrics and operations, including payment structures to improve health outcomes, medical home models and technology and data analytics to support coordination and improved quality and outcomes."

Delaware's State Implementation grant to Improve Services to Children and Youth with Special Health Care Needs (CYSHCN) is supporting the development of medical homes for CYSHCN.

Primary Care Innovations and PCMH Activity

Dual Eligible	2703 SPA	CPC	CPC+	PCMH QHP	PCMH Legislation	Private Payer

Public Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program	Outcomes
CMS State Innovation Model (SIM) Testing Award - Delaware	Grant	Statewide	CMS State Innovation Model (SIM)
Nemours Alfred I. Dupont Hospital for Children	Grant	Statewide	CMS Health Care Innovation Award (Round 1)

Private Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program	Outcomes
Delaware Medical Home Pilot	Commercial	Statewide

State Legislation

Legislation	Status	Year
Senate Bill 227 This Act promotes the use of primary care by doing the following: 1. Creating a Primary Care Reform Collaborative under the Delaware Health Care Commission. 2. Requiring all health insurance providers to participate in the Delaware Health Care Claims Database. 3. Requiring 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.	Enacted	2018
Delaware Senate Bill 199 This legislation ensures adequate spending in primary care. First, by setting Medicare rates as a baseline for primary care reimbursement. This is a short term fix to stem additional primary care failure and consolidation in Delaware. It also requires that over a period of years that the overall spend of plans into primary care increase gradually to reach the 12% investment mark, but without increasing the total spend so that premiums rise as a result of this reallocation. This legislation extends to individual, group, State employee, and public assistance plans.	Expired	2018
SB 116 An Act To Amend Title 16 And Title 18 Of The Delaware Code Relating To The Primary Care Reform Collaborative This Act expands the membership of the Primary Care Reform Collaborative and creates an Office of Value-Based Health Care Delivery in the Department of Insurance to reduce health care costs by increasing the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates. The Office of Value-Based Health Care Delivery will work with the Primary Care Reform Collaborative and the State benchmarking process.	Was Not Enacted	2019
SB 116 This Act expands the membership of the Primary Care Reform Collaborative and creates an Office of Value-Based Health Care Delivery in the Department of Insurance to reduce health care costs by increasing the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates. The Office of Value-Based Health Care Delivery will work with the Primary Care Reform Collaborative and the State benchmarking process.	Enacted	2021
Delaware Senate Bill 120 Requires the Office of Value-Based Health Care Delivery to establish mandatory minimums for payment innovations, including alternative payment models, and evaluate annually whether primary care spending is increasing in compliance with the established mandatory minimums for payment innovations.		2021