Preventing illness before it starts

Christiana Care Health System and AmeriHealth Caritas Delaware announced that they have formed a value-based collaboration aimed at meeting or exceeding measurable health goals for Medicaid-eligible Delawareans.

It’s part of the shift from volume to value, which means that, instead of being paid for individual tests, procedures and visits, providers like Christiana Care will see their compensation tied more directly to health outcomes.

AmeriHealth Caritas Delaware is one of the managed care health plans serving Delaware residents with Medicaid, a health insurance program for low-income residents.

This agreement puts Christiana Care’s and AmeriHealth Caritas Delaware’s commitment to quality on paper with measurable performance goals in seven areas the state has identified as key opportunities to improve quality and save costs. The goals are informed by the Healthcare Effectiveness Data and Information Set, or HEDIS, a commonly used set of performance measures. The goals are:

Diabetes care. Though this chronic condition is incurable, quality health care to manage diabetes can prevent deadly and debilitating complications. The goal is for patients to reduce their blood sugar levels.

Medication management for people with asthma. Medication can reduce the need for rescue inhalers and cut down on hospital visits, but studies have found that up to 60 percent of children don’t take their daily asthma medication. The goal is to improve patients’ use of asthma medications.

Cervical cancer screening. Once the most common cause of cancer death for American women, cervical cancer death rates declined by more than 60 percent in the second half of the 20th century. That was largely thanks to the Pap test, which can identify abnormalities before they turn cancerous. Yet not all women have regular access to Pap tests. The goal is to improve access to cervical cancer screening.

Breast cancer screening. Mammograms can catch breast cancer at an earlier stage, when treatments are more effective. This quality measure rates providers on how many of their patients have regular screenings.

Body-mass index assessments. Obesity is a factor in an estimated one in five deaths in America. This quality measurement looks at what percentage of adults had their body-mass index — a ratio of a person’s height to their weight — documented in the current or previous years.

Prenatal and postpartum care. Medical care early in a pregnancy is a crucial part of a healthy pregnancy and birth. This quality measurement also documents what percentage of women had a postpartum visit between 21 and 56 days after delivery.

30-day hospital readmission rates. The percentage of patients who return to the hospital within 30 days of leaving one is often used to measure the hospital’s quality.

“Paying for value plays to our institutional strengths, as efficient care is a core part of The Christiana Care Way,” said Barry Dahllof Jr., vice president, Enterprise Contracting and Payor Relations at Christiana Care.

“Thousands of people in Delaware are affected by the health issues that we aim to address through this initiative, and we’re confident in our ability to meet these standards because our health care teams already have a deep commitment to providing value-based care,” Dahllof said.

The contract, signed in June 2018 and retroactive to January 2018, begins with a data collection period so Christiana Care, AmeriHealth Caritas and the State of Delaware can develop a baseline against which they can make improvements.