CostAware Compares Health Care Costs Based on Delaware Medical Claims

The Delaware Department of Health and Social Services (DHSS) announced the launch of a new version of its CostAware website, designed to help Delawareans understand how their health care dollars are spent by comparing the variation of average costs for different episodes of care and medical services based on actual medical claims in Delaware. DHSS has also sent a letter to stakeholders regarding this new version of CostAware. In early 2020, DHSS and the Delaware Health Care Commission began working with Delaware Health Information Network (DHIN) to develop and implement various health care cost and quality analyses. These analyses leverage data in the Delaware Health Care Claims Database (HCCD), which was established through legislation passed by the General Assembly in 2016. The initial version of CostAware, launched in April 2022, compared hospital costs for several common episodes of care at six unnamed hospital systems: cardiac procedures, C-section birth, emergency department visits, knee and hip replacement, and vaginal delivery. The costs across five accountable care organizations (ACOs) are also compared for seven common services: blood count, colonoscopy, doctor visits, hemoglobin A1c, head CT, lumbar spine MRI and screening mammography. In addition to this data, this version of CostAware includes the following enhancements:

• Average cost estimates for episodes of care reported for named Delaware hospitals.
• Estimates of the average cost per visit for additional medical services, including child wellness visits, mental and behavioral/health services, diabetes care, cardiac investigations and procedures, doctor visits by complexity, and lab tests (blood and urine tests).
• Results reported by type of care setting (e.g., hospital outpatient facility, outpatient lab, professional office, urgent care facility, and telehealth) to facilitate additional comparisons.
• Additional years of data included – 2020 and 2021 were added to the 2019 data used for CostAware 1.0.
• Trend visualizations, with multiple years of data, show changes over time in average cost, quality, and other measures.
• Improved filtering of results by insurance category (Commercial, Medicaid, Medicare Advantage) and patient age range and gender (as appropriate).

CostAware also includes quality measures, including the readmission and utilization rates, and patient satisfaction scores, all from the Centers for Medicare and Medicaid Services (CMS) as part of its Hospital Compare and Medicare Shared Savings Program initiatives. Each episode of care and service can be filtered further by the type of insurance: commercial, Medicare Advantage and Medicaid.

Medicaid Members Should Verify Contact Information with DHSS

The Delaware Department of Health and Social Services (DHSS) will resume the standard eligibility renewal process for Medicaid and CHIP recipients starting April 1, 2023, as required by federal law. Annual renewals have not been required since March 2020 during the federal Public Health Emergency designation. Federal legislation, signed into law on December 29, 2022, set a specific date to resume renewals, regardless of when the Public Health Emergency ends.  

As of January 2023, approximately 310,000 Delawareans were enrolled in Medicaid. Once annual renewals begin, there may be approximately 40,000 - 50,000 Delawareans who were receiving continuous coverage due to the Public Health Emergency that will no longer be eligible for Medicaid or CHIP. The most important thing Medicaid and CHIP members can do now is to update their contact information with DMMA and sign up for electronic notifications. Contact the Change Report Center at (302) 571-4900, Option 2 or send changes via fax to (302) 571-4901. Changes and notification preferences can also be made at ASSIST Self Service, https://assist.dhss.delaware.gov/. 

Between April 2023 and April 2024, DHSS will review every member’s eligibility and, where approved by state or federal rules, use available data sources to automatically renew members. If DHSS cannot auto-renew a person’s coverage using available and approved data sources, the member will receive a renewal packet by mail or a notification by email, depending on the selected preference. Delaware Medicaid and its Managed Care Organization partners will also use texts, email, and social media when available to enhance outreach efforts.

Physicians, health care professionals, and others who provide services to members can help by reminding their Medicaid members to look for and complete their Medicaid renewals this year and to encourage them to start exploring other coverage options if they believe they will no longer qualify for their current coverage. Brochures are available to download and post in your office both in English and Spanish.

To help individuals who are no longer eligible for Medicaid coverage, the federal government has authorized a Special Enrollment Period for the Health Insurance Marketplace. Individuals who lose their coverage through Medicaid and CHIP any time between March 31, 2023, and July 31, 2024, will be eligible for a marketplace special enrollment period. After a person is determined eligible for the marketplace, they will have 60 days to choose a plan, and their coverage will start the first day of the month after the plan is selected.  

Assistance enrolling in the Delaware Health Insurance Marketplace is available from certified Health Insurance Marketplace Navigator teams at Westside Family Healthcare and Quality Insights. To be connected to a trained Navigator, call: 

• Westside Family Healthcare: New Castle County: 302-472-8655, Kent or Sussex counties: 302-678-2205 
• Quality Insights: 1-844-238-1189 

For more information, visit de.gov/medicaidrenewals.

Preparing for the End of the Public Health Emergency for COVID-19

As part of the Centers for Medicare & Medicaid Services’ (CMS) ongoing efforts to provide up-to-date information to prepare for the end of the Public Health Emergency (PHE) for COVID-19, which is expected on May 11, 2023, CMS has provided a new overview fact sheet on CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency. The CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency provides clarity on several topics including:

• COVID-19 vaccines, testing, and treatments;
• Telehealth services;
• Health Care Access

In the coming weeks, CMS will be hosting stakeholder calls and office hours to provide additional information. Please visit the CMS Emergencies Page for continuous updates regarding PHE sunsetting guidance as information becomes available to the public.

Lisa Dean Moseley Foundation Gift

Nemours Children’s Health announced on March 2nd, a $78 million donation from the Lisa Dean Moseley Foundation of Wilmington, Delaware to fund new and innovative research programs and to dramatically expand Nemours Children’s capacity to provide clinical care for children with cancer, sickle cell disease, and other blood disorders. The announcement was made in the unfinished, fifth-floor shell space at Nemours Children’s Hospital, Delaware that will now become a new inpatient unit to be known as the Lisa Dean Moseley Foundation Institute for Cancer and Blood Disorders at Nemours Children’s Health. The $78 million gift, payable over 10 years, will allow Nemours to further its existing world-class capabilities and services to support and improve the health of Delaware’s children, which is aligned with Alfred I. duPont’s philanthropic vision and the funding of the Alfred I. duPont Charitable Trust. Every dollar of the $78 million donation will be used to make immediate and long-term impacts on pediatric cancer and blood disorder treatment and research.

CDC Issues Health Advisory

The Centers for Disease Control and Prevention (CDC) has been monitoring an increase in extensively drug-resistant (XDR) Shigella infections (shigellosis) reported through national surveillance systems. In 2022, about 5% of Shigella infections reported to CDC were caused by XDR strains, compared with 0% in 2015. Clinicians treating patients infected with XDR strains have limited antimicrobial treatment options. Shigella bacteria are easily transmissible. XDR Shigella strains can spread antimicrobial resistance genes to other enteric bacteria. Given these potentially serious public health concerns, CDC asks healthcare professionals to be vigilant about suspecting and reporting cases of XDR Shigella infection to their local or state health department and educating patients and communities at increased risk about prevention and transmission. 

Shigellosis is an acute enteric infection that is an important cause of domestically acquired and travel-associated bacterial diarrhea in the United States. Shigellosis usually causes inflammatory diarrhea that can be bloody and may also lead to fever, abdominal cramping, and tenesmus. Infections are generally self-limiting; however, antimicrobial treatment may be indicated to prevent complications or shorten the duration of illness. CDC defines XDR Shigella bacteria as strains that are resistant to all commonly recommended empiric and alternative antibiotics — azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole (TMP-SMX), and ampicillin. Currently, there are no data from clinical studies of treatment of XDR Shigella to inform recommendations for the optimal antimicrobial treatment of these infections. As such, CDC does not have recommendations for optimal antimicrobial treatment of XDR Shigella infections.

CDC Issues Health Advisory

The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory to notify physicians and public health authorities of an increase in the number of cases of chikungunya reported in Paraguay. Further spread of the outbreak in Paraguay and to surrounding countries is possible. Chikungunya virus is a mosquito-borne alphavirus transmitted by infected mosquitoes, primarily Aedes aegypti and Aedes Albopictus. Humans are the primary reservoir during epidemics. Most people infected with chikungunya virus become symptomatic. The incubation period is typically 3–7 days (range 1–12 days). The most common clinical findings are acute onset of fever and polyarthralgia. Joint pains are usually bilateral, symmetric, and often severe and debilitating. Other symptoms can include headache, myalgia, arthritis, conjunctivitis, nausea, vomiting, or maculopapular rash. Consider chikungunya virus infection in travelers returning from Paraguay and surrounding countries with acute onset of fever and polyarthralgia.

DPH Issues Health Alert

The Delaware Division of Public Health (DPH) issued a Health Alert Network (HAN) Alert about gonorrhea infections with reduced drug susceptibility. On January 19, 2023, the Massachusetts Department of Public Health (MDPH) identified two cases of multidrug-non-susceptible Neisseria gonorrhoeae. Identification of these strains in Massachusetts is a warning that N. gonorrhoeae is becoming less responsive to a limited arsenal of antibiotics. On January 19, 2023, a novel strain of multidrug-non-susceptible Neisseria gonorrhoeae with reduced susceptibility to numerous antibiotics was identified in a Massachusetts resident. After further surveillance by MDPH, an additional case was identified. While gonorrhea with reduced drug susceptibility has not yet been detected in Delaware, the Delaware Division of Public Health is urging Delawareans to get tested regularly and recommending that physicians continue using CDC-recommended treatment: 500mg of Ceftriaxone intramuscular (IM) as a single dose for persons weighing <150 kg.

Goes Into Effect Immediately

A revision to Performance Improvement (PI) standard PI.01.01.01, Element of Performance (EP) 4, is going into effect immediately for hospitals, critical access hospitals, ambulatory care and office-based surgery practices. This change was made after health care organizations expressed confusion with the requirement, which directs them to collect data on significant discrepancies between preoperative and postoperative diagnoses.

The revision provides:

• Details and examples to further clarify the intent for this data collection requirement and how the data can be used in an organization’s performance improvement efforts regarding diagnostic errors.
• Clarifies that the organization’s medical staff determine which unexpected postoperative diagnoses are clinically significant.

View the prepublication standards. Questions may be directed to the Department of Standards and Survey Methods.

Concerns with National Human Trafficking Hotline

Delaware Attorney General Kathy Jennings, along with a bipartisan coalition of 33 attorneys general, sent a letter to Congressional leaders informing of a concern with the National Human Trafficking Hotline. Since 2007 Polaris has operated the hotline with funding authorized by Congress. Many states rely on the hotline to forward tips of suspected human trafficking to local law enforcement. It has been discovered that Polaris only forwards tips to state law enforcement about adult victims in limited circumstances, contrary to what Polaris advertises, to what states and organizations have come to expect from this partnership, and, the Attorneys General believe, to what Congress expects from its funding. Many states, federal agencies, and organizations have actively engaged the public in utilizing the hotline for tips on trafficking. What has been discovered with Polaris's practices diminishes the value of the hotline. Polaris has indicated no intention to revise its policies. In some cases, states have discovered delays lasting months before the hotline shared tips. The Attorneys General are urging Congress to ensure that Polaris makes changes to its current and reported planned tip reporting policies to begin forwarding tips regarding suspected human trafficking of adults in a prompt manner.

Aims to Maintain Availability for Legitimate Use in Animals While Preventing Importation for Illicit Purposes

The U.S. Food and Drug Administration (FDA) announced that it has taken action to restrict the unlawful entry of xylazine active pharmaceutical ingredients and finished dosage form drug products into the country to address a growing public health concern. The chemical xylazine has increasingly been found in illicit drugs such as illicitly manufactured fentanyl and other drugs and increasingly detected in overdose deaths. This action aims to prevent the drug from entering the U.S. market for illicit purposes, while maintaining availability for its legitimate uses in animals. Veterinarians legitimately use drug products containing xylazine to sedate large animals such as horses and deer, but it is not safe for use in people and may cause serious and life-threatening side effects. It has been identified as a contaminant found in combination with opioids such as illicit fentanyl and in combination with other illicit products that contain stimulants such as methamphetamine and cocaine. While xylazine is not an opioid, it is dangerous because it can depress breathing, blood pressure, heart rate and body temperature to critical levels. Additionally, people who inject drugs containing xylazine can develop severe skin wounds and patches of dead and rotting tissue that easily become infected and, if left untreated, may lead to amputation. These wounds can develop in areas of the body away from the injection site and may become life-threatening. The agency previously communicated to health care providers about the risks to patients exposed to xylazine in illicit drugs. 

Expanding Cost Cap

Eli Lilly and Company announced price reductions of 70% for its most commonly prescribed insulins and an expansion of its Insulin Value Program that caps patient out-of-pocket costs at $35 or less per month. Eli Lilly is reducing the list price of insulins by:

• Cutting the list price of its non-branded insulin, Insulin Lispro Injection 100 units/mL, to $25 a vial. Effective May 1, 2023, it will be the lowest list-priced mealtime insulin available, and less than the price of a Humalog® vial in 1999.
• Cutting the list price of Humalog® (insulin lispro injection) 100 units/mL1, Lilly's most commonly prescribed insulin, and Humulin® (insulin human) injection 100 units/mL2 by 70%, effective in Q4 2023.
• Launching RezvoglarTM (insulin glargine-aglr) injection, a basal insulin that is biosimilar to, and interchangeable with, Lantus® (insulin glargine) injection, for $92 per five pack of KwikPens®, a 78% discount to Lantus, effective April 1, 2023.

Because these price cuts will take time for the insurance and pharmacy system to implement, Eli Lilly is taking the additional step to immediately cap out-of-pocket costs for patients who use Lilly insulin and are not covered by the recent Medicare Part D cap. In addition to reducing the list price of its insulins:   

• Effective immediately, Lilly will automatically cap out-of-pocket costs at $35 at participating retail pharmacies for people with commercial insurance using Lilly insulin.
• People who don't have insurance can continue to go to InsulinAffordability.com and immediately download the Lilly Insulin Value Program savings card to receive Lilly insulins for $35 per month.

In the coming weeks, Lilly will launch a nationwide public awareness campaign to help ensure all Lilly insulin users understand how to access the company's industry-leading affordability solutions. For more information, go to Lilly.com/insulin.

Programs Sponsored by Delaware Division of Historical and Cultural Affairs

Designated by joint resolutions of the United States House of Representatives and Senate and proclaimed by the American president, National Women’s History Month is an opportunity to honor and celebrate women’s lives and historic achievements. Each year, National Women’s History Month employs a unifying theme and recognizes national honorees whose work and lives testify to that theme. For 2023, the theme is “Celebrating Women Who Tell Our Stories,” a recognition of women, past and present, who have been active in all forms of media and storytelling including print, radio, television, stage, screen, blogs, podcasts, news and social media. This theme honors women in every community who have devoted their lives and talents to producing art and news, pursuing truth and reflecting society decade after decade. The Delaware Division of Historical and Cultural Affairs will sponsor six free events in March to celebrate National Women's History Month. Admission is free and open to the public, however, reservations are required for some programs. Click for additional information and reservations.

ChristianaCare

For the third time, Modern Healthcare has selected ChristianaCare President and CEO Janice E. Nevin, MD, MPH, for its Top 25 Women Leaders list. Dr. Nevin previously received this prestigious honor in 2019 and 2022. The editors highlighted the bold strategic enterprise plan that Dr. Nevin has set for ChristianaCare, which focuses on vital areas, including addressing care disparities, effectively supporting employees, simplifying access to health services, and accelerating transformation and growth. They noted a number of specific initiatives related to the strategic plan, such as the rollout of Moxi cobots, which have improved the workflows for nurses and patient care technicians by handling low-value tasks like deliveries. Modern Healthcare also cited that this past year ChristianaCare spun off its first-ever private, commercial startup company, CorriXR Therapeutics, which is using CRISPR gene editing technology to develop cancer therapeutics, starting with lung cancer. This year’s honorees are profiled in the Feb. 20 issue of Modern Healthcare magazine and online at www.modernhealthcare.com/topwomenexecs.

PAM Rehabilitation Hospital

PAM Health held a ribbon-cutting ceremony Feb. 21 to officially open its new PAM Rehabilitation Hospital at 22303 DuPont Highway in Georgetown. The project is in partnership with Bayhealth. The Georgetown site joins a PAM facility in Dover and one proposed at the Bayhealth Sussex Campus in Milford. The Georgetown site was selected in 2019 and opened its facility in December 2022. PAM Health operates 70 rehabilitation and specialty hospitals and outpatient centers throughout the country. The hospital, with 34 private in-patient rooms, provides care for recovery from stroke, amputation, Parkinson’s disease, brain injury, neurological and orthopedic conditions, wounds, spinal cord injuries and respiratory failure.

ProAssurance

MSD is pleased to highlight a 2023 Premier Educational Program Partner. ProAssurance is part of the growing effort to keep our medical professionals educated through its partnership with MSD as a Premier Educational Program (PEP) Partner.

Premier Educational Partners have joined with the Medical Society of Delaware in supporting high quality professional medical education for Delaware physicians and other health care professionals to advance the health and well-being of Delaware's citizens. ProAssurance focuses on professional liability, legal professional liability, and workers’ compensation insurance. They work to ensure you are treated fairly while striving to make insurance simpler. ProAssurance has decades of experience and innovative solutions—to help you meet your coverage needs. Your policy comes with access to proven risk-reduction tools and experts, along with unmatched claims handling for today’s evolving liability environment. For more information visit: https://www.proassurance.com/

If you would like to become a PEP Partner, please contact Lynn Robinson, Director of

Professional Education.

Improve Human Papillomavirus (HPV) vaccination rates through evidence-based education at NO COST to your practice. The Quality Insights Program provides one-on-one education for health care professionals by trained clinical educators; presents evidence-based, non-commercial aims of academic groups, research centers, and clinicians; provides an effective and convenient way to stay up-to-date on latest research findings; improves clinical care based on best available safety, efficacy, and cost-effective data; and offers customizable modules based on your practices’ interests and needs. If you are interested in participating in this program or would like more information, please contact Danielle Collins at dcollins@qualityinsights.org or call 484-798-1829.

John S. Piendak, MD

It is with sadness we share that MSD member John S. Piendak, MD passed away on February 22, 2023. He was 94 years old. A native Delawarean, he moved to St. Louis to earn his medical degree. He enlisted in the U.S. Air Force as a flight surgeon and then returned home to Wilmington, Delaware. Dr. Piendak helped to pioneer radiology in Delaware by providing the state's first CAT scans as a co-founder and senior partner at Papastavros Associates, PA. Donations in memory of Dr. Piendak may be made to Salesianum School or Catholic Charities. Read obituary.

Jeffrey C. Maxwell - PCOM Medical Student (Class of 2024), ChristianaCare

Swagata Mitra, MD - ChristianaCare Pediatrics at Dover

Please join MSD in welcoming the newest members of the Medical Society of Delaware. As the third oldest medical society in the country, MSD has an amazing history. Thank you for taking part in our continued success!

Nicholas D'Orazio, MD - Anodyne Pain and Wellness Solutions, Newark / Psychiatry & Integrative Medicine (private practice in Pennsylvania)

MSD members are afforded a seven-day review period from the date of this publication to comment regarding applicants for membership. Please contact Michelle Seymour at (302) 224-4905 or Michelle.Seymour@medsocdel.org with any comments on the current pending member(s) listed above or if you know someone interested in joining MSD. You could be eligible for a referral discount!

On January 30, 2023, the Biden-Harris Administration announced its intent to end the national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic on May 11, 2023. The Centers for Medicare & Medicaid Services (CMS) has resources available to help you prepare for the end of the PHE, some of which have been updated based on recent action by Congress. The following materials reflect recent changes and are currently available on the CMS Emergencies Page:

• Provider-specific fact sheets for information about COVID-19 Public Health Emergency (PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers
• CMS 1135 Waiver / Flexibility Request and Inquiry Form: https://cmsqualitysupport.servicenowservices.com/cms_1135
• Acute Hospital At Home: https://qualitynet.cms.gov/acute-hospital-care-at-home

Updates will continue to be provided as we approach the end of the PHE. You are encouraged to regularly visit the CMS Emergencies Page for the most up to date information.

• DPH Flu Dashboard
• DPH Delaware Weekly Influenza Surveillance Reports by week.
• CDC https://www.cdc.gov/flu/weekly/index.htm

• (Delaware) General Questions: call 211 or email DPHCall@delaware.gov or Vaccine@delaware.gov for vaccine-specific questions.
• Latest information on Delaware's response (testing, treatment, vaccination): de.gov/coronavirus (Updated 2/2023)
• CDC COVID-19 Testing Locator Website (no-cost COVID-19 Testing. launched 1/2023)
• Delaware "My Healthy Community" COVID-19 Dashboard (updated weekly on Wednesdays)
• COVID-19 by County Community Level Check (# hospital admissions and beds used and total number of new cases)
• COVID-19 Community Transmission (based on cases per 100,000 people and positivity rate, both measured over the last 7 days)
• DPH Public Health Alerts: de.gov/publichealthalerts
• Federal website for information on navigating COVID: COVID.gov
• CDC COVID-19 Quarantine and Isolation Calculator
• COVID-19 Therapeutics Locator
• CDC COVID Data Tracker Weekly Review.
• FDA At-Home OTC COVID-19 Diagnostic Tests provides a list of all FDA-authorized at-home over-the-counter (OTC) COVID-19 diagnostic tests
• Subscribe to the COVID-19 Update podcast - on Apple Podcasts or Simplecast.  

The Latin phrase Rerum Cognoscere translates to learn, examine, or become aware of facts or things. In this section, we highlight measurable items of interest in health care from MSD, Delaware, the US, and the world.