Small state, big HIE innovator

By Mary Mosquera
01:44 PM

Delaware proved its mettle on data exchange, now comes insurance exchange

DOVER, DE – While Delaware is moving slowly on health insurance exchanges and other pieces of health reform, it has demonstrated it is an innovator, having established the first operational statewide health information exchange in the country in May 2007.

The Delaware Health Information Network (DHIN) provides secure direct delivery of lab and pathology results, radiology and transcribed reports, and demographic and billing information. It also includes clinical history, including medications, searchable by authorized DHIN users.

In February, DHIN accomplished full participation of all acute care hospitals and skilled nursing facilities in the state, along with 86 percent of Delaware providers, in the network, essentially a statewide community health record.

The statewide HIE gives Delaware the ability to improve the quality of care while managing its cost, said Delaware Gov. Jack Markell, a Democrat who took office in 2009. “This is the fundamental technological foundation we need to build a system of focused and managed healthcare that keeps people healthy,” he said in announcing the achievement.

Rita Landgraf, secretary of Delaware Health and Social Services, said that connecting Delaware’s nursing homes with DHIN was “a critical milestone and a key component to eliminating medication errors. By enabling access to discharge summaries and other information, we can ensure seamless transitions of care for residents in these facilities."

DHIN has a Web-based portal for providers without an electronic health record, including auto-print for paper charting and direct interface into the EHR with patient record matching for those providers with EHRs.

Delaware’s April 24 Republican primary played out against the backdrop of healthcare innovation. Delaware has the smallest number of delegates, 17, of the four primaries taking place the same day. With former Massachusetts governor, Mitt Romney, the presumed GOP presidential candidate, the primaries have become ho-hum affairs.

Earlier this month, Romney told an audience in Wilmington, Del., he would repeal the health reform law or issue an executive order for waivers to the 50 states. He has called for each state to create its own health reform plan.

Delaware may be most renowned as the state where in 2010 the Tea Party-backed Republican candidate Christine O' Donnell defeated nine-term Rep. Mike Castle, a moderate, in the primary before she lost the U.S. Senate bid in the general election, in part due to some bizarre advertising that referenced witchcraft.

In 2012, Delaware is trying to come up with some real-world solutions to developing a health insurance exchange and extending coverage to its 104,000 uninsured individuals without breaking its budget.

The Delaware Health Commission is the entity within the Delaware Health and Human Services Department exploring health insurance exchanges, which are to go live in 2014 under the health reform law. Delaware has received the early $1 million exchange planning grant and $3.4 million establishment grant. The Public Consulting Group, which offers research about state and local programs, provided earlier this month a feasibility analysis and recommendations for a strategy going forward on the exchange.

States that are small or have small populations are concerned about how they will handle the cost of health insurance exchanges. The consulting group estimated from studying other state exchanges that Delaware would enroll about 35,000 through the exchange in 2015.

“Delaware has also taken a lead role in communicating with CCIIO about issues facing ‘low-population’ states,” the consulting group explained in its report, referring to the Center for Consumer Information and Insurance Oversight, which oversees exchange development in the Health and Human Services Department.

Delaware is considering a federally facilitated exchange, a mixed state and federal exchange concept, which will allow the state to keep costs down yet maintain control over plan management and outreach. The federal government would help on website infrastructure, eligibility and enrollment, according to the consulting group.

In other healthcare improvements, the Medical Society of Delaware and Blue Cross Blue Shield of Delaware, the state’s largest health insurer, have partnered on a patient-centered medical home pilot, called the Patients First in the First State program. The model encourages a team approach to patient care and promotes the use of EHRs and electronic prescribing to improve patient outcomes.

The insurer has provided a grant for education and training of physicians and their staffs as they transition to the medical home model, according to Randeep Kahlon, MD, president of the Medical Society of Delaware.