(a)The Office of Value-Based Health Care Delivery is established within the Department to reduce health-care costs by increasing the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates.
(b)For purposes of this section:
(1)“Affordability standard” means as defined by the Department in regulations promulgated under this section using information collected under paragraphs (c)(2) and (c)(3) of this section and may include any of the following:
a. Trends, including any of the following:
1. Historical rates of trend for existing products.
2. National medical and health insurance trends.
3. Regional medical and health insurance trends.
4. Inflation indices.
b. Price comparison to other market rates for similar insu
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(a) The Office of Value-Based Health Care Delivery is established within the Department to reduce health-care costs by increasing the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates.
(b) For purposes of this section:
(1) “Affordability standard” means as defined by the Department in regulations promulgated under this section using information collected under paragraphs (c)(2) and (c)(3) of this section and may include any of the following:
a. Trends, including any of the following:
1. Historical rates of trend for existing products.
2. National medical and health insurance trends.
3. Regional medical and health insurance trends.
4. Inflation indices.
b. Price comparison to other market rates for similar insurance products and medical services.
c. The ability of lower-income individuals to pay for health insurance.
d. Effective strategies carriers can use to maintain close control over administrative costs and enhance the affordability of products and encourage delivery of high quality, efficient healthcare services.
(2) a. “Carrier” means any of the following:
1. “Health insurer” as defined in § 4004 of this title and licensed under this title.
2. A health insurer or other entity that is certified as a qualified health plan on the Delaware Health Insurance Marketplace for plan year 2019 or a subsequent plan year.
b. Notwithstanding paragraph (b)(2)a. of this section, “carrier” does not mean any of the following:
1. A plan of health insurance or health benefits designed for issuance to persons eligible for coverage under Titles XVIII, XIX, and XXI of the Social Security Act, 42 U.S.C. §§ 1395 et seq., 1396 et seq., and 1397aa et seq., known as Medicare, Medicaid, or any other similar coverage under a state or federal government plan.
2. An entity selected by the State Group Health Insurance Plan to offer supplemental insurance program coverage under Chapter 52C of Title 29.
(3) “Primary care” means as defined by the Department in regulations promulgated under this section.
(4) “Primary Care Reform Collaborative” means as defined in § 9904A of Title 16.
(c) The Office of Value-Based Health Care Delivery shall do all of the following:
(1) Establish affordability standards for health insurance premiums based on recommendations from the Primary Care Reform Collaborative.
(2) Establish, through regulations adopted under this section, mandatory minimums for payment innovations, including alternative payment models, provider price increases, carrier investment in primary care, and other activities deemed necessary to achieve the purpose of this section, to support a robust system of primary care by January 1, 2026.
(3) Collect data and develop reports regarding carrier investments in health care to monitor and evaluate all of the following:
a. The calculation of the amount of claims-based and non-claims-based primary care spending in this State, including data from the Delaware Health Care Claims Database, under subchapter II of Chapter 103 of Title 16.
b. Carrier compliance with reimbursement rates for primary care required under §§ 3342B and 3556A of this title.
c. Health-care spending data collected and reported through the state benchmarking process.
d. The percentage of spending in primary care that is delegated to hospitals and related networks for care coordination through alternative payment models.
(4) Annually evaluate whether primary care spending is increasing in compliance with the requirements of, and regulations adopted under, this title, with consideration of overall total health-care spending.
(5) Make recommendations to the Insurance Commissioner and the Primary Care Reform Collaborative about appropriate reimbursement rates for primary care.
(6) Develop and annually evaluate affordability standards, through an open and transparent process, in collaboration with the Primary Care Reform Collaborative.