SB 227

Abstract

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. Despite the demonstrated value of primary care, access to primary care for Delawareans has become increasingly difficult because insurance reimbursement rates fail to support an adequate infrastructure. The national average for primary care spending for an insurance plan is between 6% and 8% of the insurer’s total medical expenditures. Studies recommend, and some states are actively implementing, a 12% to 15% spending rate to have an effective system. Delaware’s average insurance spending on chronic care management and primary care is between 3% and 4%. Nationally, insurance reimbursement for primary care averages between 120% and 140% of Medicare rates. In Delaware the commercial market reimburses independent primary care at rates as low as between 65% and 85% of Medicare rates. Reliable data regarding insurance spending is difficult to obtain due to a combination of contractual restrictions and an absence of mandatory health care price transparency requirements applicable to commercial plans in Delaware This Act simultaneously enacts short-term and long-term solutions to strengthen the primary care system in this State. While the Primary Care Reform Collaborative and the Delaware Health Care Commission study and development long-term recommendations, requiring insurers to reimburse for chronic care management and primary care at the Medicare rates will stabilize existing resources and provide immediate benefits. The Primary Care Reform Collaborative and the Delaware Health Care Commission have reliable data and information from the Delaware Health Care Claims Database to use in this analysis and to make recommendations that will strengthen the primary care system in Delaware.