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Through Value-Based Payment, Christiana Care and AmeriHealth Caritas Delaware Partner to Improve Health of Medicaid Patients

In a groundbreaking partnership in Delaware, Christiana Care Health System and AmeriHealth Caritas Delaware have entered into a value-based payment agreement, covering Medicaid beneficiaries, in which both organizations benefit from their effectiveness in keeping patients healthy.

The agreement creates greater flexibility for Christiana Care to address both medical and non-medical health care needs of Medicaid patients. It is designed to fully align the health care payment model with the delivery of high quality, valuable care to Medicaid beneficiaries. Under the new structure, there are benefits for the partnering organizations if health care quality and cost-reduction targets are met or exceeded, and revenue is lower if those targets are not met.

“We are transforming the health system to achieve better health at lower costs,” said Janice E. Nevin, M.D., MPH, president and CEO of Christiana Care. “This value-based care agreement is an incredibly important step that empowers our caregivers to focus on providing the right care, at the right place and time for our Medicaid beneficiaries. It enhances our ability to innovate in meeting the non-medical needs of our patients — addressing challenges such as poverty, hunger and housing insecurity that prevent them from achieving their health goals. We are proud to partner with AmeriHealth Caritas Delaware in this bold new step.”

“This agreement with Christiana Care exemplifies our commitment to providing high-quality health care for our members,” said Emmilyn Lawson, AmeriHealth Caritas Delaware Market President. “It is also represents an opportunity to strengthen our relationship with a valued health care provider as our organizations continue the work to help members address the social, economic and environmental barriers to obtaining and maintaining good health.”

This value-based care agreement is a positive development for Medicaid beneficiaries, managed care organizations and health care providers because it incentivizes our collective commitment to addressing social determinants of health,” added Dr. Lenaye Lawyer, AmeriHealth Caritas Delaware Market Chief Medical Officer. “Strong collaboration with our PCPs, community health workers and case managers is essential in improving health outcomes for our members, especially those with chronic diseases.”

This novel arrangement allows Christiana Care to:

  • Focus on innovative programming to support unmet social needs.
  • Invest in innovative programming to integrate behavioral health and wellness support.
  • Integrate community health workers within clinical care teams to help patients bridge the complexities of the health care system and social services.

Unleashing the power of innovation

An innovative feature of the payment model is that it enhances Christiana Care’s ability to explore health interventions that impact a patient that might not have been covered under a fee-for-service model. Examples may include:

  • Partnering with housing agencies to support transitional housing for homeless patients with complex chronic conditions. Housing allows for improved ability to consistently treat their chronic conditions and support health.
  • Providing nutritious food to chronically ill patients who live in neighborhoods without access to supermarkets or other sources of fresh fruits and vegetables. Adequate nutrition is a foundational aspect of good health.

A bold new step in Delaware health care

This model, in which a health system has partnered with one of the state’s contracted Medicaid managed care organizations in a total-cost-of-care arrangement that includes upside and downside risk, represents an exciting step forward in value-based care for Delaware. In this agreement, Christiana Care and AmeriHealth Caritas Delaware have agreed to share accountability for the total cost of providing health care services to Medicaid members being cared for by Christiana Care providers.

Through this partnership, Christiana Care receives a pre-determined payment for the cost of providing health care services to the assigned AmeriHealth Caritas Delaware Medicaid members, ranging from wellness screenings to primary care visits to hospital stays. If the health outcome targets for the population are achieved at costs that are lower than standard market value, then Christiana Care and AmeriHealth Caritas Delaware are both able to retain some of those savings. If the health outcome metrics and cost reductions are not achieved, then Christiana Care would receive less reimbursement than it would have in a traditional fee-for-service payment model.

Through this partnership, Christiana Care receives a pre-determined payment for the cost of providing health care services to the assigned AmeriHealth Caritas Delaware Medicaid members, ranging from wellness screenings to primary care visits to hospital stays. If the health outcome targets for the population are achieved at costs that are lower than standard market value, then Christiana Care and AmeriHealth Caritas Delaware are both able to retain some of those savings. If the health outcome metrics and cost reductions are not achieved, then Christiana Care would receive less reimbursement than it would have in a traditional fee-for-service payment model.

The value-based payment agreement applies to the Delaware Medicaid beneficiaries managed by AmeriHealth Caritas Delaware who are assigned to Christiana Care as their primary health care provider. The agreement does not restrict freedom of choice or access to care for these Medicaid beneficiaries.

About Christiana Care Health System

Headquartered in Wilmington, Delaware, Christiana Care is one of the country’s most dynamic health systems, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. Christiana Care includes an extensive network of outpatient services, home health care, medical aid units, two hospitals (1,227 beds), a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women’s health. Christiana Care is a not-for-profit teaching health system with more than 260 residents and fellows. We are continually ranked by US News & World Report as a Best Hospital. With our unique, data-powered care coordination service and a focus on population health and value-based care, Christiana Care is shaping the future of health care. Learn how we deliver greater quality and value at https://christianacare.org

About AmeriHealth Caritas Delaware

AmeriHealth Caritas Delaware, part of the AmeriHealth Caritas Family of Companies, is one of the Medicaid managed care plans that participate in the Diamond State Health Plan and Diamond State Health Plan-Plus programs. AmeriHealth Caritas Delaware helps Delawareans get proper care and stay well, working with communities in need to achieve positive health outcomes throughout the state. For more information, visit www.amerihealthcaritasde.com.

About AmeriHealth Caritas

AmeriHealth Caritas is one of the nation's leaders in health care solutions for those most in need. Operating in 11 states and the District of Columbia, AmeriHealth Caritas serves more than 5 million Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) members through its integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, and behavioral health services.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 35 years of experience serving low-income and chronically ill populations. AmeriHealth Caritas is part of the Independence Health Group in partnership with Blue Cross Blue Shield of Michigan. For more information, visit www.amerihealthcaritas.com.