4 minute read
A Local Health Approach From a National Leader
BY BILL WILSON
ON JANUARY 1, 2023, Delaware First Health officially became Delaware’s newest Medicaid Managed Care Organization (MCO), covering more than 38,000 community members. We are excited to be here in Delaware and to partner with the Department of Health and Social Services, members, providers, and community stakeholders to improve the health and wellbeing of Delaware residents. Delaware First Health is a subsidiary of Centene Corporation, a Fortune 50 company and a national leader of managed care services.
Centene serves nearly one in 15 individuals across the nation, including members with unique healthcare needs, Medicaid and Medicare populations, and children’s specialty programs. With Delaware as the 30th Medicaid-managed care state, Centene now serves 26.8 million managed care members across the country. At Delaware First Health, we will extend Centene’s deep experience and established best practices to Delaware’s Medicaid Managed Care population and drive true healthcare outcomes and reduce costs across the state.
Focus on Members
Our focus is ensuring that each of our members achieves the highest possible levels of wellness while demonstrating positive clinical results. We do that through our care model:
• Integrated Care: Integration of physical and behavioral health, and long-term services through a high degree of healthcare collaboration and communication
• Coordination of Care: Involvement of personal, community, and healthcare stakeholders to facilitate the appropriate delivery of health care services
• Continuity of Care: Healthcare driven by relationships between the member, health providers, and community services to ensure ongoing health care management
Coordination of Care Approach
Our Coordination of Care approach uses people, process, and system capabilities to prioritize evidence-based interventions for members with social needs, and emerging or rising risk. We emphasize preventive care through a strong provider and partner network. We identify and address social needs that put members at risk for poor health outcomes through a suite of tools that provide analytics and insights into patient populations. We have proven processes to hear our members and empower them to make healthy choices and decisions. Well-coordinated access to care reduces the volume of services needed by beneficiaries, and more engaged beneficiaries tend to be healthier, and therefore reduces cost.
Long-Term Services and Supports (LTSS) Expertise
Delaware First Health leverages innovative strategies that lead to successful transitions and increase the independence of our members. Of our affiliates’ members utilizing LTSS today, approximately 80% live in home settings. Through satisfaction surveys and member feedback we make sure our members get the care they deserve. As such, in 2021 99% of members receiving LTSS across all our affiliates reported being satisfied or very satisfied with their case manager; and 97% reported being satisfied or very satisfied with their health plan. Well-coordinated LTSS care produces high quality, cost-effective care when all partners have shared goals and member care is handled well across multiple care settings.
Commitment to Advance Health Equity
At our core, we have sustainable and equitable solutions to address health equity based on a multitude Social Determinants of Health including location, culture, gender, race, ethnicity, language, ability, and others. This commitment to health equity is driven by listening to and relying on our members, communities, providers, and other stakeholders, and focuses on empowering local voices. Our commitment to community involvement helps to address the social determinants of health that affect the Delaware community, like transportation, access to food, and housing. Members with culturally competent access to care are less likely to postpone care or go without due to cost.
Focus On Behavioral and Physical Health Integration
Using an integrated, person- and family-centered delivery model for behavioral health services, we ensure rapid access and seamless whole-person care. With a large in-network of providers, including major hospital systems and FQHCs, integration of physical and behavioral health better manages the risk of its members who can get wholistic care right where they live and work.
For so many, accessing even basic healthcare services can be an insurmountable challenge, which leads to poorer health outcomes and higher costs for the whole system. As a managed care organization in Delaware, partnering with the state and local providers and partners, we combine strengths that will aid in reducing costs and transforming the health of the community, one person at a time.
Visit DelawareFirstHealth.com for more information about the plan, contact information, and many resources to connect with us.
Bill Wilson is the plan president and CEO of Delaware First Health.
