Delaware
About the Team
The Delaware team is comprised of:
- The Delaware Department of Health and Social Services—Division of Medicaid & Medical Assistance (DMMA)
- AmeriHealth Caritas Delaware (AmeriHealth)
- Nemours Children’s Health (Nemours)
About mid-point through the project, DMMA authorized Nemours Children’s Health to serve as a Medicaid ACO, creating a new partnership opportunity between Nemours Children’s and AmeriHealth. The ACO will provide an opportunity to further expand data sharing capabilities between Nemours and AmeriHealth and serve a larger population.
Identifying and Diagnosing the Problem
To identify health disparities within their data, the Delaware team spent significant time reconciling their race, ethnicity, and language data to accurately compare populations across their organizations.
The team identified four measures reflecting a health disparity for their Black pediatric population and to track the initiative’s success:
- Increase childhood immunization rates
- Increase lead screenings
- Increase well child visits
- Reduce avoidable emergency department admissions
The team implemented a 3-part provider and member engagement plan to gather feedback from internal staff from Nemours, AmeriHealth, and external community partners who work directly with their priority population. Those outreach efforts informed their root cause analysis and contributed to9 their knowledge about why those inequities exist.
Designing and Implementing Change
As a result of the ACO agreement, Nemours and AmeriHealth created new structures to foster collaboration between the two organizations. They created workgroups for comparable departments across Nemours and AmeriHealth (e.g. care coordination, member outreach, member engagement), so care coordinators from each organization could communicate more effectively. The workgroups provide a space for the organizations to learn from one another, be more efficient with resources, and consider key gaps in a patient’s care journey. The workgroups are in the process of identifying programs with the potential to advance equity and address the disparities identified by the Delaware team. They will design their care delivery model based on those findings.
Creating Cultures of Equity
As part of the ACO agreement, AmeriHealth and Nemours support a comprehensive approach to equity by designing a model that provides an enhanced incentive for the ACO to report disparities in care and health outcomes and address specific health disparities.
The agreement further supports creating a culture of equity by bifurcating those equity-focused measures and introducing an enhanced incentive for improvements for the prioritized population. That incentive was created to acknowledge the effort required to support outcome improvements that were identified through the project’s earlier root cause analysis.
The team also established workgroups to ameliorate power dynamics and create space for improved collaboration. The workgroups intentionally brought an equity lens to all of the work streams.
Lessons Learned
Equity should be embedded across all aspects of a team’s work. This includes how team members and organizations communicate and work with one another, as well programmatic decisions. Additionally, equity initiatives should be intentional about creating a workspace that fosters open dialogue and promotes shared learning. The teams also celebrated the impact that their work with AHE has had on advancing equity-focused work across their organizations through new and expanded initiatives