Traditionally a market with few innovative quality partnerships, Wilmington has made progress in terms of value-based agreements, mergers and acquisitions, and influential legislation that should continue to move the needle away from fee for service. Christiana Care Health System and Highmark Blue Cross Blue Shield Delaware, the two dominant entities in their respective spaces, formed a value-based partnership that impacts more than 20,000 Medicaid beneficiaries. Christiana Care also entered into a value-based agreement with AmeriHealth Caritas Delaware. The moves represent a transformation for the health system as it strives to improve patient care while lowering costs. Highmark Delaware already has value-based arrangements in place with a large percentage of primary-care physicians in the commercial space. Expect more partnerships focused on quality and incentive payments to emerge. In addition, new legislation set a healthcare spending benchmark of 3.8 percent for 2019.

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