A new Rural Health Transformation Program will support real-time insurance verification and prior authorization across the state, officials announced July 6.

Supported 100% by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services as part of a  $157,394,963.86 award, officials said, the project will leverage the Delaware Health Information Network, Delaware’s statewide health information exchange, and Smart Health Network, a technology platform that helps providers and payers exchange administrative information more efficiently to improve connectivity among clinicians, payers, health systems, and patients.

Smart Health Network’s infrastructure helps create a shared connection point that allows participating providers and payers to exchange information using common standards rather than maintaining numerous individual connections. Together, officials said, DHIN and Smart Health Network will support more efficient exchange ofadministrative information related to insurance eligibility, prior authorization, and other healthcare transactions, helping reduce administrative burdens, improve care coordination, and support faster access to care.

“Technology should make healthcare easier to navigate, not more complicated,” said Delaware Health and Social Services Secretary Christen Linke Young in a press release. “This initiative will help clinicians spend less time managing paperwork and more time caring for patients.”

Prior authorization and insurance verification requirements can delay access to care and increase administrative burdens for providers. Nationally, physician practices spend an estimated 13 hours each week completing prior authorization-related tasks, according to the American Medical Association. For example, officials said, providers often must navigate multiple payer portals, submit documentation through different systems, or make phone calls to verify coverage and obtain prior authorization for services.

By supporting more standardized electronic transactions between providers and payers, officials said, the project will help streamline these processes and reduce administrative workload.

“As a physician, I have watched prior authorization consume time that belongs to patients,” said Delaware Health Care Commission Chair Dr. Neil Hockstein in a press release. “The promise here is simple: Cut the paperwork, not the care. A neutral hub that every payer and provider can join once – and that patients can actually see into – is the change the front lines have been waiting for.”

Delaware also will build upon existing statewide infrastructure to improve interoperability and support more efficient information sharing across the healthcare system. DHIN serves as Delaware’s designated statewide health information exchange and maintains secure connections with hospitals, health systems, federally qualified health centers, laboratories, pharmacies, and provider organizations throughout the state, and it will incorporate Smart Health Network’s enhanced data integration, analytics, and interoperability tools.

“Delaware already trusts DHIN to move health information securely across the state,” said Delaware Health Information Network CEO Dr. Jan Lee. “The Smart Health Network extends that trusted, neutral foundation to the administrative transactions that sit alongside care. We are building on what Delaware already has to support patients, clinicians, and payers.”

Officials said the project supports broader goals of Delaware's multiyear Rural Health Transformation Program by improving access to care, modernizing healthcare infrastructure, supporting providers, and enabling more innovative models of care delivery, while complementing RHTP investments focused on expanding access to services, growing the healthcare workforce, and improving health outcomes in rural and underserved communities.

By leveraging DHIN’s established statewide network, the project avoids duplication of existing infrastructure, accelerates implementation, and ensures compliance with state and federal privacy and security requirements. Smart Health Network’s tools will enhance the usability of DHIN’s trusted data by supporting advanced analytics, visualization, population health management, and program evaluation capabilities.

"Delaware decided to treat this like the public infrastructure it is – neutral, and designed around patient interest,” said Smart Health Network CEO Paul Meyer in a press release. “The hub connects everyone through a single integration. Delaware is first, but the network is built for every state."