Featured Post from ChristianaCare

ChristianaCare Reduces Health Care Costs by $6.2 Million While Improving Care for Medicaid Patients

Proven care management model delivers cost savings and quality improvement to state while addressing health inequities

Jan 23, 2025

3 min

Rose Kakoza, M.D., MPHChristine Donohue-Henry, M.D., MBA

ChristianaCare’s Delaware Medicaid Partners Accountable Care Organization (ACO) has set the standard for innovative, high-quality care at lower cost for the State of Delaware’s Medicaid population. According to the most recent data available, ChristianaCare’s ACO reduced health care spending by $6.2 million in 2023 while improving care for nearly 30,000 Medicaid beneficiaries in Delaware, including approximately 8,000 children.


CaptionResizeWrap TextRemove


“We’re demonstrating that population health works,” said Christine Donohue-Henry, M.D., MBA, chief population health officer, ChristianaCare. “Our neighbors count on us to take care of them — and we can improve their health while also helping the state reduce health care costs. We do this by delivering high-quality care that emphasizes preventive care and proactive management of health conditions, and by investing in our population health infrastructure.


“In this way, we can keep people healthier and reduce the need for them to access the most expensive kinds of care, such as emergency care and hospitalization.”


ChristianaCare’s Medicaid ACO includes more than 1,900 primary and specialty care clinicians who partner with patients and families to prevent illness, manage chronic diseases and help them achieve their health goals. The ACO makes it easy for adults and children to get the screenings and treatments they need, improving overall health.


ChristianaCare’s Medicaid ACO is one of four authorized by the State of Delaware and the only one to voluntarily accept downside financial risk at its launch in 2021, which means that if ChristianaCare’s Medicaid ACO is not successful in reducing cost and improving care for a particular year, the ChristianaCare ACO is required to make a payment to the state. By sharing in both savings and losses, the ACO controls state health care costs while maintaining high-quality care.


Bending the Cost Curve by Focusing on High-Quality Preventive Care

Alongside financial savings, ChristianaCare’s Medicaid ACO has improved care quality and worked to reduce health disparities. By focusing on preventive care, the ACO has helped adults and children get the screenings and treatment they need, leading to better health outcomes and fewer unmet needs.


Since launching in 2021, ChristianaCare’s ACO has met all required quality standards and consistently improved its performance each year on key measures like diabetes management, blood pressure control and breast cancer prevention. Year over year, breast cancer screenings have increased by 4%, while patients with high blood pressure (hypertension) have shown improvement in blood pressure control. Notably, healthy blood sugar levels (HbA1c less than 8%) have also improved in patients with diabetes by 7%.


In collaboration with its Medicaid health plan partners, ChristianaCare primary care and imaging teams host patient-centered health and wellness day events to increase access to care, close quality gaps and improve the overall health of the communities they serve. These events help patients get preventive screenings and services, supporting the ACO’s goals of better care and health equity.


The ACO’s success is driven by its focus on caring for entire families, including addressing the needs of pregnant mothers and supporting children and adults throughout their lives, according to Rose Kakoza, M.D., MPH, senior clinical network director, ChristianaCare Clinical Alliance.


Key programs include enhanced maternity care to support mothers and infants, expanded mental health services and social support programs that address food and housing needs. By integrating clinical care with social support — such as help with food and housing — the ACO is working to break cycles of poor health across generations. This approach also has practical benefits. For example, the improved mental health of a parent strengthens the family environment, supporting children’s well-being and development.


“By making significant investments in population health and addressing both medical needs and the social drivers of health, we’ve not only improved health outcomes but also more effectively managed costs for Delaware’s most vulnerable residents, helping to reduce state spending,” Kakoza said.


About Delaware Medicaid Partners

Delaware Medicaid Partners ACO, led by ChristianaCare, uses a family-centered approach to save money and improve care for Medicaid patients. By combining medical care with social support, the ACO addresses the unique needs of Medicaid patients, improving health and promoting equity. Care coordination is provided by ChristianaCare’s CareVio®, whose team of nurses, social workers, and pharmacists help patients with serious health conditions get the care they need. CareVio uses real-time data to prevent complications that could lead to unnecessary hospital stays or emergency visits. Through ongoing collaboration and innovation, Delaware Medicaid Partners ACO aims to set an example for other states working to improve care while managing costs.

Connect with:
Rose Kakoza, M.D., MPH

Rose Kakoza, M.D., MPH

Senior Clinical Network Director, Population Health

Dr. Rose Kakoza specializes in using primary care to improve health equity and the effectiveness of accountable care.

Primary CarePrimary Care Delivery ReformPopulation HealthHigh Risk Population Management
Christine Donohue-Henry, M.D., MBA

Christine Donohue-Henry, M.D., MBA

Chief Population Health Officer

Dr. Donohue-Henry leads value-based care in the health system and integrated network, enhancing clinical quality and reducing care costs.

Health System OptimizationPopulation HealthClinical QualityValue-Based Care ImplementationHealthcare Cost Management

You might also like...

Check out some other posts from ChristianaCare

3 min

Expanding Comprehensive Cancer Services to Middletown, Delaware

ChristianaCare’s Helen F. Graham Cancer Center & Research Institute is expanding access to high-quality, comprehensive cancer care for residents in Middletown and nearby communities. These services will be offered at the new Middletown Health Center, now under construction and expected to open in May 2027. “Our vision is to expand and grow our services throughout the region so that more patients can access high-quality cancer care close to home,” said Thomas Schwaab, M.D., Ph.D., Bank of America Endowed Medical Director of the Helen F. Graham Cancer Center & Research Institute. “By bringing our full cancer-care team and advanced technology to Middletown, we can provide highly precise, coordinated treatment while maintaining the same high standard of care our patients expect.” The cancer care services offered at the Middletown Health Center will reflect the same high-quality, comprehensive care provided at ChristianaCare’s Helen F. Graham Cancer Center & Research Institute in Newark. Patients will have access to specialists across all major cancer types, supported by the Graham Cancer Center’s participation in the National Cancer Institute Community Oncology Research Program (NCORP), which brings advanced treatments and clinical trials directly to the community. In Middletown, this means coordinated multidisciplinary treatment planning, advanced radiation therapy, infusion services, consultations with oncologists and surgeons, nurse navigation, supportive care, clinical trial participation and both in-person and virtual visit options. Advanced Technology Enhances Precision and Comfort When services open in Middletown, patients will have access to advanced radiation therapy using the Varian TrueBeam linear accelerator, one of the most sophisticated radiation therapy systems available. TrueBeam delivers highly precise, image-guided treatments for a wide range of cancers, allowing physicians to target tumors more accurately while minimizing radiation to healthy tissue. “The TrueBeam system represents a major step forward in how we deliver radiation therapy,” said Adam Raben, M.D., chair of Radiation Oncology at ChristianaCare. “Treatments that once took 30 minutes can now be completed in just a few minutes, with real-time imaging ensuring precision. This means better tumor control, fewer side effects and a more comfortable experience for patients.” A Growing Community with Expanding Health Care Needs Middletown is one of Delaware’s fastest-growing communities, with its population projected to rise 8% by 2029, nearly twice the statewide rate, according to the US Census Bureau. Since 1990, the town’s population has grown more than 550%, and the number of residents age 65 and older has increased 24% since 2020, driving demand for accessible, high-quality health care. With continued growth and an aging population, cancer service demand in Middletown is expected to increase by 11% over the next decade, according to health care forecasts from Sg2, a Vizient company, underscoring the need for expanded local care options. Expanding Access to Meet Future Cancer Care Demand By expanding services in Middletown, ChristianaCare is responding to both the region’s population growth and the increasing need for cancer care. The new site will help patients receive timely diagnosis and treatment while reducing travel time and improving coordination with the full Graham Cancer Center team. “As our community grows, so too does the need for locally accessible, state-of-the-art cancer services,” said Schwaab. “This expansion represents a pivotal investment in the health of the Middletown—Odessa—Townsend corridor and beyond.” $92 Million Investment in Middletown’s Health The $92.3 million Middletown Health Center reflects a deep investment in the health and vitality of the state. It is part of ChristianaCare’s larger plan, announced in July 2025, to invest more than $865 million in Delaware over the next three years. In addition to cancer care, the Middletown Health Center will offer a full range of services, including primary and specialty care, women’s health, behavioral health, cardiovascular care, pediatrics, neurology, imaging, diagnostics and lab testing. The center’s healing environment will also include walking trails and abundant natural light, making high-quality, convenient and coordinated care more accessible and welcoming for patients and families. The 87,000-square-foot Health Center will be located at 621 Middletown Odessa Road, next to ChristianaCare’s existing freestanding emergency department.

3 min

ChristianaCare Launches Organoid Core to Personalize Cancer Treatment

ChristianaCare’s Cawley Center for Translational Cancer Research has unveiled a first-of-its-kind organoid core in a community cancer center program. The new laboratory facility within the Helen F. Graham Cancer Center & Research Institute grows and tests living, patient-derived tumor models, giving doctors and researchers a faster, more precise way to identify the therapies most likely to work for each patient. This innovation could change how cancer is treated in Delaware and serve as a model for community centers nationwide. There are only a handful of organoid core centers, or “tumor-on-a-chip” programs, in the United States, and ChristianaCare’s is the first within a community cancer center setting. What the Organoid Core Does Tumor organoids are tiny, three-dimensional cultures grown from a patient’s tumor tissue. They preserve the genetic and molecular traits of the original tumor, making them far more accurate than traditional cell lines. “These mini-tumors enable researchers to screen drugs faster, identify new biomarkers and discover which treatments are most likely to work for each patient,” said Thomas Schwaab, M.D., Ph.D., Bank of America Endowed Medical Director of ChristianaCare’s Helen F. Graham Cancer Center and Research Institute. “This core is a bridge between the lab and the clinic. By growing living tumor models from cells of individual patients, we can test real-world drug responses and tailor treatments for them in ways that were not possible before.” How It Advances Patient Care The organoid core strengthens the Cawley Center's research capabilities by enabling drug screening and biomarker discovery. It will bank organoids representing the wide variety of tumors seen in the community, giving scientists a realistic system for testing therapies. ChristianaCare treats more than 70 percent of cancer patients in Delaware, giving researchers unique access to treatment-naïve samples. These are tumor tissues that have not yet been exposed to chemotherapy or other therapies. Studying them provides a more accurate picture of how cancer behaves naturally and how it might respond to new treatments. Bringing a new cancer drug to patients is expensive and risky. Estimates show it can cost $1.3 to $2.8 billion, with up to a third spent on preclinical development, and only about one in 10 compounds ever reach human trials. Traditional mouse models often fail to fully mimic human tumors, making early testing less reliable. By using organoid screening, the Cawley Center can test therapies more accurately, reduce costs and failure rates and move promising treatments into clinical trials faster. Combined with existing tissue collection programs, clinical trial infrastructure and community partnerships, these resources create a direct pathway to bring lab discoveries to patients faster. Turning Point in Translational Research “Our goal is to shorten the distance between discovery and treatment,” said Nicholas J. Petrelli, M.D., director of the Cawley Center. “Too many promising drugs fail because early models do not capture the complexity of real tumors. The organoid core helps solve that problem. We can now test therapies in models that reflect the patients we actually serve.” “This is a turning point for translational research in community health,” said Jennifer Sims Mourtada, Ph.D., associate director at the Cawley Center. “Organoid technology lets us study cancer in a way that feels personal. We are not just looking at data points. We are studying living models of a patient’s tumor, which can reveal how that person’s cancer might behave or respond to treatment. This approach brings science closer to the people it is meant to help.” Looking Ahead In the coming months, the organoid core will focus on building a diverse biobank of tumors common in Delaware. Plans include collaborations with academic institutions, shared access for external researchers, and development of immune-tumor co-culture models. By combining advanced technology, strong community partnerships and direct patient access, ChristianaCare and the Cawley Center are showing how translational cancer research can thrive in a community setting, making breakthroughs not only in the lab but also in patients’ lives.

3 min

ChristianaCare Gene Editing Institute Achieves CRISPR Breakthrough That Reverses Chemotherapy Resistance in Lung Cancer

In a major step forward for cancer care, researchers at ChristianaCare’s Gene Editing Institute have shown that disabling the NRF2 gene with CRISPR technology can reverse chemotherapy resistance in lung cancer. The approach restores drug sensitivity and slows tumor growth. The findings were published Nov. 13, 2025 in the online edition of Molecular Therapy Oncology. This breakthrough stems from more than a decade of research by the Gene Editing Institute into the NRF2 gene, a known driver of treatment resistance. The results were consistent across multiple in vitro studies using human lung cancer cell lines and in vivo animal models. “We’ve seen compelling evidence at every stage of research,” said Kelly Banas, Ph.D., lead author of the study and associate director of research at the Gene Editing Institute. “It’s a strong foundation for taking the next step toward clinical trials.” Potential Beyond Lung Cancer The study focused on lung squamous cell carcinoma, an aggressive and common form of non-small cell lung cancer (NSCLC) that accounts for 20% to 30% of all lung cancer cases, according to the American Cancer Society. It’s estimated that over 190,000 people in the U.S. will be diagnosed in 2025. While the research centered on this cancer type, the implications are broader. Overactive NRF2 contributes to chemotherapy resistance in several solid tumors, including liver, esophageal and head and neck cancers. The results suggest a CRISPR-based strategy targeting NRF2 could help resensitize a wide range of treatment-resistant tumors to standard chemotherapy. “This is a significant step toward overcoming one of the biggest challenges in cancer therapy — drug resistance,” Banas said. “By targeting a key transcription factor that drives resistance, we’ve shown that gene editing can re-sensitize tumors to standard treatment. We’re hopeful that in clinical trials and beyond, this is what will allow chemotherapy to improve outcomes for patients and could enable them to remain healthier during the entirety of their treatment regimen.” Targeting a Master Switch for Resistance The research zeroed in on a tumor-specific mutation, R34G, in the NRF2 gene, which acts as a master regulator of cellular stress responses. When overactive, NRF2 helps cancer cells withstand chemotherapy. Using CRISPR/Cas9, the team engineered lung cancer cells with the R34G mutation and successfully knocked out NRF2. This restored sensitivity to chemotherapy drugs such as carboplatin and paclitaxel. In animal models, tumors directly treated with CRISPR to knockout NRF2 grew more slowly and responded better to treatment. “This work brings transformational change to how we think about treating resistant cancers,” said Eric Kmiec, Ph.D., senior author of the study and executive director of the Gene Editing Institute. “Instead of developing entirely new drugs, we are using gene editing to make existing ones effective again.” Editing Reaches Threshold Levels One of the most promising discoveries was that disrupting NRF2 in just 20% to 40% of tumor cells, was enough to improve the response to chemotherapy and shrink tumors. This insight is particularly relevant for clinical use, where editing every cancer cell may not be feasible. To test therapy in mice, the researchers used lipid nanoparticles (LNPs), a non-viral method with high efficiency and low risk of unintended, off-target effects. Sequencing confirmed that the edits were highly specific to the mutated NRF2 gene, with minimal unintended changes elsewhere in the genome. “The power of this CRISPR therapy lies in its precision. It’s like an arrow that hits only the bullseye,” said Banas. “This level of specificity with minimal unanticipated genomic side effects offers real hope for the cancer patients who could one day receive this treatment.”

View all posts
Powered by