Delaware is one of the smallest states in the Union both in terms of geography and population, but it is one of the most densely populated states and has been a ready adopter of healthcare reform. The state's health insurance exchange, Choose Health Delaware, featured just one carrier, Highmark, in 2022, however, in 2023, Aetna and AmeriHealth joined the exchange marketplace, driving competition. Delaware is in the process of implementing a model that will move the healthcare industry away from fee-for-service and focus on quality care and population health management. Highmark Blue Cross Blue Shield Delaware, AmeriHealth Caritas, and newly added Centene's Delaware First Health are the three participating MCOs. The new contracts were implemented on Jan. 1, 2023, and will run through five years with the option of three additional one-year extensions. Accordingly, the state launched its first four Medicaid ACOs, effective from July 2021 and will run through 2024. Medicare Advantage has traditionally not been a strong sector in Delaware, the growing senior population in the state might change the market scenario.