Thursday, September 19, 2013

SIM update

The September meeting of the SIM steering committee changed little to the plan except the name of the payment model. The planners reported to the committee what will happen in the next phase of the process. They changed the name of their provider risk-based payment model from Total Cost of Care to Shared Savings, apparently because people associated TCC with capitation. But it became clear that members’ assumptions that Shared Savings had the generally accepted, Medicare-based meaning, that in fact Shared Savings also includes capitation. They are looking for a term that includes capitation but doesn’t evoke strong negative reactions from stakeholders. (The problem isn’t the term.) They also intend to re-create the committee structure, possibly including consumers and/or advocates in some of the new committees. In response to advocates’ concerns, they are including an Equity Access and Appropriateness Council to monitor for denials of inappropriate care under their provider risk models. However, there is no assurance that a meaningful quality monitoring system will be in place before people are placed in the potentially harmful payment model the committee is designed to prevent. They are continuing their individual, private meetings with insurers and others to test the model.