Thursday, October 31, 2013
Maryland’s SIM proposal emphasizes quality improvement, community resources and engagement
Maryland’s newly released SIM proposal includes many attractive features CT advocates have been championing for our state. Quality improvement and sophisticated analytical tools to support quality are MD’s priority and constitute most of their proposal’s content. The foundation of their plan is to “integrate patient-centered care with community-based resources while enhancing the capacity of local health entities to monitor and improve the health of individuals and their communities as a whole.” Payment reform is less important than improving quality and resulting cost control. The proposal emphasizes local quality improvement collaboratives, including many consumers and independent consumer advocates, data analytics to identify high utilizers by geography, health condition and other metrics to effectively target resources and evaluate for effective solutions. The community utilities they will build to support providers and consumers in health improvement and self-care are impressive. In contrast to CT’s simple, incentive-based model, MD’s payment model includes provider practice performance bonuses and imposes no provider incentives to deny care. Only the community resource utilities are capitated. MD intends to begin with Medicare and Medicaid, which make up 24% of covered lives in their state, and work toward engaging private insurers in the future. This is in contrast to CT’s process that has been driven by private payers. MD does not intend to include any downside risk in the near future and are very careful and conservative in discussions of transferring any financial risk to providers. Unlike CT, consumers and advocates have been involved at SIM decision-making tables in MD.