SIM update – answers, sort of, and further delays in starting work

On Monday, advocates received answers to our questions about the SIM final plan – sort of. We did learn that they are not considering pure capitation as a payment model at this time and that any plans for Medicaid payment changes will go through the Medicaid Council – both good. Unfortunately answers to the other consumer concerns were kicked down the road to the workgroups. We also learned in Tuesday’s Health Care Cabinet meeting that creation of those workgroups will be significantly delayed. That includes the Equity and Access Committee charged, among other things, with developing a monitoring plan for under-treatment. The final SIM plan acknowledges that savings may be generated in some cases by inappropriate under-service and denying people needed care, as happened under managed care in the 1990’s. After lively debate, the plan’s final language does deny shared savings payments that were generated at the expense of necessary care, but not before the incentives are in place, as urged by advocates. The plan sends responsibility for creating that system of underservice monitoring to the Equity Committee, which is delayed indefinitely. SIM has been criticized by advocates and others for a questionable, opaque process of, among other things, choosing members of decision-making committee members, especially the payer-dominated Steering Committee. At a meeting called by SIM staff for suggestions on governance, advocates and consumers voted to make consumers and advocates constitute at least 51% of all workgroup membership and for those members to be chosen by consumers and advocates, as is done in other highly successful CT policymaking forums. The usual convention for other stakeholder groups is to ask their trade association for names for committees (see below). However, the “new” plan for appointing members to the new workgroups is for staff to develop a proposed structure with limited consumer/advocate slots, send it to that same questionable Steering Committee for approval, then seek nominations from advocates, consumers and other stakeholders for those limited spots, then the same SIM leadership will make recommendations for membership, and send them again to the same Steering Committee for approval. Advocates are concerned that this “new” process just puts additional layers on the “old” process, and creates an unnecessary delay in developing consumer protections.

In more SIM news, the participant list for last month’s SIM meeting in DC is online. Four CT hospital reps, the CSMS, and Commissioner Mullen attended along with DSS, OHA and SIM staff.