Following the medical model, qualifications for consumer representatives are people who have ”experienced health conditions such as
, diverse and balanced mix of participants, considering
life experience, individual circumstances, source of coverage, race/ethnicity,
and health conditions“ “With respect to consumers and advocates, it is
recommended that we express a preference for individuals with expertise related
to the care of health conditions.” For all other stakeholder groups, “state
agencies, private payers, and providers, we should in general express a
preference for individuals with subject matter expertise.” In response to
concerns that consumers will need support to participate meaningfully in
complex policy discussions, SIM will provide “coaching” to consumer members.
Concerns were also raised about disproportionate representation by providers, constituting a majority on the Practice Transformation committee that will develop the standards providers must meet to qualify for financial incentives. The SIM steering committee also added three more provider members.