Across
various meetings this month we’ve received a few updates on CT’s SIM planning.
CT is competing with 17 other states for 12 test grants. SIM staff has
acknowledged receipt of the independent
advocates’ letter to CMMI and an FOI regarding Consumer Advisory Board
voting and SIM budget development, but we’ve had no response to either. They
are still fully committed to the controversial rushed timeframe for the
Medicaid shift to shared savings.
SIM
also committed to using Medicare quality measures for everyone in the state, which
admittedly does not fit the needs of Medicaid and other populations and many
are self-reported, simply to improve the states’ prospects of winning the grant
to hire more
state employees and consultants. There may be opportunities to add to the
Medicare measures to ensure quality of care for other populations but it is unclear
what group will have a possible opportunity to do that for over 800,000
Medicaid members.
There
is also a huge effort to “align” quality standards across all payers. This is
unfortunate for several reasons. Variation often leads to better learning and
reduces gaps in measurement. Metrics need to make sense for each population and
alignment risks including useless measures, wasting time and effort, and
missing critical information – both on what is working well (serving as clues
to innovation) and what needs improvement. There is ample evidence that people
shift their efforts when they know their performance standards ahead of time,
focusing effort on the areas on which they will be evaluated, at the expense of
other areas. In the new world of bigger and better data that is collected
automatically, reducing human error and tendencies, there is no additional burden
on providers and minimal cost in collecting and analyzing more metrics. Quality
improvement efforts may need to be focused to be effective – quality monitoring
shouldn’t be.
The
workforce and HIT workgroups are forming and outside consultants should be in
place to help guide the SIM process soon.
