Friday, February 6, 2015

SIM update – PCMH standards undermined, weak ethics adopted, but underservice group is moving forward

Again, SIM takes one step forward but two steps back. At yesterday’s steering committee meeting, SIM adopted an ineffective, weak conflict of interest policy, without a vote or any discussion. The policy would allow members to bid on significant SIM contracts that they had a substantial role in defining, potentially advantaging their company, provider or community organization over competitors.  This is in contrast to the CT Public Officials Code of Ethics. The SIM consumer advisory board has already stipulated that they are Public Officials to defend a pending complaint under Freedom of Information concerning non-public meetings. A proposal making clear that SIM committee members making substantive decisions about funding and health system standards are prohibited from benefitting from their committee activities is stalled in that consumer committee.

In another disappointing development, SIM staff announced at the meeting that they will not be adopting patient-centered medical home (PCMH) standards recommended by the SIM Practice Transformation Taskforce. Lesley Bennett and Dr. Edmund Kim presented to the steering committee on months of work by the taskforce researching and carefully negotiating reasonable recommendations, building on successful national standards, that are achievable for CT practices but demonstrate meaningful quality for consumers. Ms. Bennett and Dr. Kim described lengthy, collaborative discussions to work out a consensus proposal, including cultural competence standards of care. SIM staff cited the difficulty that some providers have encountered reaching national PCMH standards and doubts from some providers about quality improvements. However the number of nationally recognized PCMHs in CT continues to grow every month and there is an abundance of evidence on the effectiveness of nationally recognized PCMHs including the stability of those improvements between certifications.

In good news, the SIM Equity & Access Committee continued to work through shared savings policy options and make recommendations to monitor and prevent inappropriate underservice and adverse selection. Hopefully our hard work will be adopted by SIM leadership when we are finished.