Wednesday, April 29, 2015

SIM responds to advocates’ Medicaid concerns

Monday the Lieutenant Governor responded to a letter sent earlier this month signed by twenty independent consumer advocates and providers raising concerns about SIM’s plans for Medicaid. In her letter, the Lieutenant Governor agreed that CT’s Medicaid program has become a national model of success, improving access to care, raising quality and controlling costs. Those achievements resulted from our transition three years ago from financial risk models to care coordination – through person-centered medical homes and intensive care management. Advocates are concerned that SIM’s rushed return to financial risk models will unravel those achievements. Data systems and policies are not ready to carefully monitor financial incentives in de facto downside risk arrangements, or to identify and correct under-service driven by the new incentives. The advocates’ letter urges the administration to learn the lessons of the spectacular HUSKY MCO failure and consider well-tested, better options that have greater potential to improve quality, coordinate care and further control costs.

In her letter, the Lieutenant Governor understands our concerns and has agreed to delay implementation of the new Medicaid plan by six months. That is a good start; hopefully it will be sufficient to protect people and hard-won progress. In any event, the advocates remain committed to work constructively with the administration toward the common goal of developing a value-based program.