Wednesday, May 6, 2015

CT conference on SIM payment reforms in other states

Yesterday the CT Health Foundation hosted an interesting conference highlighting SIM plans from leading states – VT, OR, MN, and ME. The conference started and ended with reports from CT’s DSS about our significant Medicaid successes in improving quality and access while controlling costs – and how that progress was only possible when we shifted from a financial risk, fully-insured model to one that focuses on care coordination and quality.

So it was unfortunate that the underlying assumption of the conference, stated often, was that the only way to move toward value-based purchasing is “moving up” the ladder of financial risk toward full capitation (at least they put those more risky models in orange on the slide). This is despite the opposite evidence from our own state. Nothing is simple and even economists are coming around to understand that theoretical incentives and financial risk are not the only drivers of health care spending or quality – not even close. In fact, CT’s Medicaid experience shows they can get in the way.

We heard a lot about other states’ payment reforms and impressive work to tie payments to quality. These states, and their SIM planners, deserve the credit and recognition for their accomplishments.  They have been at this a long time and have engaged all stakeholders in transparent, thoughtful planning processes. One best practice that resonated with the audience is that you should never underestimate the number of conversations needed and the need for clear communications and expectations. They all emphasized that reform won’t happen if everyone isn’t on board. Lisa Letourneau from Maine acknowledged that shared savings along isn’t going to really transform care. These states moved into reforms gradually, testing their progress at each step, and revising accordingly. However these states are different from CT in important ways that make a direct translation of their lessons to our state risky. I also know that while it was great to hear from state SIM officials and consultants from those states, we would have gotten a richer description of the challenges and lessons if the voices of consumers, advocates, legislators, and providers from those states had been included. 

The conversation also would have benefitted from a discussion of CT’s collaborative plans to build health neighborhoods for our state’s dual eligible beneficiaries – a model of thoughtful policymaking that includes shared savings but with good consumer protections and strong quality backstops. But overall, there was a lot of good information for CT.