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.
