Sunday, August 16, 2015

SIM update, equity planning questions

At Thursday’s SIM steering committee meeting in public comments, SB Chaterjee raised concerns about DPH’s planning to address health equity. Important planning meetings occur in closed meetings, without public notice or minutes. (Sound familiar?) Questions were also raised about how federal funds have been spent and the required conflict of interest policy is not available. (Also familiar). But in contrast to SIM, DPH’s representative had the right answer. He thanked SB for raising the issues, DPH is taking the concerns seriously, are looking into answers for his questions, and will work to make all meetings public. (That’s how advocacy is supposed to work.)

Consultants gave a presentation on the SIM Practice Transformation Task Force’s (PTTF) plans for a Community and Clinical Integration Program. CCIP is meant as a resource of services in the community, clinical and non-clinical, to supplement PCMHs. It was reported that it will focus on Medicaid’s reforms and will be a requirement in DSS’s RFP for networks to receive shared savings. The consultants reported that the PTTF has made important decisions about the target populations, core elements of the program, and program design. They are now finalizing standards for the program. Target populations that Medicaid networks can choose among for care management include complex patients, people experiencing equity gaps, and people with behavioral health needs. They plan to develop an algorithm to identify target patients. There was a great deal of discussion about consulting with other SIM committees and aligning with SIM’s goals. Connecting with Medicaid, or its existing, very successful Intensive Care Management program and existing risk profile data work was not mentioned. PTTF leadership sitting in at the table made it clear that decisions are still being made and nothing is set in stone.

There was a presentation on CAB’s communications plan to explain SIM to consumers and get feedback. There were several recommendations from steering committee members to include both the risks and benefits of shared savings, especially risks of underservice. One member felt it was too early to be talking with consumers about reforms, it would be too confusing for them and the minutes of SIM meetings are available online, but other members disagreed. CAB’s representative agreed to bring the comments back to the committee.

Evaluators for SIM proposed creation of a Rapid Response Team, with membership similar to the Steering Committee, to monitor progress toward SIM’s goals, such as moving half the state’s population into shared savings by 2017 and 88% by 2020. If the state doesn’t reach SIM’s goals, the team would enact policy changes to move faster. It was suggested that it would function like a SWAT team. There was no discussion of who would appoint members to this very powerful, new committee or if their work would be public. (See above) However, the Steering Committee didn’t see the need for a new committee that would replicate their functions.