Connecticut’s SIM plan acknowledges that risks of
inappropriate under-treatment and cherry-picking are higher in new shared
savings payment models.
Advocates
were successful in getting a provision included in the SIM final plan that
prohibits payment of shared savings to provider networks that systematically
deny needed care or cherry pick patients to generate those savings. The task of
implementing that provision fell to SIM’s Equity and Access Council, which has
released its draft
report for public comment, due today. In June the Council issued 28
recommendations to prevent, identify and fix underservice and cherry picking in
new payment arrangements. All but one of those
recommendations were adopted by consensus. The one controversial provision
directs payments denied due to underservice or cherry picking to be invested in
improving quality and access to care, reversing the problem and building value
across the system. That recommendation was opposed only by insurers on the
Council who, in its absence, would keep the inappropriately-derived profits. In
public
comments, a group of fourteen advocates have voiced our support for all
twenty eight of SIM’s Equity and Access Council recommendations, including the
provision to ensure all resources promote value over profit-taking across
Connecticut’s $30 billion in health care spending.
