Thursday, September 10, 2015

Advocates support SIM underservice, cherry picking protections

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.