In a 13 to 4 vote Tuesday, the Health Care Cabinet voted to
impose the controversial downside
risk payment model on CT’s Medicaid and state employee plans. DSS, OPM, DPH
and the only consumer advocate at the meeting all voted against the option
(votes are listed below). Deep
concerns have been raised about downside risk including underservice
incentives to deny necessary treatments, incentives to avoid costly patients, and
disincentives to even tell people about treatments that may be costly. The
Cabinet’s proposal includes no mention of even monitoring for underservice. Other
downside risk concerns include a broken
promise, disincentives to invest in quality, it is very new and
experimental, it is based on extrapolating economic theory from very different
subjects, and providers are widely rejecting it in other states. In many ways
downside risk is worse than capitation, which “failed spectacularly” in CT.
Other troubling options endorsed by the Cabinet include creation
of a costly Office of Health Strategy, giving the Attorney General subpoena
power to monitor health market trends, to study applying for a costly Medicaid
1115 waiver with a risky DSRIP option to implement downside risk, and to create
a new comparative effectiveness committee to make recommendations about which
treatments should be approved in CT. In good news, the Cabinet did endorse
creation of community health teams to connect medical care with public health
and social services. The concept is modeled on Vermont’s
successful Blueprint for Health program.
A troubling plan to create a state agency-only Health
Planning Council was scrapped when concerns about open meeting/Freedom of
Information laws reached
social media during the meeting.
The Cabinet will take public comment on their plan at a
public hearing on Nov. 15th at 9 am in the LOB. Advocates are
invited to hear more in a webinar November 9th at 2 pm about the
plan, better alternatives to downside risk, and the many many issues that are
missing from the Cabinet’s plans. Click here
to register for the webinar.
Cabinet members’ organizations and votes on downside risk are
listed below. For links to the vote tally click
here and the voting guide click
here. * indicates funders of the Cabinet consultants who developed the plan.
The votes are provisional; they may be changed after the public hearing Nov. 15th.
Voted against
downside risk
|
Office of Policy and Management
|
Dept. of Social Services
|
Dept. of Public Health
|
CT Health Policy Project
|
Voted for downside
risk
|
Office of State Comptroller
|
Acting State Healthcare Advocate
|
AccessHealthCT
|
CT Pharmacists Association
|
Bristol Hospital
|
TR Paul, Inc.
|
CT Coalition of Taft-Hartley Health Funds
|
Universal Healthcare Fndn of CT*
|
CT Health Fndn*
|
Bill Handleman, MD
|
Gary Letts, MD
|
Masonicare
|
Hussam Saada
|
