An update on the SIM project was the main agenda item at yesterday’s Health Care Cabinet meeting. At last month’s meeting, members were asked to collect feedback on SIM proposals for payment and delivery reform to cover 80% of CT residents. The SIM committee is planning to set payment and delivery models for the state by Sept. 1st and apply to the federal government for a $40 to 60 million grant to the state to implement the models they are deciding on now. The proposal centers on provider risk-sharing, including total cost of care models (capitation) which elicited grave concerns among advocates. Capitation has a very troubled history in CT. When capitation in the HUSKY program was eliminated, savings were significant, provider recruitment, utilization, access to care and care coordination improved and patient-centered medical homes were launched. CT is also behind other states in being able to measure quality or access to care – if the payment reform is harmful to people as advocates fear, we won’t know it and we won’t be able to do much about it. The SIM committees include no consumer advocates among the 75 members but state agencies, insurance industry and provider groups are very well-represented. Concerns were also related from advocates who are troubled that a very small group of people, no matter how well-intentioned, are making very large decisions for our state very quickly, largely out of public view. This is in contrast to the very successful health neighborhood project by DSS for people eligible for both Medicare and Medicaid that was developed in an open, deliberative process and resulted in overcoming all stakeholder reservations to earn universal support. Advocates asked that the process be opened and that we take more time to be sure we build a reform plan that engages the wisdom among all stakeholders, especially consumers, and has every chance to be successful. Advocates will be sharing their concerns formally in a letter to the SIM leaders.