Cabinet meeting update: SIM project described, exchange plans offering low rates to doctors, Charter Oak redux?

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Yesterday’s Cabinet meeting focused on the state’s $2.8 million State Innovation Model (SIM) grant. The plan is to develop a grant proposal by the fall to create a multi-payer approach to design care delivery and payment reforms that touch 80% of CT residents. The project will test innovative models to lower costs and maintain or improve quality. (We have 31 ways to start that.) McKinsey consultants and others have been hired to guide the project which will be headed by a planning committee with three workgroups focused on developing coordinated state models for care delivery, payment, and HIT. The Health Care Cabinet will offer stakeholder input. We are promised all materials and meetings will be completely public and transparent. In a separate discussion concerns about the CT Health Insurance Exchange were raised. It was reported that physicians are being offered Exchange contracts from insurers with payment rates significantly below commercial rates. Exchange staff reported that they do not regulate or monitor provider payment rates but require the plans to comply with network adequacy standards. It was noted that there are many ways that providers can be listed on a panel but not accept appointments. In fact, this is exactly what happened in the capitated HUSKY program and was only uncovered with a secret shopper survey. The exchange has rejected conducting such a survey to monitor real access to care. Concerns were raised that low provider rates combined with high costs, that will leave many young, healthy state residents out of the exchange, will lead to the same dynamic that now plagues the Charter Oak Program — skyrocketing premiums and plummeting enrollment levels.