conflict of interest
New SIM under service survey — please help protect consumers
The SIM Equity and Access Committee is working to develop a monitoring system for inappropriate underservice as CT’s health system moves toward shared savings payment models. Underservice can be denial of appropriate care, limiting expensive treatment options, limiting access to certain providers, avoidance of consumers that may not generate savings, or cost shifting to consumers.…
Read MoreSIM moving ahead with risky Medicaid plan despite 25 advocates’ objections
At yesterday’s meeting, the SIM steering committee chose to move ahead with plans to radically change the Medicaid program – to include shared savings and an 1115 waiver. The new plan, rushed out in only a few weeks, reverses earlier assurances to advocates that the state would go slowly into shared savings payment incentives, recognizing…
Read MoreMedicaid Council voices concerns about new SIM proposal
In a special meeting yesterday, the majority of Medicaid Council members voiced concerns about the rushed, new SIM proposal for Medicaid. Legislators compared the new proposal to the failed HUSKY HMO proposal 20 years ago and made it clear that they are concerned about “going back down that road”. Concerns included the application’s aggressive pace of…
Read MoreQuestions for SIM about radical new Medicaid proposal
Questions sent yesterday for today’s meeting about SIM’s risky, new Medicaid proposal have been posted. One asks why a dangerous 1115 waiver is necessary? Did SIM planners explore other, less dangerous options? 1115 waivers necessarily include a cap on federal reimbursement (to meet the federal budget neutrality requirement) endangering the state budget and potential future…
Read MoreSpecial Medicaid Council meeting on new SIM Medicaid plan
The very new SIM plan for Medicaid will be the subject of a special MAPOC meeting tomorrow July 8th at 9:30 in Room 2C of the LOB. Concerns have been raised about both the content and the process for this radical departure from the original SIM plan for CT’s largest health plan. We expect more…
Read MoreCT News Junkie Op-Ed: SIM shouldn’t just chase a federal grant
A new Op-Ed in CT News Junkie outlines consumer advocate concerns that SIM planners are putting their pursuit of a federal grant ahead of what’s best for CT. Contrary to the original plan, SIM leaders are now planning to move Medicaid back to an incentive scheme similar to the failed HUSKY HMOs. Since we moved…
Read MoreSIM update: PCMH standards affirmed but rushing into a radical Medicaid payment change
The good news: At yesterday’s meeting the SIM steering committee voted to accept their workgroup’s recommendation to use NCQA national standards, with some CT-specific additions, as the patient-centered medical home (PCMH) standard for the SIM glide path program. SIM will work with NCQA to develop the additional standards, possibly to include oral and behavioral health…
Read MoreGood news on SIM and PCMH national standards
The new SIM Practice Transformation Workgroup met last night for the first time and support for patient-centered medical home national standards was strong. Advocates have been strong supporters of national standards for PCMHs over a CT-specific program. There is growing evidence that PCMHs that meet national standards perform better on quality, enhance access to care…
Read MoreSIM committee to discuss PCMH national home standards
The first meeting of the SIM Practice Management Taskforce will re-visit SIM’s earlier decision to reject national standards for patient-centered medical homes. National standards, such as NCQA, have been very successful nationally and in CT in improving health outcomes while controlling costs. Advocates have serious concerns about eroding standards that promote quality care and ensure…
Read MoreSIM update – good news but new concerns
Last week’s SIM steering committee included some good news but new concerns. Based on public comment from independent advocatessupporting national standards for patient-centered medical homes and urging SIM to reconsider their decision to create a CT-specific standard, wasting time and resources to fix something that is not broken and working well. In response, the committee…
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