Today a letter was sent to state SIM planners from 24 CT consumer advocates representing 21 organizations proposing an alternative to the state’s proposed SIM plan. The SIM project, funded with a $3m federal grant, is developing payment and care delivery models for at least 80% of state residents – 3 million people or more and $30 billion in CT health spending. Advocates are concerned that the decision-making groups lacked consumer input, and that the process was largely conducted out of public view over a short few months in the summer. The plan includes a controversial plan to shift financial risk onto providers. The state now intends to apply for up to $60m in federal funding to implement the model. In the letter, advocates affirmed our support for the concept – to improve quality and access to care, while controlling costs. But advocates also urged policymakers to build a meaningful, feasible quality monitoring system for CT, in an inclusive process engaging all stakeholders, including consumers and advocates. It is critical that this quality system be working and in place, beforeany provider risk incentives attach. Advocates are optimistic that this alternative will serve the goals of the SIM project but will also protect consumers from savings generated by withholding appropriate care as opposed to the intended reductions in unnecessary care and duplication of services.