Health Care Cabinet meeting — SIM, exchange updates

By Ellen Andrews | April 9, 2014 |

Yesterday’s Cabinet meeting was lively — not sure it was productive. The insurance exchange reported on a flurry of last minute activity that significantly boosted enrollment. Final numbers will be available in a few weeks when it becomes clear how many people follow through and pay premiums, and the backlog of people in the queue are able to complete the process. The exchange is looking ahead to the next enrollment period starting in November. Unfortunately they do not expect to keep on the vast majority of navigators and assisters who did such a great job with Medicaid enrollment. It is important to note that the March 31^st deadline for exchange enrollment had no impact on Medicaid – people eligible for that program can and should still sign up. The exchange plans to work on better reporting capability, consumer engagement, and connect with state agencies and brokers. Unfortunately there are no meaningful plans to address the very expensive premiums.

SIM staff asked for comment on their most recent policy papers, especially about financing new services. Concerns were raised that there be no disincentives to providing innovative new services likely to improve health and save money including care coordination and medication management. SIM was urged to finance these promising new services in the same way as promising traditional treatments. Providers are not asked to pay up front for new drugs that keep people out of the hospital, nor are the costs of those drugs subtracted from their shared savings payments. The SIM new services are also expected to improve value and should not be treated differently than other care. The SIM steering committee is creating a finance subcommittee to discuss these issues and more. The group agreed to hear reports on Medicaid’s health neighborhood pilot development at future meetings.

Note: Independent consumer advocates also submitted comments to SIM opposing any state of mind test to enforcement of under service standards.

Posted in conflict of interest, CT Health Reform, insurance, SIM