SIM update – moving in a better direction

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Yesterday’s SIM meeting showed some positive movement toward a system that respects and protects consumers. Recognizing the potential harm to consumers, SIM leaders now intend to monitor for under-treatment and inappropriate treatment, and the payment model no longer includes capitation, both serious concerns raised by advocates. However advocates remain troubled that there is no commitment to withhold savings payments from providers who, through monitoring and a fair resolution process, are found to have reduced appropriate care. The current plan does commit to withhold incentive payments from providers who do not score well in either patient experience of care or in reducing health disparities. Advocates also remain concerned about the possibility of downside financial risk for providers – recouping funds from providers whose patients’ care costs exceed expectations. The steering committee, which includes no consumers or advocates, debated whether to include “patient-centered” in the term for their proposed new CT-specific medical home standards developed by a working group of providers. SIM leaders expect to release a draft plan next week for public comment and to meet with stakeholder groups in November for feedback.