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Yesterday’s meeting with advocates called by SIM staff included some good news but more challenges focusing on process over content. Advocates were encouraged that the SIM planners are now interested in getting input from both “real” consumers, especially from under-served populations, and from professional, independent advocates who follow complex policy proposals on behalf of Connecticut consumers. The state’s SIM plan, now finalized, has been criticized for missing the input of critical stakeholders including consumers, and for overstating the minimal input they’ve gotten from independent consumers and advocates. They are now seeking our input on how to implement the plan they have created.

While it is encouraging that the SIM planners are now seeking consumer and advocate input for new committees, there are many challenges.  Advocates pointed out that we have key unanswered questions about the plan, this administration’s intentions, and how it could affect people if implemented. Many advocates have not yet decided whether to support or oppose the state’s application for a federal grant to implement the final SIM plan and the answers to those questions are key. Advocates also await their commitment to, and degree of, genuine consumer involvement in decision-making going forward.
Advocates expressed concerns about SIM planner’s over-attentiveness to the interests of insurers – arguing that consumers should be SIM’s key constituency as both the ultimate payers and ultimate consumers of health care. Advocates made it clear that just listening to advocates is not sufficient – it is critical that they be in decision-making roles and that their input from a variety of means is incorporated into policy. Advocates repeatedly objected to SIM staff plans to have only a few consumers or advocates on each committee, placing them in a minority position. Advocates repeatedly urged SIM to focus less on getting a few “perfect” consumer representatives for their committees, as consumers are not organized into trade associations like other stakeholders, but to open the decision-making process to include and incorporate public input. Advocates gave SIM numerous examples of successful and respectful past policy decision-making models. Advocates urged SIM to ensure that consumers and advocates make up a majority of members of all committees, as in many of those successful models. Advocates also expressed concern that membership would be at the sole discretion of the administration, unlike successful models like the Medicaid Oversight Council whose membership is set in statute. SIM staff resisted that recommendation concerned about sustaining that effort and making enough space for other stakeholders, specifically insurers.

Points I wasn’t given the opportunity to make during the meeting include a concern that these committees, even if they include consumer voices, will still be three levels below where decisions are made on the SIM organizational chart. There is a history in CT of overruling consumer committee input at higher level boards. It is also critical that in any online communications about public input, that consumers be allowed to check whether their input was included or not. Too often policymakers incorrectly believe they have faithfully included consumers’ input but have missed critical points. It is also critical that meetings, especially those with insurers about payment models, be public and transparent rather than private. It is important to note that no advocate asked to be included in secret meetings, we have repeatedly asked that there not be secret meetings. Nothing was decided at the meeting; we await answers to our questions about the plan’s impact on the Medicaid program, CT’s public health system, and promising medical home programs as well as responses to advocates’ strong recommendations for consumer/advocate majority representation on all committees and for transparency and meaningful public input in decision making beyond the committee structure. We look forward to a constructive process that works to foster successful, responsible reforms of CT’s health care system.