Most of today’s Cabinet meeting was spent on SIM’s decision to create a CT-specific medical home standard rather than using well-vetted, evidence based national standards. (May 29th we are hosting a webinar with NCQA to learn more about the NCQA system that has certified 1,009 PCMH providers in CT already. Register here.) Questions were raised about paying for value/quality and how that fit with lowering standards to reach “late adopter” practices. SIM intends to place an emphasis on incentives for practices to engage in a process of transformation rather than reach a set of standards. Concerns were raised about eroding consumer protections and not ensuring value for rising health spending. Concerns were also raised about wasting grant dollars to re-create national standards that are associated with better health outcomes. Other states add state-specific requirements on top of national PCMH standards, such as CLAS standards for culturally appropriate care. Emphasizing outcomes over process could raise incentives for adverse selection, avoiding exactly the patients who stand to benefit most from coordinated care.