Cabinet meeting – exchange and SIM updates

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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.

Other concerns included ensuring that, to avoid past SIM problems, consultants assigned to workgroups should not steer decision-making but should be there to support the workgroups of CT stakeholders. Groups should also solicit a lot of outside input, accessing the wisdom of CT’s health policy community. A list of possible future policy briefs was shared. SIM agreed to accept suggestions for others.

The health insurance exchange update included an emphasis on training and education to retain current members. Plans to improve the SHOP exchange include a focus on adapting products and lowering prices. There was a great deal of discussion of high prices but little tangible action toward lowering them. This year the exchange will not be engaging consultants to review rates or enhance affordability.