The SIM Equity and Access Committee is working to develop a monitoring system for inappropriate underservice as CT’s health system moves toward shared savings payment models. Underservice can be denial of appropriate care, limiting expensive treatment options, limiting access to certain providers, avoidance of consumers that may not generate savings, or cost shifting to consumers. Limits may be complete denial of treatment, offering only some treatment options, or limiting the scope/duration/frequency of treatment. While inappropriate underservice occurs now, especially in the Medicaid program, it is possible that shared savings incentives will encourage the problem. To protect consumers, the SIM plan includes a principle denying shared savings payments that were generated by systemic, inappropriate underservice.