SIM primary care capitation proposal gets another tepid reception

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This week, SIM presented to the Healthcare Cabinet their proposal to capitate primary care, initially for Medicare members, but eventually for all state residents. The proposal is to move primary care to capitated “bundles” – one for basic primary care services and a voluntary, supplemental payment for expanded activities such as infrastructure and HIT and services to address social needs. It is important to dispel confusion by SIM’s use of terms; these “bundles” are not the usual use of the term in health policy, which refers only to an episode of care, and is far less controversial. Connecticut rejected capitation in our Medicaid program seven years ago. Since then, costs are down substantially while enrollment, quality, and access to care are up. Concerns about the capitation proposal were raised by diverse stakeholders at the Cabinet. Despite SIM’s broad statements to the contrary, there has been a lack of consumer engagement in developing the proposal. Most recently dozens of consumer and disability advocates have registered concerns with the proposal but have been ignored. Additional concerns included that the proposal is too prescriptive leaving little flexibility for ACOs, that the onerous requirements will increase consolidation in Connecticut’s healthcare market and raise costs, it would limit consumer choices for care and resources to only contractors and staff hired by large ACOs, consumers would have to access care at their primary care site whether or not that is the best option for them, it relies on process rather than outcome accountability, and the promised “savings” are estimates based on modeling and assumptions from SIM’s consultants. The beneficial features associated with the proposal could be accomplished now without shifting to capitation and putting consumers and taxpayers at risk.

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