SIM proposal draft – no commitment to deny payment to providers who deny care

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During yesterday’s meeting, SIM leaders posted their first draft online of the administration’s plan to reform health care in CT. SIM is designed to radically transform how health care is delivered and paid for in our state across all payers – Medicare, Medicaid, private insurance, self-insured employers, individuals and small businesses. Despite earlier encouraging conversations, the draft does not include a provision crucial to advocates to deny payments to providers who achieved savings by inappropriately under-treating consumers. Consumer advocates have been very concerned that shifting provider incentives from volume to financial risk could result in inappropriate under-treatment causing harm. In contrast, the draft does commit to limiting payment for poor consumer experience of care and poor performance in addressing health equity. Steering committee members raised concerns about weak health equity provisions, placing Medicaid providers at strong financial risk, inadequate consumer empowerment in system change, and whether goals for cost savings are ambitious enough. One member asked that the next draft list the considerable risks that the plan will fail. There are no independent consumers or advocates on the SIM steering committee, but insurers, state agencies and other payers are well-represented. Steering committee members received the draft well before the meeting, but a public version was not available until half way through the meeting. Steering committee meetings do not include opportunities for public input.