SIM update

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Across various meetings this month we’ve received a few updates on CT’s SIM planning. CT is competing with 17 other states for 12 test grants. SIM staff has acknowledged receipt of the independent advocates’ letter to CMMI and an FOI regarding Consumer Advisory Board voting and SIM budget development, but we’ve had no response to either. They are still fully committed to the controversial rushed timeframe for the Medicaid shift to shared savings.
SIM also committed to using Medicare quality measures for everyone in the state, which admittedly does not fit the needs of Medicaid and other populations and many are self-reported, simply to improve the states’ prospects of winning the grant to hire more state employees and consultants. There may be opportunities to add to the Medicare measures to ensure quality of care for other populations but it is unclear what group will have a possible opportunity to do that for over 800,000 Medicaid members.
There is also a huge effort to “align” quality standards across all payers. This is unfortunate for several reasons. Variation often leads to better learning and reduces gaps in measurement. Metrics need to make sense for each population and alignment risks including useless measures, wasting time and effort, and missing critical information – both on what is working well (serving as clues to innovation) and what needs improvement. There is ample evidence that people shift their efforts when they know their performance standards ahead of time, focusing effort on the areas on which they will be evaluated, at the expense of other areas. In the new world of bigger and better data that is collected automatically, reducing human error and tendencies, there is no additional burden on providers and minimal cost in collecting and analyzing more metrics. Quality improvement efforts may need to be focused to be effective – quality monitoring shouldn’t be.

The workforce and HIT workgroups are forming and outside consultants should be in place to help guide the SIM process soon.