SIM update – more consumer concerns

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Yesterday’s SIM steering committee was not encouraging for those hoping to see real consumer involvement. The long-awaited workgroups will only have 25% (plus or minus) consumer and advocate representatives. In addition, they expect anyone appointed to be a supporter of the final SIM plan, and to agree to “champion” the recommendations of the workgroup, even before the recommendations are developed. (Upon questioning, they agreed to wordsmith the word “champion”, but the expectations didn’t change.) It was noted that independent advocates would have a difficult time making such an open-ended commitment.

Following the medical model, qualifications for consumer representatives are people who have ”experienced health conditions such as , diverse and balanced mix of participants, considering life experience, individual circumstances, source of coverage, race/ethnicity, and health conditions“ “With respect to consumers and advocates, it is recommended that we express a preference for individuals with expertise related to the care of health conditions.” For all other stakeholder groups, “state agencies, private payers, and providers, we should in general express a preference for individuals with subject matter expertise.” In response to concerns that consumers will need support to participate meaningfully in complex policy discussions, SIM will provide “coaching” to consumer members.

Concerns were also raised about disproportionate representation by providers, constituting a majority on the Practice Transformation committee that will develop the standards providers must meet to qualify for financial incentives. The SIM steering committee also added three more provider members.