Troubling Cabinet vote for downside risk on Medicaid and state employees, but there will be a public hearing

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In a 13 to 4 vote Tuesday, the Health Care Cabinet voted to impose the controversial downside risk payment model on CT’s Medicaid and state employee plans. DSS, OPM, DPH and the only consumer advocate at the meeting all voted against the option (votes are listed below). Deep concerns have been raised about downside risk including underservice incentives to deny necessary treatments, incentives to avoid costly patients, and disincentives to even tell people about treatments that may be costly. The Cabinet’s proposal includes no mention of even monitoring for underservice. Other downside risk concerns include a broken promise, disincentives to invest in quality, it is very new and experimental, it is based on extrapolating economic theory from very different subjects, and providers are widely rejecting it in other states. In many ways downside risk is worse than capitation, which “failed spectacularly” in CT.
Other troubling options endorsed by the Cabinet include creation of a costly Office of Health Strategy, giving the Attorney General subpoena power to monitor health market trends, to study applying for a costly Medicaid 1115 waiver with a risky DSRIP option to implement downside risk, and to create a new comparative effectiveness committee to make recommendations about which treatments should be approved in CT. In good news, the Cabinet did endorse creation of community health teams to connect medical care with public health and social services. The concept is modeled on Vermont’s successful Blueprint for Health program.
A troubling plan to create a state agency-only Health Planning Council was scrapped when concerns about open meeting/Freedom of Information laws reached social media during the meeting.
The Cabinet will take public comment on their plan at a public hearing on Nov. 15th at 9 am in the LOB. Advocates are invited to hear more in a webinar November 9th at 2 pm about the plan, better alternatives to downside risk, and the many many issues that are missing from the Cabinet’s plans. Click hereto register for the webinar.

Cabinet members’ organizations and votes on downside risk are listed below. For links to the vote tally click here and the voting guide click here. * indicates funders of the Cabinet consultants who developed the plan. The votes are provisional; they may be changed after the public hearing Nov. 15th.
Voted against downside risk
Office of Policy and Management
Dept. of Social Services
Dept. of Public Health
CT Health Policy Project
Voted for downside risk
Office of State Comptroller
Acting State Healthcare Advocate
CT Pharmacists Association
Bristol Hospital
TR Paul, Inc.
CT Coalition of Taft-Hartley Health Funds
Universal Healthcare Fndn of CT*
CT Health Fndn*
Bill Handleman, MD
Gary Letts, MD
Hussam Saada