Health Care Alert

Health Care Alert

Have you heard of SIM (State Innovation Model)? SIM is CT’s plan to transform our health care system by changing how care is delivered and how care is paid for.

What is SIM? The proposed payment model is called Total Cost of Care (TCC). It gives providers financial control over each patient’s care, in that primary care providers will get paid more if they reduce the total cost of care of their own patients, in order to encourage that result. The specific payment methods for doing this set forth in the plan include:

Shared Savings: Providers who save money on their patients care will share in the savings.
Downside risk: Providers lose money if their patients end up costing more than what is expected or estimated.

Will this impact me? Yes, SIM is meant to reform healthcare for every state resident whether you are on Medicare, Medicaid, state insurance exchange coverage, private employer insurance, public employees, etc… EVERYONE.

Why haven’t I heard of it before? The plan was developed by a SIM steering committee and three workgroups, but there were no independent consumer advocates on these groups. Meetings were held with little or no notice to the public.

Can I give input now? A SIM draft has been compiled and is posted on the Office of the Healthcare Advocate website or The CT Health Reform & Innovation site.

You can provide input about the SIM draft in writing by emailing: sim@ct.gov.
You can also contact the Lieutenant Governor Nancy Wyman by phone and share any concerns. (860) 524-7384 or (866) 712-6998

Feedback on the draft must be provided by November 26, 2013.

What needs to happen moving forward? To ‘do no harm,’ the Caring Families Coalition (CFC) recommends that the plan be amended to clearly include each of these elements:

  • Providers found to have denied or restricted access to necessary care need to be prohibited from receiving shared savings or other financial rewards
  • The system to measure and sanction under-treatment needs to be in place before any provider incentives are implemented
  • Quality measures of under-treatment, including inappropriate denials or limitations on care or avoidance of expensive patients, needs to be developed by an inclusive committee with significant independent consumer advocacy membership
  • Independent consumer advocates need to be immediately added in meaningful numbers, before the plan is finalized, to all SIM committees.
  • All decisions about the SIM plan need to be reached in a transparent way, using a public process based on significant public input
  • As in the first SIM plan draft, downside risk payment models need to be excluded in the Medicaid program.

Act Now! The end of November is approaching quickly. Make your voice heard by sharing your feedback with calls or emails. If you have questions please call Alta at 860-524-0502. Thank you.

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