State Seeks Comments on Healthcare Payment Ideas

The State Innovation Model is a significant effort to improve quality and reduce costs in Connecticut’s healthcare system, in part by changing how it’s paid for.

One example of that effort is that SIM is promoting a shift from medical payments based on volume of services (the traditional “fee for service” system) to payments based on the value of care delivered, a whole-person centered approach.

One of SIM’s workgroups—the Equity & Access Council—has just proposed a number of recommendations in a new report. 

This month the public is being invited to comment on the recommendations. Now is a critical time and opportunity for the voice of the employer community to be heard to make the SIM initiative a success for everyone in Connecticut. (See details below.)

Why This Impacts You

Employers are paying attention to the council’s recommendations because the ultimate goal is to transform the healthcare payment model and hopefully save money.  And the federal government is making a significant push–$45 million—to make SIM’s goals a reality.

Given the impact of healthcare costs on businesses, the support behind the new initiative, and the fact that some kind of plan will move forward, it’s important to make sure employers’ perspectives are heard. 

Another reason to keep an employers’ eye on SIM is that the legislature again approved making fully insured plans help fund SIM through the Insurance Assessment—with an impact of more than $3 million in what’s virtually another tax on employers.  

Recommendations

The report includes many recommendations in more than 70 pages. Here are just two examples:

• Cost: SIM receives funding from outside sources (through Connecticut insurance policies and federal funding) but certain initiatives in the program will require more. For example, much of the program depends on establishing new Accountable Care Organizations –and some say that Connecticut’s employers and insurers should foot the bill to get them up and running.
• Shared Savings: Some items allow ACOs to get “bonus” payments without demonstrating how they’ve achieved actual savings. But this departs from the original intent of “shared savings” in which everyone has to save money in order to get the benefit. In addition, the recommendations allow for certain instances of shared savings payments to go to independent entities–not back to the original payers, such as self-insured employers.

Your Comments</p>

For more information about the council’s recommendations and how to comment on them, contact Jennifer Herz at 860.244.1921 | jennifer.herz@cbia.com | @CBIAjherz