A Core Principle Supporting Health Equity in the State Innovation Model (SIM)

In November, we sent an email asking you, our readership, to provide public comment to a draft of the State Health Innovation Plan (SHIP) model, which was created by the steering committee. Many of you did. Thank you.

The SHIP team received more than 80 responses. From those responses, they culled seven themes and put together responses for how they plan to address them, and updated them as of this week.

Embedding health equity into the process of the SHIP creation has been a top priority for the Connecticut Health Foundation. One prominent example of a health equity issue is in how the draft SHIP addresses quality and cost, especially for underserved consumers.

A shared savings payment model, as opposed to the current fee-for-service payment method, is proposed. In the shared savings payment model, providers theoretically share in savings resulting from higher value care that improves patient outcomes and reduces unnecessary costs – “did the patient actually get better?” – rather than the volume of services – CT scans, office visits, lab work – the patient received. From the document summarizing public comment themes:

A number of respondents raised concerns that shared savings payment methods will incentivize providers to withhold necessary care.  They asked what safeguards SIM will put into place to prevent this from happening.  Some proposed the development of methods for monitoring under-service and an explicit principle that practitioners will be disqualified from receiving shared savings if they demonstrate under-service.

At their December 17 meeting, SIM leaders adopted a core principle that will prohibit shared savings from going to providers who under serve.  In short, while implementation is still to be worked out, this consumer protection principle would prevent providers from making their shared savings on the backs of the patients they serve, which is critical for patient populations that harbor health inequities.

You can listen to today’s Where We Live discussion of Connecticut SIM featuring a range of viewpoints, including those CT Health’s own Pat Baker, here