How the State Innovation Model (SIM) Planning Grant Will Advance Health Equity

This article was written by Jenn Whinnem, communications officer for the Connecticut Health Foundation.

“When it comes to the health of Connecticut residents, you can’t look at aggregate data.”

The state of Connecticut is known for its good health: in 2012, United Health Foundation’s America’s Health Rankings rated Connecticut sixth across the nation for overall health. When Connecticut sought to apply for a State Innovation Model (SIM) planning grant from the federal government, consultants assisting the state advised them that they would have a tough case to make. Connecticut is healthy; what would they need the money for?

It’s when you break down the data that you get a very different picture of health in Connecticut. For example, the mortality rate of non-Hispanic black infants is three times that of non-Hispanic white infants. Latinos have 2.3 times the rate of diabetes and 3.1 times the rate of lower extremity amputations compared with white residents[1]. Data like this, which highlights the health disparities that continue to exist across racial and ethnic groups, is lost when looking at health outcomes more broadly.

Data like this has also influenced the Connecticut Health Foundation (CT Health)’s decision to shift our strategic direction to focus on expanding health equity by helping people of color gain more access to better care. We see three steps in getting us there:

  1. Help people get enrolled and stay enrolled in an affordable health insurance plan.
  2. Once enrolled, show them how to navigate the health care system to get the kind of care they need, when they need it. This includes bringing care to where they are – including community health centers, hospital clinics and school-based health centers.
  3. Finally, make sure that their providers are offering the kind of care we all want to receive – care that is affordable, comprehensive (including mental, oral and physical health), and accountable to the goal of improving our health.

Number three can only be made possible through health system transformation. When the state of Connecticut had the opportunity to apply for a grant to facilitate transformation, it seized the chance and was awarded a $2.8 million SIM Design Grant from the federal Centers for Medicare and Medicaid Services (CMS). Patricia Baker, president & CEO of CT Health, was invited to participate in the steering committee, creating an opportunity to advocate for health equity.

Connecticut’s vision for care transformation is to establish a whole-person-centered health care system that improves affordability, promotes value over volume, and eliminates health inequities for all of Connecticut.  This system will provide, for example:

The Steering Committee, known as the SHIP (State Health Care Innovation Planning) Team, has also agreed that addressing health inequities will be a critical component of the vision for care delivery.

Based on communication with advocates, consumers, and other stakeholders, Connecticut created four work groups to examine what needed doing in these areas:

The Care Delivery Work Group consists of consumers, clinicians, hospitals, employers, and payers. Based on self-reported challenges that patients have faced, the group has recommended that Medicaid, Medicare, and private carriers promote a medical home model[2].

Health equity opportunity: The medical home model of care puts patients, not doctors, at the center of care. Since the priority is to meet patients where they are, the model takes into account all of the different factors in a patient’s life that have an impact on his/her health, such as their culture, socioeconomic status, language barriers, and community support network.[3]

The goal of The Payment Model Work Group is to recommend a payment model that shifts payment away from fee-for-service care to one that rewards providers for achieving high-quality, high-value outcomes for their patients. Care must be taken to ensure that payment models adjust for the needs of populations who harbor disparities.

Health equity opportunity: Fee-for-service care rewards providers for the volume of care they provide. Shifting the focus to reward providers for whether or not their patient got well will help determine which services are most effective, strongly discourage medical errors, and lack of care coordination.

The HIT Work Group has been tasked with designing a harmonized system of technological tools that connect and enable providers, consumers, and physicians. Improved technological solutions will improve communication between patients and providers, and improve care coordination between doctors in different practices.

Health Equity Opportunity: Technology can enable a much more consumer-friendly health care experience. Improvement in and accountability for addressing racial and ethnic health disparities is one of the most important outcomes built into HIT.

Comprehensive information about these task forces’ activities can be found on the Office of Health Reform & Innovation’s website.

The SIM Grant Work Groups are in the process of finalizing their recommendations. The next step is for the SHIP is put together their innovative design proposal. While 16 states were selected for planning grants, only six states will get grants to implement their proposed models. CT Health believes implementing these recommendations would expand health equity exponentially.

[1] Connecticut Department of Public Health, the Connecticut Health Disparities Project. “2009 Connecticut Health Disparities Report.” September 17, 2013.

[2] Bau, Ignatius. “What’s in an (awkward) name: Why “medical homes” would improve health care in Connecticut,” Shaking the Foundation – Blog. September 17, 2013.

[3] Bau, Ignatuis. “Advancing Health Equity Through Medical Homes,” Connecticut Health Foundation, September 17, 2013.