Connecticut will receive $45 million in federal funds to help it redesign how the state pays for and delivers health care.
The $45 million is part of a $620 million grant from the U.S. Department of Health and Human Services, which was awarded to 11 states under the Affordable Care Act.
This funding will be used to help support the controversial State Innovation Model or SIM, which will change the way healthcare is delivered, tracked, and paid for in Connecticut. The final plan the 17-member board adopts will impact 80 percent of the state’s population, including those on both public and private insurance.
“This funding is great news for Connecticut because it’s an important part of continuing our efforts to increase access to quality healthcare,” Gov. Dannel P. Malloy said Tuesday in a press release. “Connecticut has been at the forefront of implementing affordable, accessible coverage. When it comes down to it, these efforts are really about improving the quality of life for the people of our state.”
The idea behind the reform is to make sure the state is paying for coordinated care. It seeks to move away from a payment system that pays providers by the procedure and toward a more holistic approach.
Connecticut’s plan includes more than $6 million to measure and improve community health and health equity, address increasing rates of obesity and diabetes, and strengthen primary care. The state also plans to implement a Medicaid Quality Improvement Shared Savings Program designed to reward providers that invest in delivering better quality care, more equitable care, and a better care experience for Medicaid beneficiaries.
“This grant will improve coordinated care, shift the focus onto personal healthcare goals, and make the quality and cost of treatment more transparent,” Dr. Tom Raskauskas, a member of the steering committee and CEO and president of St. Vincent Health Partners Inc., said. “Helping patients take charge of their healthcare is key— making it easier to communicate with their doctors and build expert coordinated care teams to ensure they have the tools to set healthcare goals and reach them.”
The “shared savings” program for Medicaid patients is what has advocates concerned.
Advocates worry the new payment method would incentivize providers to deny patients care or access to specialists.
The grant seeks to test the “shared savings” model with 200,000 Medicaid patients in January 2016. But advocates remain skeptical and believe it’s more likely they will be denied care by providers looking to obtain some of the shared savings from not having to provide medical services.
“Access to care for vulnerable Medicaid enrollees, already suffering from serious access issues, particularly with regard to specialists, could worsen because providers will have a direct financial interest in keeping the total cost of care down in order to achieve shared savings and thus could, consciously or not, resist making appropriate referrals,” a group of 25 advocates wrote in a letter to the SIM board in July.
Mark Schaefer, director of Healthcare Innovation, has said he believes there will be enough safeguards in place once the program is finalized.
More information about the grant application is available at http://www.healthreform.ct.gov/ohri/cwp/view.asp?a=2741&q=335460.