
Albert Einstein believed the definition of insanity is doing the same thing over and over but expecting a different result. Unfortunately, Connecticut policymakers haven’t learned this lesson.
Provider financial risk is a bad idea that has failed both in our state and nationally. Despite this, our ironically-named State Innovation Model (SIM) office is trying again to force it on Connecticut’s struggling health system. Their new twist on the bad idea, to impose it on primary preventive care, is even more dangerous.
Provider risk is a very simplistic idea meant to solve the very complex problem of rising healthcare costs. Provider risk models give large health systems incentives to lower the costs of care their patients receive. Health systems could save by preventing problems and keeping us out of more expensive care, or they could deny people necessary care, as happened in the 1990s with managed care insurers. Since we abandoned that bad model six years ago, our state’s Medicaid program has saved hundreds of millions of dollars every year, the best cost-control record in the nation, while substantially improving quality and access to care.
Poorly designed incentive schemes are notorious for backfiring. Chasing profits lost to Japanese imports in the 1970s, Ford executives ignored warnings about the Pinto, pressing ahead with a dangerous gas tank design, and people died. Enron’s ambitious revenue goals, and their auditors paid to look the other way, precipitated the largest bankruptcy in American history in 2001. But not all humans are motivated by money.
In one study, paying women to donate blood actually decreased participation from 53 percent to 30 percent. The drop was reversed if they could donate the money to charity. Highly trained doctors don’t go to medical school to get rich or deny patients needed care; they want to heal people.
Shared savings, the current version of this bad idea, doesn’t even lower costs. Large health systems under shared savings have actually increased spending, both in CT and across the nation. But rather than learning from these failed experiments, supporters are doubling down to propose increasing the level of coercion on providers. It’s unclear where the escalation will stop as pressure tactics continue to fail.
There is a better way, and we know what works.
There are plenty of evidence-based policy options to improve care and control costs. Great options include eliminating payment disparities between primary and specialty care, paying directly for promising innovations such as Community Health Workers and targeted professional care management for high-risk/high-need patients, promoting the use of high-value care matched to patients’ needs and health problems, using sophisticated analytics to identify gaps and target scarce resources, engaging public health professionals to help us all make better health decisions, medication education and management, and smarter quality incentives, such as avoiding preventable hospitalizations and ER visits, for things that both improve health and lower costs.
If the state would leave out the middlemen at large health systems, taxpayers could get all the savings. Michigan has saved millions by directly supporting common-sense options. Instead, SIM would have us apply financial pressure on health systems and hope for the best.
SIM’s latest iteration of their failed idea is to capitate primary care practices, an even worse idea.
Under this proposal, primary care providers would get a set amount of money for each patient, regardless of whether costs go up or down. Primary care providers are paid less than specialists, face very tight margins, and are in short supply. As the first line of care, primary care is the worst place to impose incentives to deny services. Primary care providers have neither the time nor the extra funds to do this right. Independent advocates and the legislative Co-Chairs of Connecticut’s Medicaid oversight council have raised serious concerns. Tightening the screws on overworked primary care providers is a stunningly bad idea.
Support authentic, locally owned and operated public service journalism!
Let’s stop putting lipstick on a pig by repeating failed experiments. We should start over with evidence-based solutions that are working here and in other states. Connecticut’s health system needs real innovation.
Ellen Andrews, PhD, is the executive director of the CT Health Policy Project. Follow her on Twitter @CTHealthNotes.
DISCLAIMER: The views, opinions, positions, or strategies expressed by the author are theirs alone, and do not necessarily reflect the views, opinions, or positions of CTNewsJunkie.com.
More State Budget news

Lamont Signs The Budget
Alongside Democratic legislative leaders, Gov. Ned Lamont signed the $24 billion budget adjustment Monday that includes $600 million in tax relief. That’s more than they anticipated they would be able to offer Connecticut residents this Election year because revenue came in higher than expected, but it still creates about an $800 million deficit in 2024. …
Keep reading
ANALYSIS | It’s A Wrap: The Winners and Losers of the 2022 Session
It was a short legislative session, but the House and the Senate were able to move a lot of business this year, including the passage of a $24-billion budget with around $600 million in tax cuts.
Keep reading
Connecticut Acts To Help Its Lead-Poisoned Children
After decades of inertia, Connecticut is finally moving to help its thousands of lead-poisoned children and prevent thousands of other young children from being damaged by the widespread neurotoxin.
Keep reading
Bill Bolstering Contracting Oversight Board In Jeopardy After Lamont Administration Raises Concerns
It passed unanimously in the Senate, but a bill that would give the State Contracting Standards Board greater oversight over state contracting appeared stalled in the House Wednesday on the last day of session. “The governor and I have not talked about the bill,” House Speaker Matt Ritter said. “The commissioners have sent us a…
Keep reading
Senate Approves Tax Cuts, Sends $24B Budget to the Governor
The state Senate gave final approval late Tuesday to a $24 billion election year budget plan that includes around $600 million in tax relief while enabling the state to make an $3.5 billion payment on its unfunded pension debt. Senators voted 24-12 at around 10:30 p.m. to send the midterm budget adjustment to the desk…
Keep reading
House Green-Lights $24B Budget
On a party-line vote early Tuesday, the House passed a $24 billion budget adjustment package containing more than $600 million in tax cuts which Democrats heralded as “historic” and Republicans derided as temporary. Lawmakers voted 95 – 52 at around 12:20 a.m. to send the 673-page budget document to the Senate for consideration before the…
Keep reading
Budget Materials
The General Assembly is preparing to debate adjustments to the $24 billion state budget. Below are a few of the documents we’ve been provided as back-up materials. The budget, HB 5506. Town runs. Car tax impact on municipalities. Finance Committee Power Point.
Keep reading
Lawmakers May Vote for First Pay Increase in 20 Years
With legislative retirements mounting, lawmakers on both sides of the aisle were considering Monday raising the salaries of General Assembly members for the first time in more than two decades and indexing their pay in the future. During a morning press briefing, House Speaker Matt Ritter told reporters that funding for pay raises had been…
Keep reading
Amid Surging Revenue, House Prepares to Vote on Budget Adjustments
Connecticut’s House of Representatives was expected to vote Monday on a $24 billion budget adjustment package, buoyed by revised revenue predictions that exceeded expectations by more than $350 million. The revised consensus figures released Monday confirm the surge in revenues that enabled Gov. Ned Lamont and legislative Democrats to reach an agreement last week on…
Keep reading
Dems Detail Budget Deal With $500 Mil in Tax Cuts, Extension of Gas Tax Holiday
Legislative Democrats and Gov. Ned Lamont’s administration announced Wednesday the details of a $24.2 billion budget adjustment package, which they say provides around $500 million in tax relief including extending a gas tax holiday until December. Lamont and legislative leaders outlined the agreement during an afternoon press conference in the state Capitol building. Both chambers…
Keep reading
Health Care Workers Call for New Hires
After a record number of health care workers are expected to retire this year, health care staff called on Gov. Ned Lamont to commit to filling 1,000 vacant positions by August 1 of this year. A record 1,137 state workers who notified the state that they will retire this year comes at a moment of…
Keep reading
Senate Joins House And Votes To Give Raises, Bonuses To State Employees
The Senate gave final approval by a 22-13 vote on a plan to give unionized state workers a set of raises and bonuses. The plan, negotiated by Gov. Ned Lamont’s administration and a coalition of public sector labor unions, provides three years of 2.5% raises and step increases as well as a total of $3,500…
Keep reading
House Advances Labor Deal In Historic Vote
Lawmakers in Connecticut’s House of Representatives signed off on a plan to give state workers a set of raises and bonuses Thursday in a mostly partisan vote on a negotiated labor agreement. The House voted 96 to 52 in support of the deal with 1 Republican, Rep. Tom Delnicki of South Windsor, joining all Democrats…
Keep reading
Republicans Propose Last-Minute Tax Package
Legislative Republicans pitched a $1.2 billion tax relief plan Thursday which reduces state income, sales and gas taxes and proposes to join other states in suing the federal government to challenge restrictions on spending pandemic relief funds. House and Senate Republicans announced the plan during a state Capitol press conference Thursday morning. It cuts the…
Keep reading
The Budget Battle Begins To Take Shape
Tax collections have improved and pushed Connecticut’s budget surplus to $4 billion, but the state budget still relies heavily on federal funding and without it the state would end up running a “sizeable operating deficit.” The Office of Policy and Management told state Comptroller Natalie Braswell Wednesday that if not for the use of the…
Keep reading
Ritter: Time Is Running Short For Budget Agreement
The legislature will have a difficult time approving a state budget before the end of its session in two weeks if lawmakers and Gov. Ned Lamont do not reach an agreement in the next 48 hours, House Speaker Matt Ritter told reporters Wednesday. During a morning press briefing, Ritter said the legislative schedule was looking…
Keep readingMore Health Care News & Analysis

Coalition of Health Insurers Questions Viability of Connecticut Partnership Plan
Members of Connecticut’s Health Care Future, a coalition of health insurers, hospitals, and businesses, are questioning whether Connecticut lawmakers have done enough this year to protect teachers and municipal employees from increases in health insurance premiums. “Despite repeated bailouts from taxpayers, the Connecticut Partnership Plan continues to be a fiscal Titanic that demonstrates why government-controlled health…
Keep reading
AG’s Tackle Mental Health Parity
Attorneys General in Connecticut and Rhode Island threw their support Monday behind a coalition of mental health advocacy groups asking a federal appeals court to revisit a recent ruling giving insurance companies more flexibility to deny mental health claims.
Keep reading
Budget Green Lights Psychedelic Therapies
Buried in the budget Gov. Ned Lamont signed this week is a provision that would create a pilot program to allow Connecticut to be the first-in-the-nation to study the impact of psychedelic drugs like psilocybin and MDMA on patients with depression and PTSD. The budget now creates a pilot program within the Department of Mental…
Keep reading
Officials Highlight Effort To Boost Mental Health Services For Kids
At a Hartford-based community provider Wednesday, Gov. Ned Lamont and a handful of his agency commissioners highlighted the expected impact of more than $100 million in recently passed funding aimed at increasing behavioral health services for Connecticut children. The governor appeared at The Village for Families and Children, a recipient of new state funding included…
Keep reading
Democrats Turn Focus To Roe v. Wade
With the legislative session and the conventions in the rearview mirror, Democrats in Connecticut are turning their focus to the U.S. Senate and the upcoming vote to codify Roe v. Wade and the impact it could have on the 2022 Elections. U.S. Sen. Chris Murphy was on Fox News Sunday talking about the issue, which…
Keep reading
OP-ED | Policymakers Did Little to Lower Healthcare Costs This Session
Last year, Connecticut policymakers accomplished little to reduce the cost of healthcare, and those costs haven’t gotten any better since then. Incumbents will be asked what they did this year to provide some relief. Unfortunately, they have little to offer.
Keep reading