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Will Ohio’s SIM Grant Make Us Healthier? – 1/14/15

News flash: health care costs too much. But we’re also not getting our money’s worth. Health care reform is about spending more wisely to get better care at lower costs.

On December 16, 2014, Governor John Kasich received a nice holiday gift from the federal Centers for Medicare and Medicaid Services (CMS)  – notice that Ohio received a four-year, $75 million State Innovation Models (SIM) test grant.

According to the award letter, this grant is to test new ways of paying for health care across all payers – Medicaid, Medicare, or private insurance – that will “improve health system performance, increase quality of care, and decrease costs for Medicare, Medicaid and Children’s Health Insurance Program beneficiaries – and for all residents of participating states.”  That’s a big promise – better care at lower costs for all Ohioans. Boy, do we need that!

Health care in Ohio (as in the rest of the US) is in serious trouble. First, we pay way too much. Health care costs depress wages and keep many people from getting needed care. Worse, for all that money, we don’t always get the care we need.  According to a recent scorecard from Health Policy Institute of Ohio, Ohio ranks 47th (close to the bottom) in health care “value,” which considers both quality and spending. We’re near the bottom on infant mortality, adult diabetes, avoidable emergency department visits by Medicare beneficiaries, air quality, and smoking rates, to name a few. For people of color, the numbers are even more dismal. Given Ohio’s health rankings, we need cheaper health care that improves our health. That’s what this SIM grant aims to achieve.

The grant will test new ways of paying for health care – paying for better care at lower costs.  Under today’s system, providers often make money on doing more tests and procedures – whether they hurt or help you. The SIM grant will test two new ways of rewarding providers for better and more cost-effective care. Sounds great – but there’s a lot of money on the line, in this test, for the key players. Will the Kasich administration and their private partners (including insurers and providers) make the right changes needed to improve the health and wellbeing of Ohioans? Will consumers really come out ahead? Only if consumers have a strong, ongoing voice in this test.

Last year, Ohio Consumers for Health Coverage issued a brief on the importance of consumer engagement in the SIM process.  That paper – which could have been subtitled “Nothing for us without us” – set out detailed recommendations on how to make sure Ohio consumers have an ongoing, meaningful voice in designing and testing the proposed changes. The lengthy plan that went to CMS, despite input from OCHC, does not lay out a plan for meaningful consumer involvement.

The question for consumers is this: are we going to leave it up to insurance companies, large employers, providers and the Kasich administration to make health care better and more affordable for Ohio consumers? It’s time for us to get active.

In the next few months, UHCAN Ohio will be posting blogs, infographics, and other tools to help consumers understand health care and get involved in reform that works for us. Do you want to host a discussion of health reform? Contact us