Connecticut’s federally funded effort to introduce primary care innovations (through the State Innovation Model or SIM grant) is entering its final years of implementation. In the coming months, the state will present and finalize its proposals (to review and comment on proposals as they are released, see here). Right now is an opportune time to ensure these proposals can transform Connecticut’s health system to promote equity by investing in prevention and addressing social and economic factors that make some in our state far less healthy than others.
As a reminder, many states applied for the federal SIM grant funds to advance health reform. Connecticut has used this funding as an opportunity to explore new models of primary care delivery with a focus on health disparities. Specifically, SIM piloted a primary care health home model that incorporated community health workers into the care team for some patients. As with any pilot or model, there continue to be bumps that need smoothing and culture that needs shifting. The premise, however, is solid: the current system does not do enough to reduce the deep disparities in both individual and population health that reverberate through communities of color. Specifically, the current system does not do enough to connect families with community-based services where they live.
Commitments to any one payment model can serve as a barrier to improving health outcomes. The fee-for-service approach of the Medicaid payment system is limited in flexibility and for too long some have safeguarded it as the only viable path. This is not an “us” against “them” situation but rather a recognition that, in its current form, fee-for-service is a barrier to scaling up efforts to connect primary care with community-based services in long-term and meaningful ways. With an innovative approach, Connecticut can adapt the state’s health systems to the needs of all of our residents while simultaneously safeguarding access to quality health care and vital services.
As advocates and stakeholders disagree about what payment or delivery system approach will meet the triple aim of lower cost, high quality care while maximizing access – the question is: what do consumers want? What do consumers need? And how do consumers define success? And if the goal is to center on health equity in this work, what systematic and systemic changes are needed? Connecticut’s approach of focusing on primary care to meet these needs is admirable. Primary care is the first touch point for many people when they interact with the health care system and a venue of frequent contact with parents and young children. It is also a space ripe for culture change given the right supports. A whole-family and integrated care approach is, without a doubt, the future of health care delivery and what is needed to advance health equity in Connecticut.
How we get there while ensuring that any system reflects the needs and wants of consumers themselves is less clear. Listening to consumers is hard work; it requires patience, resources and time to build trust. Specifically, it is essential to build trust with communities of color and those communities left out of economic progress; it also demands a long-term commitment from key stakeholders and decision makers. Finally, it requires advocates and stakeholders to be listeners and innovators.
As Connecticut’s decision makers contemplate next steps regarding how to implement some of the learnings from their SIM work over the next six or so months, those advocating for better care and health equity should consider what mechanisms would support needed changes that reflect consumer feedback. Reconsidering the pathways – the “how” – as we forge ahead with advocacy in a financially scarce environment will be important to meeting our goals for health equity and readying the system for more ambitious work around social determinants of health. Let’s get to work together.
Tekisha Dwan Everette, PhD*, Executive Director, Health Equity Solutions and Karen Siegel, M.P.H., Health Policy Fellow, Connecticut Voices for Children contributed to this blog as guest bloggers.
*Dr. Everette is a subcontractor with the Consumer Advisory Board but the opinions written here are wholly her own and do not represent any other entities.