Patients With Diabetes Hospitalized Less When Enrolled in Special Needs Plans

Specialized Medicare Advantage (MA) plans called chronic condition special needs plans (C-SNPs), may demonstrate greater improvement in outcomes and utilization of care for the beneficiaries when compared to non-SNP Medicare plans, according to a new analysis from Avalere Health.

SNPs limit enrollment to certain groups of Medicare beneficiaries, such as those who are dually eligible for Medicare and Medicaid or who have a severe chronic condition, and they coordinate care for their populations. C-SNPs are a subgroup offering plans to beneficiaries with certain chornic conditions or co-occurring conditions. Nearly all C-SNP enrollees are in plans that focus on diabetes care either alone or in combination with another condition, Avalere explained in its report.

The Avalere analysis utilized Inovalon’s propriety MORE Registry in order to compare the outcomes for diabetes beneficiaries who are enrolled in diabetes-related C-SNPs with patients who have diabetes and were enrolled in other non-SNP plans. The registry included information on the demographics, enrollment, individual medical encounters, and prescription drug fills for 159 million people from 2000 to 2017. The researchers used this data to determine the effect of C-SNPs by comparing the actual outcomes with the expected outcomes for those enrolled in C-SNPs.

“Outcomes for beneficiaries enrolled in C-SNPs were consistently better across primary care and inpatient care,” Cara Kelly, vice president at Avalere, said in a statement. “Importantly, C-SNP enrollees also received more diabetes-specific services, including antidiabetic medications and blood glucose testing.”

C-SNP enrollees with diabetes were 38% less likely to be admitted to a hospital and 32% less likely to be readmitted after an inpatient stay. Also, C-SNP enrollees with diabetes were 22% more likely to have a primary care visit, 10% more likely to have had a blood glucose test, and 6% more likely to fill and refill an antidiabetic prescription.

Despite the benefits of C-SNP plans for patients with diabetes, the analysis noted that C-SNP enrollees have worse health statuses than non-SNP enrollees. Additionally, C-SNP enrollees are typically more disadvantaged than others in MA plans—C-SNP enrollees are twice as likely to be disabled, more likely to be dually eligible for Medicare and Medicaid, and have lower incomes. The authors also noted that C-SNP enrollees are more likely to suffer from chronic co-comorbidities.

“This study sheds new light on how specialized plans can positively impact enrollee outcomes,” Dan Mendelson, president at Avalere, concluded. “As Congress and CMS continue to refine SNP policy and requirements, these results demonstrate the value that specialized plans can provide to beneficiaries and the Medicare program.”