A new analysis from Avalere Health, sponsored by Anthem’s Public Policy Institute, highlights the improvements in care that chronic condition special needs plans (C-SNPs) can deliver to Medicare beneficiaries with diabetes as compared to non-SNP plans.
Avalere’s analysis found that Medicare beneficiaries with diabetes enrolled in C-SNPs experienced better outcomes than they would have in a non-specialized Medicare Advantage (MA) plan. Specifically, Avalere found that enrollees in a diabetes-focused C-SNP were:
- 22 percent more likely to receive primary care services,
- 10 percent more likely to receive appropriate diabetes testing
- 38 percent less likely to have an inpatient admission,
- 32 percent less likely to have a readmission, and
- 6 percent more likely to fill (and refill) a prescription for an antidiabetic medication.
The analysis is the first of its kind to demonstrate that C-SNPs can improve outcomes for beneficiaries with diabetes compared to non-SNPs. The full report is available here.
Special Needs Plans Offer Tailored Care to Medicare Beneficiaries
Special needs plans (SNPs) are an important plan option for some of Medicare’s most vulnerable beneficiaries. SNPs are a type of MA plan that focus on, and limit enrollment to, specified groups of Medicare beneficiaries. There are three types of SNPs and each provide targeted services to MA beneficiaries who are either institutionalized (I-SNPs), are dually eligible for Medicare and Medicaid (D-SNPs), or have a severe or disabling chronic condition (C-SNPs). SNPs offer more tailored programs and coordinated care, with the goal of achieving better outcomes for those with significant healthcare needs. There are more than 2 million SNP enrollees in 2017.
CMS has defined 15 conditions and 5 multi-condition groups that C-SNPs can focus on, including common chronic conditions like diabetes. The Avalere report notes that C-SNPs enroll approximately 15 percent of all SNP beneficiaries. In 2017, nearly all C-SNP enrollees are in plans that focus on diabetes care alone or in combination with cardiovascular disorders. Diabetes is the seventh leading cause of death in the U.S, and 25% of U.S. adults age 65 and older have diabetes.
While SNPs were first authorized in the Medicare Modernization Act of 2003, their authorization was time limited, and so the program has been re-authorized several times since then. Current SNP authorization expires December 31, 2018, and Congress is currently debating SNP reauthorization.
Analysis Highlights Importance of C-SNPs for Medicare Beneficiaries
This new analysis compares clinical and utilization metrics across C-SNP and non-SNP MA enrollees. As demonstrated by the data (and shown in Figure 3 in the report), the analysis demonstrates improvements in primary care, inpatient utilization, and diabetes condition management. Specifically, C-SNP enrollees with diabetes were almost 22% more likely to visit a primary care physician, were nearly 38% less likely to have an inpatient admission, and 32% less likely to have a readmission. Also, importantly, C-SNP enrollees with diabetes received more diabetes-specific services. C-SNP enrollees had a 6% increase in the percent days covered for antidiabetic medication. C-SNP enrollees were also 10% more likely to receive diabetes condition monitoring using a blood glucose test compared to non-SNP enrollees.
The Avalere analysis also found that C-SNPs are treating Medicare beneficiaries who are more vulnerable, on average, than those in non-SNP plans. C-SNP enrollees had more co-occurring conditions, were more likely to be dually eligible for Medicare and Medicaid benefits, and were twice as likely to be disabled. The Avalere analysis accounted for differences in health status and demographics between C-SNP enrollees and non-SNP enrollees.
C-SNPs are uniquely positioned to improve care for beneficiaries with chronic conditions because they focus on managing a particular condition or conditions and are held to robust standards. C-SNPs offer care coordination, more targeted provider networks, and quality standards designed specifically for that condition—all features that emphasize effective care delivery in order to improve outcomes. C-SNPs must have a Model of Care (MOC) approved by the National Committee for Quality Assurance (NCQA) that provides the basic framework under which the SNP will meet the needs of each of its enrollees. The MOC is a vital quality improvement tool and integral component for ensuring that the unique needs of each enrollee are identified by the SNP and addressed through the plan’s care management practices.” Non-SNP plans do not have to receive approval of an MOC like C-SNPs do.
For example, CareMore emphasizes care coordination and empowers enrollees to participate in better managing their own care. CareMore uses an interdisciplinary team to proactively address issues and improve outcomes for beneficiaries, which includes nutritionists, social workers, psychiatrists, psychiatric nurse practitioners, behavioral health therapists, exercise specialists, and pharmacists. Additionally, CareMore plans encourage member adherence to evidence-based therapies through benefits such as no co-payments for key medications like insulin.
The findings from this analysis clearly demonstrate the improvements in care that C-SNPs offer beneficiaries with diabetes over non-SNP plans. These improvements are likely attributable to the C-SNPs’ tailored benefits and programs, along with beneficiary engagement in management of their chronic conditions. As policymakers continue to evaluate and refine the SNP program, this new analysis offers insight into the value that specialized plans, with models of care tailored to specific chronic conditions, can provide for Medicare beneficiaries with chronic conditions.
Note: Funding for Avalere’s analysis was provided by the Anthem Public Policy Institute. Avalere maintained full editorial control.
 American Diabetes Association, Statistics about Diabetes, available at http://www.diabetes.org/diabetes-basics/statistics/ (accessed September 2017). The prevalence estimate of diabetes among U.S. adults age 65 or older includes both diagnosed and undiagnosed seniors.
 Centers for Medicare & Medicaid Services. “Special Needs Plans—Model of Care. August 2016.” Available at: https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans/SNP-MOC.html.
 CareMore data was not included in this analysis.
 The Commonwealth Fund, CareMore: Improving Outcomes and Controlling Healthcare Spending for High-Needs Patients, March 2017, available at http://www.commonwealthfund.org/publications/case-studies/2017/mar/caremore[pdf_download src="https://antheminc.com/cs/groups/wellpoint/documents/wlp_assets/d19n/mziw/~edisp/pw_g320739.pdf"]