Medicare Advantage vs. specialized Medicare Advantage plans: Outcome effects

October 17, 2017

Avalere Health analysis has intriguing results about beneficiaries enrolled in diabetes-focused chronic condition special needs plans.

Medicare Advantage chronic condition special needs plans (C-SNPs), improve outcomes and appropriate utilization of care for their enrollees relative to other non-special needs Medicare Advantage plans, according to new analysis.

MA beneficiaries with diabetes enrolled in a diabetes-focused C-SNP are more likely to receive primary care services than members enrolled in non-special needs Medicare Advantage plans, less likely to use inpatient care, and more likely to be adherent to their antidiabetic medications than beneficiaries with similar demographic and medical profiles enrolled in non-specialized plans, according to the Avalere Health analysis. 

Specifically, diabetic MA beneficiaries enrolled in a diabetes-focused C-SNP are:

  •  38% less likely to be admitted to a hospital than they would have been in a non-SNP MA plan

  •  32% less likely to be readmitted to a hospital following an inpatient stay

  •  22% more likely to have a primary care visit

  •  10% more likely to have had a blood glucose (HbA1c) test   

  •  6% more likely to fill (and refill) a prescription for an antidiabetic medication

Kelly

“The results demonstrate the value that specialized managed care plans can provide to Medicare beneficiaries with diabetes,” says Cara Kelly, vice president at Avalere. “This is the first study to evaluate SNPs compared to non-specialized managed care plans, and suggest that plans can meaningfully improve outcomes through targeted care management programs and benefit/network design, deep knowledge of these population’s service needs and care patterns and specialized data analytics.”   

Based on the study, Kelly offers three follow-up actions for healthcare executives:

  • Benchmark your own performance against the results in the study, which data from include multiple plans.

  • Based on benchmarking exercise, identify potential operational areas for improvement and gap closure (SNP or non-SNP plans) and develop strategic plan to improve performance.

  • Educate policymakers on the value of specialized plans and broader flexibility in plan design.

Avalere used Inovalon’s proprietary MORE2 Registry to compare outcomes for beneficiaries with diabetes enrolled in diabetes-related C-SNPs to beneficiaries with diabetes enrolled in other non-SNP MA plans for this study. Avalere calculated a “C-SNP effect” by comparing actual versus expected outcomes for C-SNP enrollees.