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Newsletter Article


Report Studies Special Needs Plans and High-Risk Beneficiaries

By Mary Agnes Carey, CQ HealthBeat Associate Editor

If benefits are tailored to meet specific needs of high-risk beneficiaries, Medicare's special-needs plans hold the promise of improving health care and reducing costs, according to a new analysis from Avalere Health.

The report was commissioned by the Association of Community Affiliated Plans, a group whose members cover more than 4 million Medicare and Medicaid beneficiaries. Of the 29 health plans in the association, 12 are special-needs plans or SNPs, according to the group's Web site.

In a news release, Avalere said it studied six not-for-profit Medicare managed care health plans across the country that entered the SNP insurance market over the last two years, documenting how the plans use highly tailored strategies and focused care models to provide benefits that the report said go beyond traditional models of insurance for dual-eligible beneficiaries: individuals who qualify for both Medicare and Medicaid. SNPs also cover beneficiaries who are institutionalized and patients with severe chronic diseases or conditions.

Some of the tailored services provided by the health plans include assignment of patient navigators who are dedicated to helping coordinate the complexities of Medicare and Medicaid benefits, deployments of intensive medical case management programs for those at highest clinical risk and enhanced benefit designs that cover dental care or other services that are not covered by Medicare or Medicaid.

"These six plans are using the SNP flexibilities as an opportunity to develop targeted programs that meet unique needs," the lead author of the paper, Avalere senior manager Ellen Lukens, said in the release. "Their approaches may serve as models of innovation for policymakers as they consider reauthorization of this program."

The number of SNPs grew to 477 plans operating in 2007 from 276 in 2006, according to Avalere. Authorization of the program sunsets Dec. 31, 2008, and Congress will need to reauthorize the program for it to continue.

At its December meeting, the Medicare Payment Advisory Commission (MedPAC) approved a recommendation to have Congress extend the authority to limit SNP enrollment for three additional years, with the extension to reflect a number of conditions specified in other recommendations the panel approved.

One of those stated that Congress should require the secretary of Health and Human Services to establish additional tailored performance measures for the plans and evaluate their performance on those measures every three years.

Another recommendation would have the HHS secretary provide beneficiaries and individuals who counsel them with information that compares SNPs' benefits and performance to those of other Medicare Advantage plans and traditional Medicare. Additional recommendations on SNPs would require the plans that serve dual-eligibles to work more closely with states within three years to better coordinate benefits with Medicaid, and would compel Congress to require SNPs to enroll at least 95 percent of their members from their target population.

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