Effects of Early Dual‐Eligible Special Needs Plans on Health Expenditure

Zhang, Yongkang; Diana, Mark L.

doi:10.1111/1475-6773.12778

Cited by 8 publications

(9 citation statements)

References 25 publications

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“…The only multi-state study of the effects of D-SNPs covered the preregulation time period (2007-2011) and focused exclusively on healthcare expenditures. Zhang et al (2018) examined the impact of D-SNP penetration on state Medicare, Medicaid and total healthcare spending [11]. Controlling for state-level demographic, socioeconomic, and healthcare resource factors along with state and year fixed-effects, having a higher percentage of dual-eligible beneficiaries enrolled in D-SNPs was linked with reduced Medicare spending per enrollee but not reductions in Medicaid or total healthcare spending.…”

Section: New Contributionmentioning

confidence: 99%

The impact of Dual Eligible Special Need Plan regulations on healthcare utilization

Narain

Harwood

Mangione

et al. 2021

BMC Health Serv Res

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Background To determine if requiring Dual Eligible Special Need Plans (D-SNPs) to receive approval from the National Committee of Quality Assurance and contract with state Medicaid agencies impacts healthcare utilization. Methods We use a Multiple Interrupted Time Series to examine the association of D-SNP regulations with dichotomized measures of emergency room (ER) and hospital utilization. Our treatment group is elderly D-SNP enrollees. Our comparison group is near-elderly (ages 60–64) beneficiaries enrolled in Medicaid Managed Care plans (N = 360,405). We use segmented regression models to estimate changes in the time-trend and slope of the outcomes associated with D-SNP regulations, during the post-implementation (2012–2015) period, relative to the pre-implementation (2010–2011) period. Models include a treatment-status indicator, a monthly time-trend, indicators and splines for the post-period and the interactions between these variables. We conduct the following sensitivity analyses: (1) Re-estimating models stratified by state (2) Estimating models including interactions of D-SNP implementation variables with comorbidity count to assess for differential D-SNP regulation effects across comorbidity level. (3) Re-estimating the models stratifying by race/ethnicity and (4) Including a transition period (2012–2013) in the model. Results We do not find any statistically significant changes in ER or hospital utilization associated with D-SNP regulation implementation in the broad D-SNP population or among specific racial/ethnic groups; however, we do find a reduction in hospitalizations associated with D-SNP regulations in New Jersey (DD level = − 3.37%; p = 0.02)/(DD slope = − 0.23%; p = 0.01) and among individuals with higher, relative to lower levels of co-morbidity (DDD slope = − 0.06%; p = 0.01). Conclusions These findings suggest that the impact of D-SNP regulations varies by state. Additionally, D-SNP regulations may be particularly effective in reducing hospital utilization among beneficiaries with high levels of co-morbidity.

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Section: New Contributionmentioning

confidence: 99%

The impact of Dual Eligible Special Need Plan regulations on healthcare utilization

Narain

Harwood

Mangione

et al. 2021

BMC Health Serv Res

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“…12 While increased D-SNP penetration has been associated in one study with reduced Medicare spending per dual-eligible beneficiary, state Medicaid budgets did not experience a similar benefit from these savings. 13 Shared-savings could be used to motivate greater integration between Medicare and Medicaid. 3 Given that FIDE SNPS are currently the only D-SNP plan that is financially at risk for all Medicare and Medicaid services, successful integration models developed by these plans should probably be adopted as the standard.…”

Section: Are These Plans and Models Improving Quality And Reducing Comentioning

confidence: 99%

“…3 Through bundled services under a single health plan and payer, there is greater incentive to control the costs for the population, and for organizations to benefit from any potential savings. 13 …”

Section: Are These Plans and Models Improving Quality And Reducing Comentioning

confidence: 99%

Strange Bedfellows: Coordinating Medicare and Medicaid to Achieve Cost-Effective Care for Patients with the Greatest Health Needs

Elmaleh-Sachs

Schneider

2020

J GEN INTERN MED

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This perspective describes federal efforts in the United States (U.S.) to integrate care for an especially complex, vulnerable, and costly patient population: adults eligible for both Medicare and Medicaid insurance. The goal of the paper is to demystify for clinical policy leaders and practicing clinicians the origins and evolution of the Dual-Eligible Special Needs Plans (D-SNPs) recently permanently authorized by the U.S. Congress and to explore the potential for these policy changes to help such health plans improve care for the sickest and most vulnerable Americans.

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“…Data from 2011 and 2013 indicate that D‐SNPs have higher average margins relative to regular MA plans . More recently, a study which relied on aggregated state‐level data estimated that increases in the penetration of D‐SNPs within a state were associated with modest reductions in Medicare spending and no change in Medicaid or total per‐beneficiary spending …”

Section: Introductionmentioning

confidence: 99%

“…9,10 More recently, a study which relied on aggregated statelevel data estimated that increases in the penetration of D-SNPs within a state were associated with modest reductions in Medicare spending and no change in Medicaid or total per-beneficiary spending. 11 To our knowledge, no studies have examined the factors that influence insurers' decision to enter into the D-SNP market and their ability to attract dual eligibles into these plans. This question is of particular interest since D-SNP plans are paid in a manner identical to regular MA plans.…”

mentioning

confidence: 99%

The effects of plan payment rates on the market for Medicare Advantage Dual‐Eligible Special Needs Plans

McGarry

Layton

Grabowski

2019

Health Services Research

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Objective To determine the effect of higher potential benchmark payment rates on the market for Medicare Advantage (MA) Dual‐Eligible Special Needs Plans (D‐SNPs). Data Sources/Study Setting Publicly available county‐level data from 2009 to 2015 regarding the number of D‐SNPs operating within the county, the enrollment in and five‐star quality of score of these plans, and the benchmark amounts used to determine capitated plan payments. Study Design This study exploits the introduction of quality bonus payments to the MA program in 2012, and exogenous geographic variation in the potential size of these bonuses to estimate the effect of benchmark payment increases on the availability, quality, and take‐up of D‐SNPs. We use a difference‐in‐difference estimation approach to compare changes in the market for D‐SNPs in counties eligible for a double bonus to those that are not. Principal Findings The doubling of bonuses was associated with a relative 29 percent increase in the number of D‐SNPs offered (P = 0.021) and 0.1‐star increase in the average quality of available D‐SNPs (P = 0.034). No relative increase in overall D‐SNP enrollment was detected. Conclusions These findings indicate that larger benchmark payment amounts may influence insurers’ decisions of whether to participate in the D‐SNP market but not dual‐eligibles' decision of whether to enroll in these plans. Future research is needed to inform discussions about whether D‐SNPs are a viable mechanism for integrating benefits for dual eligibles and the degree to which Medicare policies should support their continued growth.

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Effects of Early Dual‐Eligible Special Needs Plans on Health Expenditure

Cited by 8 publications

References 25 publications

The impact of Dual Eligible Special Need Plan regulations on healthcare utilization

The impact of Dual Eligible Special Need Plan regulations on healthcare utilization

Strange Bedfellows: Coordinating Medicare and Medicaid to Achieve Cost-Effective Care for Patients with the Greatest Health Needs

The effects of plan payment rates on the market for Medicare Advantage Dual‐Eligible Special Needs Plans

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