Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients

Abstract

The Affordable Care Act of 2010 authorized the continued availability of Medicare Advantage Chronic Condition Special Needs Plans (C-SNPs). This case study examines the model of care used by the largest such plan, Care Improvement Plus, and compares utilization rates among its diabetes patients with those of other beneficiaries enrolled in fee-for-service Medicare in the same five states. This special-needs plan emphasizes direct contacts with patients to help identify gaps in care and promote primary and preventive health care. The comparative analysis indicates that people with diabetes in the special-needs plan-particularly nonwhite beneficiaries-had lower rates of hospitalization and readmission than their peers in fee-for-service Medicare. For example, risk-adjusted hospital days per enrollee among special-needs plan participants were 19 percent lower than for fee-for-service Medicare enrollees (27 percent lower for nonwhite enrollees). Risk-adjusted physician office visits were 7 percent higher among C-SNP enrollees than among comparable fee-for-service enrollees (26 percent higher for nonwhite enrollees). Although this study does not include a cost analysis, we believe that savings from reduced hospitalizations are likely to more than offset the additional costs of enhanced primary care programs. Our study suggests that the Centers for Medicare and Medicaid Services may be able to adapt methods used by the C-SNP program to improve care and outcomes for beneficiaries with a broad range of chronic diseases.

The Effect of Medicare Advantage on Hospital Admissions and Mortality

“…For example, Landon et al (2012) find that MA enrollees have fewer emergency-room visits, ambulatory surgeries, and inpatient admissions than comparable TM enrollees. Other work examines rates of readmission to the hospital (Lemieux et al 2012, Cohen et al 2012) and rates of admission for outpatient-care-sensitive illnesses (Basu and Mobley 2012), and finds them to be lower in MA as well.…”

Role of Interprofessional primary care teams in preventing avoidable hospitalizations and hospital readmissions in Ontario, Canada: a retrospective cohort study

“…There is a body of evidence that links chronic disease management programs to lower preventable hospitalizations [55][56][57][58]. In Ontario, patients being served by both interprofessional and non-interprofessional teams have access to certain chronic disease programs including diabetes education and heart failure clinics.…”

Association of Chronic Condition Special Needs Plan With Hospitalization and Mortality Among Patients With End-Stage Kidney Disease

“…Although no prior examinations of the association of C-SNP enrollment with outcomes among patients with ESKD have been published, a few studies have highlighted the benefits of C-SNPs in other chronic diseases. In 2012, Cohen and colleagues 8 reported the consequences the care model had for the Care Improvement Plus plan. They demonstrated that diabetic patients enrolled in the C-SNP had lower rates of hospitalization and readmission compared with fee-for-service Medicare beneficiaries in states where the plan operated.…”