The number of Medicare Advantage (MA) Special Needs Plans (SNPs) has surged in enrollment, growing its member base by more than twofold from 2020 to 2022. This influx of new members has generated an opportunity to achieve better health outcomes for targeted groups of people and provide members with tailored care solutions.  

These plans are not only popular with members, they also appear to be associated with positive consequences, such as decreases in all-cause hospitalizations. Nevertheless, increased enrollment is accompanied by increased operational challenges, as the high-touch model of member management continues to scale. 

Alphabet of MA Special Needs Plans

A Special Needs Plan (SNP) provides benefits and services to people with specific diseases, certain health care needs, or who also have Medicaid. SNPs tailor their benefits, provider choices, and list of covered drugs to best meet the specific needs of the groups they serve.

For example, there are SNPs for those with chronic conditions (C-SNPs), individuals who are dually eligible (D-SNPs), and people who require institutional care (I-SNPs).

Since 2018, the number of C-SNPs has grown rapidly, mainly targeting those with diabetes, heart disease, and lung issues. These specialized plans offer benefits to improve long-term care such as increased coordination between doctors and providers, or discounts on medications/medical equipment. They also make it easier for people who are living with complex or chronic conditions to manage the long-term care services they need to live in the home and community. 

MA Plans are Booming:
How Will You Stay Competitive?

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Staffing Shortages Challenge In-Home Services

In fact, in 2023, in-home support services (IHSS) became the fastest-growing benefit among a newly expanded set of supplemental options for MA members. These services support activities of daily living (e.g., bathing and dressing) and help people who are aging in place or living with complex needs. Members can also enlist help for housekeeping or personal care services.

Medicare Advantage patient receiving In-Home Support Services (IHSS)According to ATI Advisory, some in-home services produced unintended, but positive, consequences. For example, there were numerous instances where the presence of a home visitor reduced the hospitalization rate and incidence of in-home falls among members. It might be the case that the  presence of an engaged, empathetic visitor can achieve some of the benefits that MA plans were designed to deliver without the need for specialized equipment or skilled nursing.

However, one significant challenge is the shortage of post-acute and in-home healthcare providers. While it is crucial to allocate funding for the IHSS program, simply providing funds is insufficient if there are no available professionals. Health plans often seek out innovative solutions to address this issue and help close the gap. 

The upward trend around the delivery of in-home health services is expected to continue led, in part, by consumer demand. MA plans should prepare to manage this ongoing shift in healthcare delivery.



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