With all the excitement about the President’s budget bill earlier this month, you may have overlooked some important Medicare updates. The budget bill incorporated many of the provisions in the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (“CHRONIC”) Care Act of 2017 (see The Bipartisan Budget Act Boosts Medicare: Flexibility and Financing for Healthcare Plans and Providers), with one of the most important being the permanent authorization of Medicare Advantage Special Needs Plan (SNPs). Previously, Congress was authorizing the use of these plans every couple of years on a limited basis.
SNPs are essentially vertical consumer-specific specialty plans for dual eligibles, Medicare beneficiaries with chronic conditions, and Medicare beneficiaries who are institutionalized. The 2.5 million Medicare beneficiaries served by SNPs account for 12.3% of the total 20.4 million Medicare Advantage enrollees, and 4% of the total 58.9 million Medicare beneficiaries. While the numbers seem small, this is an increase of 92% between 2010 and 2017. Dual eligibles are the predominant group participating in SNPs, representing 83% of the total population, while individuals with chronic conditions represent 14% of the population, and individuals in institutions represent 3% of the population.
For executive teams of provider organizations serving complex consumers, the opportunities associated with SNPs are growing. SNP members generally are populations with more and more severe health conditions, requiring more services. And Medicare Advantage plans, like commercial health plans and Medicaid health plans, are increasingly using value-based payment arrangements and innovative population health management programs – all opportunities for entrepreneurial provider organizations. (For more on the approaches health plans are using to manage the care of consumers with complex needs, see the just-released report Trends In Behavioral Health: A Reference Guide On The U.S. Behavioral Health System Financing & Delivery System – with the results of our national survey of U.S. health plans.)
But there is another opportunity that is part of the legislation. The new rules require health plans to implement new care coordination programs and have more robust models of care. These care coordination requirements include: face-to-face encounters with enrollees more than once annually, increased integration with Medicaid for D-SNPs, and the authorization of supplemental benefits for individuals with chronic conditions that could help to improve or maintain the health of the enrollee (for more, see House Resolution 1892 – Bipartisan Budget Act Of 2018).
The Medicare Advantage SNP market, likely many markets in health care, is dominated by a few large players. And that market concentration is growing—although enrollment has increased over the years, the number of plans being offered has decreased. A few insurers own a large share of the SNP market – in total, the ten largest insurers cover more than 72% of the market. UnitedHealthcare is the largest player with more than 31% of the SNP market share.
To inform your organizations strategy development, check out our just-released market intelligence report: Medicare Specialty Vertical Carve-Out Plans: The 2018 OPEN MINDS Medicare SNP Market Share Report. It has the information your team needs to assess the opportunities in Medicare specialty health plans including:
- Change in Medicare Advantage SNP enrollment over time
- Medicare SNP enrollment by state and type of Medicare Advantage SNP
- National Medicare Advantage SNP market share, by insurer
And for more on how to serve consumers with complex conditions, join us at The 2018 OPEN MINDS Strategy & Innovation Institute for the session, “Innovative Community-Based Care Models For Consumers With Complex Conditions,” featuring Kristin Cline, MS, LPC, CAADC, Clinical Lead Specialist, NHS and Nancy Wexler, DBH, MPH, Director, Innovation and Collaborative Care, University of Arizona Health Plans/ Banner Health Network.