Early evidence on the quality of care provided by special needs plans.

BACKGROUND

Medicare Advantage special needs plans (SNPs) have grown significantly over the past 7 years, but patient outcomes have only recently been publicly reported.

METHODS

Reporting rates and scores on 4 publicly reported Healthcare Effectiveness Data and Information Set (HEDIS) measures of 697 SNPs in 2008 are examined, as are SNP characteristics associated with reporting HEDIS scores.

RESULTS

SNP participation increased from 11 plans serving 12,774 beneficiaries in 2004 to 762 plans serving 1,323,132 beneficiaries in December 2008, and then dropped to 455 plans serving 1,293,579 beneficiaries in February 2011. Fifty-eight percent of the 697 SNPs were dual-eligible SNPs, 30% were chronic SNPs, and 12% were institutional SNPs. The total number of SNPs and total SNP enrollment was concentrated in 9 states and Puerto Rico, representing 59.4% of all SNPs and 75% of all SNP enrollments. Seventeen percent of SNPs reported all 4 HEDIS measures in 2008, but 60% were not required to report HEDIS measures. Among SNPs reporting scores, 42% of enrollees received colorectal cancer screening, 86% received appropriate monitoring of long-term medications, 55% had blood pressure control, and 56% of physicians were board certified.

CONCLUSIONS

These early HEDIS reporting and performance results raise questions about whether SNPs add value above traditional Medicare Advantage plans. New HEDIS measures and new regulatory requirements have the potential to improve SNP care practices, and are likely to improve our understanding of SNP outcomes most relevant to enrollees.