McCormack Grace, Wu Rachel, Meiselbach Mark
University of Southern California, Los Angeles, USA.
Johns Hopkins University, Baltimore, MD, USA.
Med Care Res Rev. 2025 Feb;82(1):58-67. doi: 10.1177/10775587241296194. Epub 2024 Nov 19.
Enrollment in Medicare Advantage (MA) Dual-Eligible Special Needs Plans (D-SNPs) among individuals dually eligible for Medicare and Medicaid has more than tripled over the past decade. Little is known about whether D-SNP plan design differs from standard MA plan design nor whether this design reflects the needs of dual-eligible enrollees. We characterize the degree to which D-SNPs specialize in an important plan design dimension-provider networks. We find that in 2022, 46% of D-SNPs offer networks that are distinct from the insurer's standard MA plan networks. Compared with D-SNP networks that are shared with standard MA plans, specialized D-SNP networks include more psychiatrists, Ob/Gyn's, and neurologists, providers that specialize in treating conditions more common among dually eligible enrollees. Network specialization is more common among insurers participating in the local Medicaid market and less common in provider shortage areas, suggesting investment in Medicaid and reduced provider negotiation costs may facilitate specialization.
在过去十年中，符合医疗保险和医疗补助双重资格的个人加入医疗保险优势（MA）双重资格特殊需求计划（D-SNP）的人数增长了两倍多。对于D-SNP计划设计是否与标准MA计划设计不同，以及这种设计是否反映了双重资格参保人的需求，我们知之甚少。我们描述了D-SNP在一个重要的计划设计维度——提供者网络方面的专业化程度。我们发现，2022年，46%的D-SNP提供的网络与保险公司的标准MA计划网络不同。与与标准MA计划共享的D-SNP网络相比，专门的D-SNP网络包括更多的精神科医生、妇产科医生和神经科医生，这些提供者专门治疗双重资格参保人中更常见的疾病。网络专业化在参与当地医疗补助市场的保险公司中更为普遍，而在提供者短缺地区则不太常见，这表明对医疗补助的投资和降低的提供者谈判成本可能有助于专业化。
