Consumer Group Recommends Improved Accountability and Appropriate Payment for Medicare Advantage Special Needs Plans
SNPs hold promise of offering specialized coordinated care for many of Medicare’s sickest enrollees
Boston, MA, June 28, 2007. Amid Congressional debates about Medicare Advantage (MA) plans and payments, a nationwide consumer group today weighed in, highlighting the need for Congress to address weaknesses in the Special Needs Plan (SNP) program. SNPs are a subset of MA plans. Community Catalyst, a national non-profit consumer advocacy organization, launched the SNP Consumer Education Project earlier this year.
In a brief distributed to members of Congress, the group maintains that SNPs, which were established in the Medicare Modernization Act of 2003 for high-risk Medicare beneficiaries, offer the promise of providing improved quality of care for people with multiple chronic conditions. Additionally, the group recommends Congress use this opportunity to improve the accountability of the plans.
“Case studies of a number of mission-driven Special Needs Plans indicate that at least a subset of SNPs are providing the kind of specialty care that Congress intended when it created the program,” said Project Director Renée Markus Hodin. “Our goal is to ensure that SNPs are able to fulfill their original purpose and to identify regulatory changes that we believe will create a standard of coordinated care and procedures for all SNPs.”
SNPs were created as an approach to improve the quality of care for individuals with multiple or chronic health needs where traditional fee-for-service programs often led to unnecessary hospitalizations and/or lengthy nursing home stays. Evaluation of data indicates that while many SNPs may be reaching the populations they are intended to help, SNP-specific quality/ performance measurement standards are lacking and there are no methods to account for how well these high-need populations are actually being served.
The brief outlines recommendations for Congress to direct the Centers for Medicare and Medicaid to take four specific steps to strengthen the SNP program:
- Establish stricter standards for approval of SNP plans.
- Create enforceable quality/performance standards.
- Design initiatives that will encourage formal Medicare/Medicaid coordination.
- Refine the risk adjustment system to ensure SNPs receive appropriate payment.
For a copy of the briefing paper, click here.
About Community Catalyst
Community Catalyst is a national non-profit advocacy organization working to build the consumer and community leadership that is required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst has provided leadership and support to state and local consumer organizations, policymakers, and foundations working to change the health care system so it serves everyone – especially vulnerable members of society since 1997. For more information, visit www.communitycatalyst.org.
About the Special Needs Plan (SNP) Consumer Education Project
The Special Needs Plan Consumer Education Project seeks to educate state and federal payers, advocates, health care providers and the public on the opportunities and risks that come with SNPs. Along with education, this project promotes best practices that enhance patient care within a state’s health care framework. Funded by the Retirement Research Foundation, the SNP Consumer Education Project is an initiative of Community Catalyst.