Boston, MA –  Amid growing concerns over the rising costs and declining quality of health care, a national consumer advocacy organization today stressed the need for health plans that serve the sickest and frailest Medicare beneficiaries to adhere to enforceable quality standards.  The organization’s briefing paper points to standards that, if implemented, would both improve care and contain costs. 

The briefing paper released today by Community Catalyst coincides with the first time Medicare Special Needs Plans (SNPs) must submit data to the National Committee for Quality Assurance (NCQA) as part of a new evaluation of the plans.  NCQA will use the data to assess plan performance in a number of specific clinical areas, such as glaucoma screening in adults, as well as against a number of structure and process measures, such as the steps the plan takes to manage care for those with the most complex health care needs.  This is phase one of a three phase approach to developing SNP-specific quality measures.  The NCQA will deliver an assessment report to the Center for Medicare and Medicaid Services on September 30th.  It is unclear how that report will be used or whether it will be made public.

In 2003, Congress created SNPs to address the needs of Medicare beneficiaries with complex health issues by improving quality of care to reduce avoidable emergency room visits and nursing home admissions, resulting in cost savings.  There are now 769 approved SNPs.  Last year, Congress imposed a moratorium on the approval of new SNPs due to concerns about rapid program growth and uncertainty whether the program has achieved improved health outcomes for its beneficiaries.

“Medicare beneficiaries with complex health care needs require health care delivery systems that coordinate their care and their benefits,” said Renée Markus Hodin, director of Community Catalyst’s Special Needs Plan Consumer Education Project.  “While the SNP program presents an opportunity to provide exactly this sort of care, we’ve seen that plans provide dramatically varied levels of coordination, integration, and consumer involvement.  The NCQA evaluation represents a positive step forward, but is not enough.  Enforceable federal quality standards must be implemented in order to ensure that the promise of the SNP program is met.”

The Community Catalyst paper discusses the risk that exists to beneficiaries without a comprehensive set of federal quality guidelines for SNPs and suggests standards to ensure that SNP enrollees receive coordinated, integrated care. 

“Developing strong quality standards for the SNP program may also provide a blueprint for re-designing our ailing, fragmented health care system,” added Hodin. 

View the report, Medicare Special Needs Plans: A Critical Need for Quality Standards of Care.

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

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.  Funded by the Retirement Research Foundation, the SNP Consumer Education Project is an initiative of Community Catalyst.