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Related Experiment Videos

Medicare advantage: understanding special needs plans.

Kevin B Piper1

  • 1Health Results Group, LLC, USA.

Managed Care (Langhorne, Pa.)
|August 11, 2006
PubMed
Summary

Federal risk adjustment payments prevent managed care plans from avoiding sicker patients. Special Needs Plans (SNPs) now allow tailored care for specific populations, improving efficiency.

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Managed care (Langhorne, Pa.)ยท2006
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Area of Science:

  • Health Services Research
  • Public Health Policy
  • Managed Care

Background:

  • Managed care plans historically engaged in risk selection, enrolling healthier individuals to minimize costs.
  • This practice created disincentives for plans to enroll beneficiaries with higher healthcare needs.

Purpose of the Study:

  • To explain the implementation of risk-adjusted payments to mitigate risk selection in managed care.
  • To introduce Special Needs Plans (SNPs) as a mechanism for tailored care delivery to specific populations.

Main Methods:

  • Federal risk adjustment of payments to managed care organizations.
  • The establishment and focus of Special Needs Plans (SNPs) on defined populations.

Main Results:

  • Risk adjustment removes financial disincentives for managed care plans to enroll beneficiaries with greater care needs.
  • Special Needs Plans (SNPs) enable focused service delivery for institutionalized, dually eligible, and chronically disabled beneficiaries.

Conclusions:

  • Risk adjustment and SNPs are key strategies to improve equity and efficiency in managed care.
  • Tailored care systems through SNPs can enhance service delivery for vulnerable populations.

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