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Publicly Reported Quality Performance for Dual-eligible Special Needs Plans, 2010-2019
Laura M Keohane1, Srivarun Tummarakota2
1Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.
Journal of Aging & Social Policy
|June 22, 2023
Summary
Dual-eligible Special Needs Plans (D-SNPs) showed slightly lower quality scores than Medicare Advantage plans, but gaps narrowed from 2010-2019. D-SNPs also reported incomplete data, highlighting a need for greater transparency in managed care quality.
Area of Science:
- Health Services Research
- Managed Care Quality
- Health Policy
Background:
- Dual-eligible Special Needs Plans (D-SNPs) serve low-income individuals eligible for Medicare and Medicaid.
- Increasing enrollment in D-SNPs necessitates robust evidence on their quality of care.
- Existing data on D-SNP quality compared to broader Medicare Advantage (MA) programs is limited.
Purpose of the Study:
- To evaluate the quality of care provided by D-SNPs compared to the overall Medicare Advantage program.
- To analyze trends in quality performance and reporting completeness for D-SNPs between 2010 and 2019.
Main Methods:
- Utilized publicly reported Healthcare Effectiveness Data and Information Set (HEDIS) measures from 2010-2019.
- Compared median HEDIS performance scores between D-SNPs and overall MA contracts.
- Assessed the completeness of performance reporting for D-SNPs and MA contracts.
Main Results:
- Median HEDIS performance scores were generally slightly lower for D-SNPs compared to the overall MA program.
- Quality performance gaps between D-SNPs and MA contracts showed some reduction between 2010 and 2019.
- D-SNPs exhibited more incomplete performance reporting than MA contracts, particularly for clinical condition measures.
Conclusions:
- D-SNPs demonstrate a need for improved quality performance and reporting transparency.
- Current Medicare Advantage reporting requirements may not adequately capture D-SNP specific performance.
- Enhanced transparency in D-SNP performance reporting is crucial for ensuring quality of care for dual-eligible beneficiaries.
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