How Specialized Are Special Needs Plans? Evidence From Provider Networks

Area of Science:

• Health Services Research
• Health Policy
• Managed Care

Background:

• Enrollment in Medicare Advantage (MA) Dual-Eligible Special Needs Plans (D-SNPs) has surged over the last decade.
• Understanding D-SNP plan design, particularly provider networks, is crucial for serving dually eligible individuals.

Purpose of the Study:

• To analyze the extent of provider network specialization in D-SNPs compared to standard MA plans.
• To determine if D-SNP network design aligns with the healthcare needs of dually eligible enrollees.

Main Methods:

• Analysis of D-SNP and standard MA plan provider networks in 2022.
• Comparison of network composition, focusing on specialist inclusion.

Main Results:

• In 2022, 46% of D-SNPs featured provider networks distinct from standard MA plans.
• Specialized D-SNP networks showed higher concentrations of psychiatrists, Ob/Gyns, and neurologists.
• Network specialization was more prevalent in areas with local Medicaid market participation and less common in provider shortage areas.

Conclusions:

• D-SNP network specialization is a significant design feature that appears tailored to the needs of dually eligible populations.
• Factors such as Medicaid market presence and provider negotiation costs may influence the adoption of specialized networks.