Special needs plans

BACKGROUND: Privately sponsored special needs plans (SNPs) are growing rapidly in Medicare and are seen as a way to access patient populations that have been served primarily through traditional Medicare (not Medicare Advantage), private plan programs, or Medicaid. It remains to be seen if such plans are able to provide improved care while controlling costs. OBJECTIVE: To review current trends in the development of Medicare Advantage (MA) SNPs. SUMMARY: Medicare Advantage SNPs are designed to address the health care needs of specific target populations that include some of the most vulnerable patients in the Medicare system. SNPs differ from other types of plans by virtue of the fact that they are defined by the specific populations they serve rather than by the type of contract. SNPs are permitted to restrict enrollment to 3 specific target populations: dual eligibles, institutionalized beneficiaries, and those with serious, chronic disabling conditions. Plans can design special clinical programs to provide services for groups with distinct health care needs, with the goal of reducing hospitalizations and institutionalizations. An important attribute of the SNP model is the potential to modify care patterns and provide greater disease management that can lead to improved outcomes while reducing costs. CONCLUSIONS: The 3 types of SNPs authorized by CMS have the potential to provide added value for beneficiaries and plans compared with other Medicare Advantage prescription drug (MA-PD) plans. At present, however, most SNPs have not been in operation long enough to make a clear determination about how well that potential will be realized.