Featured Infographic   Managed Care Shows Promise for Partial Duals as Population Grows   Managed care plans, particularly Dual Eligible Special Needs Plans (D-SNPs), are showing promise in improving health outcomes and reducing health care utilization among Medicare-eligible individuals who qualify as partial Medicare-Medicaid dual eligibles, according to a March 2023 study published by Elevance Health’s Public Policy Institute. Elevance’s analysis of 2020 CMS data found that 5% of the 65.9 million Medicaid eligibles that year were partial duals — those who are eligible for Medicare but are not yet enrolled in or do not qualify for the full range of Medicaid benefits in their state.  Meanwhile, the D-SNP population has grown considerably in recent years, from just over 2 million members in 2017 to 5.1 million members in 2023, according to AIS’s Directory of Health Plans (DHP). (Elevance, for its part, is the third-largest D-SNP insurer nationally, serving just over 600,000 members as of DHP’s March 2023 update). A handful of states also participate in CMS’s Financial Alignment Initiative for duals, enrolling their qualifying duals in Medicare-Medicaid plans (MMPs). And the vast majority of people enrolled in the Program of All-Inclusive Care for the Elderly (PACE) are dual eligibles.

Click to enlarge   Elevance researchers analyzed Medicare utilization data from 2012 to 2019 and found that partial duals enrolled in D-SNPs generally had lower risk-adjusted health care utilization rates compared to those enrolled in traditional Medicare (TM), and comparable utilization rates to those enrolled in standard MA plans. Notably, partial duals enrolled in D-SNPs had greater access to primary care physicians and better utilized PCP visits than those enrolled in TM or MA plans. D-SNP enrollees also had lower rates of acute hospitalizations, 30-day readmissions and skilled nursing facility visits compared to both MA and TM enrollees. And while D-SNP enrollees had more emergency department visits than MA enrollees, they had fewer ED visits than TM enrollees.    Click to enlarge   Click to enlarge   The study authors posited that the higher rates of PCP access among D-SNP enrollees, coupled with D-SNPs’ emphasis on care coordination and tailored benefits, may be contributing to these positive outcomes. Not all partial duals have equal access to managed care, however. Some states allow only full duals to enroll in D-SNPs, while others allow both full and partial duals to enroll. In some states, only partial duals who qualify for certain Medicare Savings Programs, such as the Qualified Medicare Beneficiary (QMB) program and the Specified Low-Income Beneficiary (SLMB) program, are eligible to enroll in D-SNPs. The authors suggested that state policymakers could consider measures that would expand eligibility and access to D-SNPs. Medicaid eligibility “churn” stood out as one area for improvement. Partial duals are more likely to experience churn in their Medicaid eligibility status, which can disrupt access to health care and lead to poor outcomes. Allowing partial duals to enroll in D-SNPs before gaining full dual status, or to remain in D-SNPs even if their status fluctuates, “could support continuity of care and help ensure individuals are connected to resources as their financial and medical situations evolve,” the authors wrote.    SOURCES: DHP, AIS’s Directory of Health Plans; “Managed Care Models Improve Outcomes for Partial Dual Eligible Individuals,” Elevance Health Public Policy Institute, March 2023.     From Radar on Medicare Advantage Learn more about subscribing to AIS Health's publications.