While this is certainly not the last word on how Medicare Advantage “special needs plans” (SNPs) affect outcomes for patients with end-stage renal disease (ESRD), it may just be the first. The above chart, from a new study in Health Affairs, compares 3-year unadjusted survival rates of patients with ESRD who switched into a Medicare SNP with similar patients who chose to stay within Medicare fee-for-service coverage. The results, after adjustment for clinical and sociodemographic factors, suggest that SNP enrollees had an average hazard ratio of 0.51, meaning that they were about half as likely as the control group to die at some time within three years. 

Since 2003, Medicare patients with ESRD could choose to enroll in a specialized Medicare Advantage (MA) plan targeted to their needs as patients with ESRD, a complex condition requiring proactive care. Patients with ESRD have generally been a high-cost and high-need group. SNPs receive risk-adjusted capitated payments and in return, tailor benefits to ESRD patients, including care coordination, population health management, and network and formulary design.

The research team, which includes LDI Senior Fellows Kristin Linn and Amol Navathe, overcame significant data challenges that had prevented rigorous evaluation of these specialized Medicare Advantage plans. They identified ESRD patients that switched to a SNP and compared them with patients that did not switch, although a SNP was available in their county. 

Survival was not the only outcome they measured. In an analysis of surviving patients, they found that SNP enrollees used less services in the 12 months after enrollment than their FFS counterparts, including fewer inpatient days and admissions, fewer skilled nursing facility days and admissions, and fewer home health days.

The authors note the policy importance of their study, even as they acknowledge its limitations, including a relatively small sample size and analysis from only one SNP:

To our knowledge, this is the first evaluation of ESRD SNPs since the plans were established in 2003. Although our study was not without limitations, it offers important evidence to inform policy makers in a rapidly changing landscape of payment and delivery models for patients with ESRD. Our study results suggest that SNPs may be an effective alternative financing and delivery model for patients with ESRD, which is important evidence amid a dynamic policy landscape and limited data to inform policy decisions.

The study and methods are well worth a full read. 

The study, The Beneficial Effects Of Medicare Advantage Special Needs Plans For Patients With End-Stage Renal Disease, was published in the September 2020 issue of Health Affairs. Authors include Brian W. Powers, Jiali Yan, Jingsan Zhu, Kristin A. Linn, Sachin H. Jain, Jennifer Kowalski, and Amol S. Navathe.