Priority Health on the Current State of Special Needs Plans and What Drives Member-Centric Design

In a recent webinar, Lana Djordjevic, Director of Growth & Strategic Markets at Priority Health, and SafeRide CRO Andy Auerbach discussed the merits of member-centric design and why it’s essential for meeting the diverse set of SNP member needs.

For generations, health insurance has typically operated as a one-size-fits-all model for millions of people living with a wide range of health conditions. A major exception has been the evolution of Medicare Advantage (MA), from its roots in the 1960s as a government-provided insurance program to today’s privately administered MA plan landscape established in 2003 by the Medicare Modernization Act. The legislation paved the way for more customization for members with highly specialized care needs. Special Needs Plans (SNPs) stand out among the pack of plans for its flexibility, and, most recently, growth in both enrollment and plan offerings for beneficiaries.

Today, SNPs have three coverage options which are segmented by specific eligibility requirements:

  • Chronic condition SNP (C-SNP) provides coverage for members with one or more severe or chronic conditions (cancer, chronic heart failure, dementia, or neurological disorders).
  • Institutionalized SNP (I-SNP) is available for those who live in an institution such as a nursing home or require nursing care at home.  
  • Dual Eligible SNP (D-SNP) is available for individuals who are dually eligible for Medicare (age/disability) and Medicaid (low income).  

Enrollment in SNPs have tripled over the last decade, most recently from 3.8 million beneficiaries in 2021 to more than 4.6 million in 2022. Additionally, a certain segment of SNP beneficiaries has also seen an increase in plan offerings. Since 2019, the number of D-SNP plan options has grown from 471 in 2019 to 792 in 2023. The rise in offerings meets a market need: as a population that’s dually eligible for MA and Medicaid, D-SNP beneficiaries are people living with multiple health conditions and often experience barriers to care, such as access to reliable transportation.

The Intersection of SNPs and Non-Emergency Medical Transportation (NEMT)

With so many unique care needs, SNPs are spearheading the shift from a one-size-fits-all health plan structure. However, the question remains: how can health plans build custom benefit structures for SNP members? In a recent webinar, Lana Djordjevic, Director of Growth & Strategic Markets at Priority Health, and SafeRide Chief Revenue Officer Andy Auerbach discussed the merits of member-centric design and why it’s essential for meeting the diverse set of SNP member needs.

Looking closer at D-SNP member trends, research shows that transportation is a leading supplemental benefit, primarily aiming to prevent, cure, or diminish an illness or injury. As many as 90% of D-SNP members have enrolled in transportation benefits—a signal that transportation access is a significant need, of many, for this at-risk population. The same can be said for beneficiaries in the broader SNP landscape. During the webinar, Lana and Andy explored a few key product design principles that health plans must consider for building customized SNP benefit programs that cater to the needs of these vulnerable populations.

Do your due diligence: know the regulations and the market. While understanding the competitor environment is a must, so is being well-versed about how Medicaid eligibility and services differ on a state level. Knowing the legal and regulatory nuances at a state and federal level is critical to creating a cohesive SNP benefit package. These factors, combined with regional variability of SNP spending benchmarks, often dictate the parameters for building any SNP.

Health equity considerations: build it right so they will come. The best member-centric plans are customized to individual patient needs and require foundational knowledge of the beneficiary to be effective. Health plans should rely on multiple data sources such as patient records, insights from a member’s care management team, health risk assessments, and customer service inquiries; and external sources, including CDC’s Social Vulnerability Index and Special Supplemental Benefits for the Chronically Ill (SSBCI). The latter includes benefits like transportation that can be offered under the expectation of improving or maintaining the health or overall function of chronically ill members. It’s true that tech-enabled partnerships between MA plans and modern NEMT solutions can help move the needle on health equity and the social determinants of health (SDoH).

Smarter benefits structures: data-driven member engagement. The opportunity for customization comes when health plans leverage member data, such as supplemental benefits information, for personalized messaging. Health Reimbursement Arrangements and other member records can identify patient pain points and enable health plans to intelligently craft communication around relevant member needs that help them bridge gaps in care. During the webinar, Lana from Priority Health expanded on the importance of utilizing data to engage members.


Lana Djordjevic

Director of Growth & Strategic Markets Priority Health

“When we tailor that communication to speak transportation, dental, or whatever the benefits might be to that very specific cohort of the population, that's when we find that engagement resonates much, much better with those members.”

Innovation through automation: the better way forward. As patient populations age, they become more technologically savvy and often prefer the ease of doing things digitally. Healthcare should not be an exception. Administrators for D-SNP plans that partner with tech-enabled NEMT brokers can automate benefit plans based on certain identifiers such as a patient’s geographic location, condition, when they enter certain treatment programs, and frequency of appointments. As Andy shared during our webinar, this approach makes benefits management on the member side more personalized and synchronized while empowering them to take more control.


Andy Auerbach

Chief Revenue Officer of SafeRide Health  

We rely too heavily on call center-centric models for delivering benefits. When in reality, we're dealing with an increasingly technologically savvy population that can manage their own benefits in a much more meaningful way … If we can start to automate things and provide better and meaningful self-service tools for the percentage of the population that wants that –and frankly prefers that—and it works when they go to try to use it, that allows us to offer more and better services for [the people] that really need it.

To learn about how SafeRide can help Special Needs Plans gain a competitive advantage, watch our recent webinar “Supporting Dual Eligible Special Needs Plan Members with Best-in-Class NEMT Benefits” on demand.

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