How Specialized Health Plans Benefit Adults Living with Chronic Conditions

As chronic conditions and C-SNPs to better support them rise, health plans continue to seek innovative benefit partners that ensure vulnerable members have access to life-sustaining care. Learn how SafeRide tailors benefits for chronic conditions.

After a few years of ambiguity and rapid growth, 2023 has been a transformative year for public health plans. Individuals enrolled in Medicaid and Medicare Advantage (MA) face various policy changes that require them to confirm eligibility or change coverage for the upcoming year.

More than 10 million Medicaid enrollees and counting have been disenrolled since the unwinding of the continuous enrollment provision began in April. Meanwhile, in Medicare, members are increasingly choosing to enroll in MA plans for these plans’ ability to meet more than the standard medical needs with elevated focus on person-centered care and supplemental benefits that better support their individual health situation and care journey.

With these shifts in the health plan landscape, this year’s open enrollment period provided an important time period for eligible beneficiaries to decide if their health plan was meeting their needs or if they should consider shopping around for a plan that better fits their needs.

Every health journey is different, but below are a few of the qualifying factors that have contributed to a rise in the popularity of special needs plans (SNPs).

  • No longer qualify for Medicaid based on income requirements
  • Qualify for Medicare based on age (increasingly important with an aging baby boomer population and living longer)
  • Seeking more tailored benefits to meet a specific medical need
  • Recent diagnosis of a certain condition

While there are multiple subsets of SNPs, Chronic Condition SNPs (C-SNPs) were developed to improve access to Medicare managed care for certain high-acuity populations including people who have a chronic condition (including more severe, disabling, or even multiple chronic conditions).

For more on the different types of SNPs and how they meet specific subpopulation needs, check out our white paper, Supporting Special Needs Plans with Member-Centric Benefit Design Principles.

The Value of C-SNPs for Managing Chronic Disease

The prevalence of chronic disease continues to rise and contribute to reduced quality of life, long-term disability, hospitalization, and death among Americans. Consider the following insights:

  • Six in 10 adults have a chronic disease and 40% have two or more. These rates are even higher for older adults with 95% having one chronic condition and 80% having two or more. Managing chronic conditions is vital to the physical and mental health of individuals as well as the financial health of the nation.
  • Seven chronic diseases are the leading causes of death and disability as well as the primary drivers of the nation’s $4.1 trillion in annual healthcare costs. For many, having reliable transportation access to get to treatment and programs that help people manage their diseases and chronic conditions can be difficult to obtain.

Typically, health plans aim to offer generic coverage that satisfies the majority of members. While this approach delivers the greatest amount of good to the greatest number, this approach falls short for many adults who have unique needs and are managing disabling and life-threatening chronic conditions. Customizing benefit structures to be built around SNP members’ unique story and care needs, rather than a fixed list of options, can drive better outcomes and lower costs. With a concentrated focus on this population, C-SNPs offer unique benefits that help their members access valuable healthcare services.

The presence of chronic disease is often associated with unjust differences in social determinants of health (SDoH). Low-income individuals are at an increased risk for chronic disease and are more likely to have worse health outcomes due to unmet social needs, environmental factors, and barriers to accessing healthcare such as limited access to transportation. C-SNPs can play a major role in addressing healthcare disparities by offering personalized care approaches that meet the unique needs of chronic disease patients.

C-SNPs provide insurance to a relatively limited population, which enables them to curate highly-customized benefits—and be particular about their benefits partners—to make members feel seen and understood by their health plan. The Centers for Medicare and Medicaid Services approved the following 15 SNP-specific chronic conditions:

  1. Chronic alcohol and other drug dependence
  2. Autoimmune disorders (limited)
  3. Cancer, excluding pre-cancer conditions or in-situ status
  4. Cardiovascular disorders (limited)
  5. Chronic heart failure
  6. Dementia
  7. Diabetes mellitus
  8. End-stage liver disease
  9. End-stage renal disease requiring dialysis
  10. Severe hematologic disorders (limited)
  11. HIV/AIDS
  12. Chronic lung disorders (limited)
  13. Chronic and disabling mental health conditions (limited)
  14. Neurologic disorders (limited)
  15. Stroke

To best serve this population, C-SNPs provide comprehensive healthcare coverage that includes all the benefits of Original Medicare Part A (hospital coverage) and Part B (medical coverage) as well as Medicare Part D prescription drug coverage. C-SNPs also provide access to other benefits that aren’t typically covered by traditional Medicare plans including dental care, meal delivery, and transportation assistance. Additional benefits can make a significant difference for those living with chronic conditions—and for their family and/or caretakers—to have access to the right doctors, treatments, and resources.

Tech-Enabled Transportation Moves More C-SNPs Members to Care

As part of higher-acuity condition management, C-SNP beneficiaries are likely to have increased transportation needs to meet a higher volume of recurring primary care visits and specialist appointments. C-SNPs should tailor their non-emergency medical transportation (NEMT) benefit to meet the needs of individuals who may be too sick to drive, no longer have their license, or lack access to reliable transportation. However, many health plans are limited by the cookie-cutter benefit structures offered by traditional NEMT brokers that don’t have the necessary resources to provide flexible and personalized transportation services.

As a technology-enabled NEMT broker, SafeRide Health empowers health plans to cater to the specific needs and challenges of C-SNP beneficiaries. Our fully customizable platform helps C-SNPs structure the transportation benefit around their beneficiaries’ unique needs, not the other way around. One of the most meaningful customizations a health plan can make is to proactively identify and anticipate various ride needs based on demographic and health history. We can build customizations for beneficiaries based on treatment type, ride count, cost, distance, and necessary modality level of transportation.

C-SNPs also provide dedicated care teams and care plans tailored to the health needs and goals of each member based on their chronic disease, levels of mobility, and other factors like SDoH. Members typically have multiple people on their care team—including primary care physicians, specialists, nurses, case managers, and other healthcare professionals—requiring careful care coordination to manage a members’ condition.

SafeRide helps plans drive optimal member experience by allowing care providers, care teams, and/or family members to book rides if members rely on someone else to manage rides. In addition, the digital platform provides ride booking and adjustment capabilities across multiple channels (SMS texting, AI-powered phone calls, a mobile-friendly member portal, and our highly trained call center). This level of flexibility can improve member experience, and simultaneously, reduce complaints and grievances.

While studies show that having health insurance is associated with better health monitoring and improved access to health services, if the coverage or benefits are inadequate, an individual’s health can deteriorate over time. Having access to the appropriate healthcare services and benefits helps C-SNPs better manage members condition, improve overall health outcomes, and decrease associated costs.

With SafeRide, C-SNPs can manage transportation benefits with complete transparency using integrated and optimized solutions that help avoid fraud and waste risks. With highly coordinated care plans, C-SNPs can prevent expensive hospitalizations and other medical interventions, and ultimately help insurance companies reduce healthcare costs and provide access to more affordable healthcare coverage.

Keeping C-SNP Members Healthy

Access to transportation can improve quality of life for people living with chronic conditions. Given that the majority of MA plans offer a transportation benefit, what helps move the needle for C-SNP members is when their plans are intentionally designed with custom benefit structures to address their many unique healthcare needs. Everyone wins when C-SNPs partner with benefit providers like SafeRide Health to build and administer a transportation program to meet members’ specific needs with consideration to care pathways, frequency of visits, types of doctors, and more. For C-SNP members, having consistent and reliable access to transportation can make all the difference in keeping their chronic condition under control.

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