Consumer Group Guide Highlights Benefits and Risks of Medicare Advantage Special Needs Plans

Boston, MA, February 29, 2008 - In a fragmented health care system where the sickest, frailest and most disabled individuals often receive inadequate care, well-designed and regulated Special Needs Plans (SNPs) offer the potential to deliver high-quality, coordinated services that address consumer needs, according to Community Catalyst, a national non-profit consumer advocacy organization.

In a guide released today, Community Catalyst’s SNP Consumer Education Project highlighted the SNP program’s promise: that specialized care for Medicare’s most vulnerable beneficiaries, many of whom also qualify for Medicaid, will also help to contain Medicare and Medicaid costs, By providing comprehensive appropriate care, SNPs can help enrollees with complex or chronic health care needs avoid unnecessary hospital or nursing home stays.

SNPs, a subset of Medicare Advantage (MA) plans, were established by the Medicare Modernization Act of 2003 to improve the quality of care for high-risk Medicare beneficiaries with multiple or chronic health needs. Most SNPs focus on individuals dually eligible for Medicare and Medicaid; about 7 million people currently qualify.

Community Catalyst also stressed the importance of appropriately designed benefits and health delivery structures, strong oversight, and enforcement capability. “Without these key elements, SNPs may come to represent a lost opportunity to address one of the thorniest issues in health
care policymaking: how to meet the needs of the minority of individuals who account for the majority of the nation’s health care expenditures,” cautioned Project Director Renée Markus Hodin.

The guide comes as state officials express growing concern about increasingly burdened state economies and federal rules that would add to states’ Medicaid costs. “The federal government should not look to shift additional costs to states. Instead, it should work with states to promote innovative, improved, coordinated care for the most vulnerable populations and share in resulting savings,” Hodin added.

Prepared with support from the Henry J. Kaiser Family Foundation and the Retirement Research Foundation, the guide is meant to inform health access advocates, policymakers and SNPs themselves as they work to improve quality for SNP enrollees. The guide includes promising practices for coordinating care and models for integrating Medicare and Medicaid benefits.

View the Medicare Special Needs Plans: A Consumer Advocate’s Guide to Opportunities, Risks, and Promising Practices.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization working to build the consumer and community leadership that is required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst has provided leadership and support to state and local consumer organizations, policymakers, and foundations working to change the health care system so it serves everyone – especially vulnerable members of society since 1997. For more information, visit www.communitycatalyst.org.


About the Special Needs Plan (SNP) Consumer Education Project
The Special Needs Plan Consumer Education Project seeks to educate state and federal payers, advocates, health care providers and the public on the opportunities and risks that come with SNPs. Along with education, this project promotes best practices that enhance patient care within a state’s health care framework. Funded by the Retirement Research Foundation, the SNP Consumer Education Project is an initiative of Community Catalyst.

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