When Commonwealth Care Alliance nurses visit Cynthia Monty’s home, she likes that they don’t talk rough.
Instead, the providers always ask about her cats and her art projects. The not-for-profit insurer’s employees ask what she needs. They never rush when taking her blood pressure. CCA paid for the 68-year-old’s walker, wheelchair and in-home hospital bed, which helps keep her feet elevated so they don’t swell up from chronic obstructive pulmonary disease while she sleeps. When Monty complained the bed was uncomfortable, CCA bought her a mattress cushion.
“I am just so thankful for CCA because I’d still be struggling if it wasn’t for them,” said Monty, a retired nurse’s aide from Boston who CCA connected to Modern Healthcare.
Monty is part of a small but quickly growing segment of the population made up of the nation’s most vulnerable patients: She is eligible for Medicare and Medicaid and is enrolled in CCA’s dual eligible special needs plan, or D-SNP.
While the rapid growth in general Medicare Advantage plans tends to get the most attention, D-SNPs are the driving force behind privatized Medicare’s increasing edge over the fee-for-service program.
During the past year, the number of D-SNPs on the market rose 16.4% to 703 plans, a growth rate more than twice that of general Medicare Advantage policies, according to Milliman. And in 2021, D-SNP offerings increased more than 10%. D-SNP enrollment rose 22% year-over-year to more than 4 million at the start of 2022, according to data from the Centers for Medicare and Medicaid Services.
Along with being the most vulnerable, dually eligible beneficiaries can be expensive. These enrollees made up 19% of the Medicare population yet accounted for 34%, or $275.9 billion, of Medicare spending in 2019, according to the most recent data from the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission.
As health plans’ and patients’ interest in D-SNPs grows, experts worry about the potential for financial wrongdoing. At the same time, a number of state and federal policy changes could result in fewer plans, raising concerns about market competition.
The shifting regulatory environment could further complicate the experience for beneficiaries, who are often left to navigate the two systems on their own, said Allison Rizer, a principal at ATI Advisory.
“We’ve created this complex set of programs for individuals who are some of the most vulnerable in our nation,” Rizer said. “They are the lowest-income, they have high rates of social need. They have high rates of functional frailty, they have a lot of medical conditions. And we’ve now put them in the middle of an amazingly complex system.”