Impact of I-SNP Enrollment on Medicare Advantage Outcomes

The latest report by ATI Advisory, supported by the American Health Care Association and the National Center for Assisted Living, investigates the impact of Institutional Special Needs Plan (I-SNP) enrollment on healthcare outcomes for Medicare Advantage beneficiaries in long-term care. The 2023 study highlights improved outcomes, including reduced emergency department visits, hospitalizations, readmissions, and lower mortality risk among I-SNP enrollees.

The analysis leverages CMS's Virtual Research Data Center, comparing I-SNP enrollees to both Medicare fee-for-service and non-I-SNP Medicare Advantage members across crucial performance indicators such as utilization, quality, and spending. Findings reveal a 6% lower mortality likelihood for I-SNP participants versus their non-I-SNP MA and Medicare FFS counterparts, with positive impacts on health outcomes like pressure ulcers and infections.

Nisha Hammel of AHCA/NCAL emphasized the policy implications, suggesting that the coordinated care model of I-SNPs, integrating financing, care delivery, and clinical services, could significantly enhance the quality of care for seniors with complex medical needs. However, access to I-SNPs remains limited, with many nursing facilities and counties lacking these programs. The report calls for policymakers to address barriers to I-SNP access and consider expanding these plans to improve healthcare delivery for older adults.