Opportunities in the D-SNP market: Essential insights for MA leaders

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Hello and welcome to today's webinar, Thriving in the Evolving D SNP Market.

 

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Essential Insights for MA leaders.

 

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Before we get started, I'd like to review a few housekeeping details.

 

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Today's webinar is being recorded and an online archive of today's event will be available within one to two business days.

 

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If you have trouble seeing the slides at any time during the presentation, please press F5 to refresh your screen on APC or Command R if you're using a Mac.

 

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You may ask a question at any time during the presentation by typing your question into the Q&A box located on the right side of your screen and pressing Enter.

 

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And finally, I'd like to remind you of a HIPS antitrust statement located in the link just below the slide viewer.

 

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We will, as always, comply with that statement.

 

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Among other things, the antitrust statement prohibits us from discussing competitively sensitive information.

 

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We're very fortunate to have with us today Miss Corey Leach, Vice President of Medicaid Product and Strategy at Optum Home and Community and Mr.

 

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Jared Landis, Vice President of Health Plan Research at Advisory Board.

 

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At this time, I'd like to turn the floor over to the speakers.

 

1:12

Hi, everyone, welcome.

 

1:13

I'm Corey Leach, nice to meet you all.

 

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I'm a registered nurse.

 

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I have over 15 years of experience in dual populations, including health and operations, clinical operations, model development and strategy and growth.

 

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And I am very passionate about ensuring our vulnerable populations receive seamless, comprehensive and quality care that improves their health and safety in the community.

 

1:39

Corey Hi everyone.

 

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Jared Landis, vice president over a health plan research within advisor board.

 

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If you're not familiar with advisor board, we are a strategic insights market intelligence research firm that's been around for last 40 plus years.

 

1:55

Goal is for my team to serve the health plan strategy function Chief strategy officer.

 

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We do that through a significant the amount of coverage related to line of business dynamics.

 

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And so we'll be bringing some of that in combination here with Corey today to you as we look at the D Snip market.

 

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I'm going to take us through the 1st portion of the material here and then we'll turn things over to Corey to share her expertise when we get into the real nitty gritties related to success within the D Snip space.

 

2:33

So quickly, just want to Orient you to what we'll be covering in our time today.

 

2:38

So Section 1 all provide an overview of D Snips, what the D snip landscape looks like today, ensure that we're all working from the same set of information there.

 

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We'll spend the majority of our time in Section 2 talking about four primary challenges that we see health plans facing in the D snip market right now and for the immediate future, as well as diving into the steps health plans can and should take to overcome these challenges.

 

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And then lastly, we'll have some time available at the end for Q&A.

 

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And so you can feel free to submit questions into the Q&A box throughout the webinar and we'll get to as many of them as we can at the end.

 

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With that, let's go ahead and get started from the registration list.

 

3:27

I know we have a mix of individuals on the line today, so for some of you, I'm preaching to the choir here, but for others on the line, it's important to establish a baseline level of familiarity with D SNPs.

 

3:39

So for those of you on the line looking for the two O 1 or the three O 1 information, I promise it's coming shortly, but I do want to get everyone on the same page upfront.

 

3:50

So the most basic D SNPs here talking about today are dual eligible special needs plans.

 

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They are one of three types of Medicare Advantage special needs plans, institutional special needs plans, Isnips or chronic condition special need plans.

 

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C SNPs being the other.

 

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These are Medicare Advantage plans that are designed for individuals with specific needs or health conditions.

 

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People are eligible to enroll in a dual eligible special needs plan AD snip if they are eligible for both Medicare and Medicaid and if you're not familiar, if that sentence didn't make any sense, these patients are commonly called dual eligibles or duals, folks that are eligible for both Medicare Advantage or Medicare and Medicaid.

 

4:41

When compared to the broader Medicare Advantage population, these individuals D SNP individuals tend to be older, have more chronic conditions and comorbidities and have greater social determinants of health needs.

 

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D Snips are by far the largest of those Medicare Advantage special needs categories.

 

5:02

Different plans that I just mentioned.

 

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D Snips comprise roughly 88% of the SNIP market at the end of 2024.

 

5:10

Almost 6,000,000 beneficiaries enrolled in D Snips in 2024 compared with 675,000 or so individuals in C Sips and ISNIPS institutional special needs plans, that number is around 115,000.

 

5:26

So D Snips, the vast, vast majority of the special needs plan market across all special needs plans, we've seen tremendous growth in recent years.

 

5:37

You may have seen some highlights in particular related to C SNP growth from, you know, 23 to 24, but the D SNP growth has really been a little bit of a longer term and much larger trajectory than either Isnips or C SNPs, as you can tell from the aggregate numbers that I just mentioned.

 

5:56

But just to put that in context, 10 years ago there were just around 1.5 million patients enrolled in these plans.

 

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And we'll talk a little bit more about some of the trends driving that enrollment as well as the, you know, potential market, if you will, in terms of number of individuals that could be eligible for D SNP participation but are not currently enrolled in AD SNP program.

 

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What makes D steps different from other MA plans?

 

6:24

That's kind of our middle column here on this slide.

 

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Special needs plan.

 

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D SNPs are intended to facilitate the coordination of an individual's Medicare and Medicaid benefits.

 

6:36

We'll dive into, you know, some of what this looks like as we go along here today.

 

6:41

But accordingly D SNPs are able to offer some enhanced or additional benefits that not available different kind from individual MA plans.

 

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And then on the right hand side of the slide, you can see in the blue box a few definitions of some subsets of the DSNP market.

 

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We won't spend a ton of time on these different groupings today.

 

7:05

They will come up periodically throughout.

 

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But I just want to note up front here, DSNPS are not monolithic.

 

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There are those that just coordinate benefits, aptly named coordination only plans and those that integrate benefits under a single contract.

 

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This will become more important when we talk through some of the regulatory changes.

 

7:25

So as I said, won't spend a ton of time on that, but it will be relevant to certain points of the conversation.

 

7:32

With that overview, let's go ahead and turn now to see why we're seeing increased interest in D Snips from the health plan perspective.

 

7:41

My team at advisor board, right, as I kind of, you know, alluded to in, you know, my introduction, we are researchers at the end of the day.

 

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And so we conduct dozens and dozens of interviews with health plans on an annual basis about their corporate strategy, their growth ambitions.

 

7:59

Medicare Advantage has been a theme of those conversations, you know, every year for years at this point.

 

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But in the last 12 to 18 months, virtually every conversation that I have with a health plan about their growth ambitions includes, you know, increased interest in the D SNP market, whether that's related to starting a plan or expanding their existing plans.

 

8:22

A few reasons driving this interest that we've laid out here on this slide.

 

8:27

The 1st is how D SNPs fit in the larger conversation about Medicare Advantage enrollment.

 

8:34

Big picture as you think about the Medicare Advantage market, we have seen both a slow down in terms of the growth rate number you know of traditional Medicare beneficiaries converting to Medicare Vantage on an annual basis and you have also seen you know saturation.

 

8:53

Hyper competition is the term that we tend to use as far as health plans looking to grow in that you know individual Medicare Advantage market.

 

9:04

Accordingly, given that hyper competition and the difficult growth trajectory there, we have seen plans pivot and target D Snips as their next opportunity for growth.

 

9:18

An extreme example of that is Anthem's recent announcement around their intent to pull back from individual MA plans focused solely on D Snip enrollment for the rest of 2025.

 

9:30

Relatedly, the health plan's executives believe this growth is possible because many estimates indicate that dual eligibles are currently underserved by the D SNP model.

 

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Recent estimates indicate that only about 30% of eligible duals are actually enrolled in D SNP.

 

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So from a health plan perspective, there's certainly room to grow enrollment.

 

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Then in the middle second here, given de snip focus on care coordination for complex patients, they present an opportunity for plans to meet CM s s increasingly strict requirements related to quality value.

 

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A belief among the plans that we talked to that the higher touch de Snip model is an opportunity for strong stars performance.

 

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You'll even hear mention of a potential Halo effect around how D Snip success can trickle out across the rest of a plan's Medicare Advantage infrastructure.

 

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Lastly, reasons plans are targeting D Snip growth is higher margin potential for D Snips compared to other Medicare Advantage products.

 

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The average margin for MA plans and or excuse me, the average margin for dual eligible plans in 2022, seven and a half compared to 3.6% for all MA plans.

 

10:49

You will note I should call out that I said margin potential, that's important.

 

10:55

Success is not guaranteed with these SNPs.

 

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Plenty of health plans have tried to enter or be successful in the D SNP market and we're not able to.

 

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This is a complex patient population so you do have to be thoughtful in your plan design and roll out.

 

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So how can you best set yourself up for success?

 

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Yes, and that's kind of a segue into the rest of our conversation here today.

 

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As we look at the De Snip market, I would argue there are four primary challenges right now that plans need to overcome.

 

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We'll spend the rest of our time double clicking on each of these quickly to top line them.

 

11:32

However, first we'll look at the evolving regulatory environment for any government sponsored insurance model.

 

11:39

Regulatory compliance is key, but the D SNP space is particularly active as we'll talk about.

 

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Corey will then take us through the remaining three challenges, creating appropriate care models to address the needs of duals, integrating and coordinating care and benefits and lastly, engaging duals in both enrollment and ongoing member services.

 

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We'll walk through each of these challenges in turn, giving a bit more detail as we go into some of the opportunities and some of the necessary steps health plans must take to overcome the challenges as well.

 

12:10

Go ahead and get started.

 

12:13

Here I'll cover our first challenge, the actively changing regulatory environment for D SNPs.

 

12:20

By far the biggest regulatory change right now involving D SNPs came in the 2025 final rule.

 

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CMS set out a mandate to move the D SNP market toward exclusively aligned enrollment.

 

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That is where Medicare, excuse me, Medicaid benefits for full duels must come from the DSNP or its affiliated Medicaid plan.

 

12:41

This change will take place over time.

 

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The first big milestone will come in 2027, by which full duels will be required to join a DSNP that has an affiliated Medicaid plan.

 

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The second milestone is 2023, where D SNPs must have an affiliated Medicaid plan or disenroll full doles.

 

13:02

This is a big change, especially for health plans who offer D SNPs but not Medicaid plans in the same state.

 

13:10

These changes will roll out slowly over the next few years, and we'll have some variation.

 

13:16

There might be some changes to that, you know, underlying dynamic as we go along, but plans will have to make important decisions as these deadlines approach.

 

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And they'll have to make these decisions, you know, well in advance of the actual deadlines themselves.

 

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You can see the options for plans that currently do not have an affiliated Medicaid plan on the right side of the slide here along with potential ramifications of each choice.

 

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Plans can start or acquire a Medicaid plan.

 

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They can choose to stay in the market as a coordination only DSNIP or they can exit the DSNIP market altogether.

 

13:53

That may sound strange as I talked about, you know the growth potential here earlier, but we are seeing health plans right now make choices related to product rationalization as a means of stabilizing margins.

 

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And as mentioned earlier, margin success is not guaranteed or easy with D SNPs.

 

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So for organizations struggling to succeed, this may be a natural exit ramp or maybe an opportunity to find a partner who can really help you, you know, accelerate and avoid, you know, that that option of exiting the D SNP market.

 

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At the end of the day, this regulatory shift is going to bifurcate.

 

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The market will likely see some D SNPs focusing efforts on full duels through exclusively aligned enrollment, while others focus on partial duels through those coordination only plans.

 

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So what can MA plan leaders do?

 

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It's likely that we'll continue to see regulatory changes and pressures as D SNPs grow.

 

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Two key strategies to think about as you're looking at the changing regulatory environment here for D SNPs.

 

15:03

First, need to pay attention to those states that have been early adopters in integrating Medicare and Medicaid benefits through D SNPs.

 

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18 states have already implemented fully integrated programs ahead of the new CMS rules.

 

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Especially if you are in an adjacent state.

 

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Learn from successes, failures of these early aligned plans.

 

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Second, now is the time, if you haven't already, to nurture relationships with your state Medicaid agencies.

 

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Building these partnerships can facilitate communication, collaboration, ideally lead to smoother negotiations.

 

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That's going to be a really important dynamic going forward in the regulatory space.

 

15:45

That wraps up the end of my remarks.

 

15:48

And the first challenge here related to the regulatory environment associated opportunities, recognize that, you know, we're covering some complex stuff and moving quickly.

 

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So again, just a reminder, you know, feel free to put questions in the Q&A box and we'll circle back to those later.

 

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But otherwise, Corey, I'll see the floor to you.

 

16:10

Thanks, Jared.

 

16:12

So the second challenge we're going to talk about is care models for DSNIP, how to create a model that addresses the needs of these dual populations in a comprehensive way.

 

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Care models that bring together the Medicare and Medicaid networks and services to provide a seamless experience across the continuum of care are really key to successful outcomes for decent patients.

 

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As Jared mentioned earlier, these dual eligible patients have very complex needs and they have social determinant of health needs.

 

16:40

So they really require tight and seamless coordination of care across all of the benefits available to them, Medicare and Medicaid, in this case.

 

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On the slide here, we have 4 focus points for successfully doing this.

 

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I am going to walk through them all clockwise, starting at the top.

 

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As Jared mentioned earlier, there's a lot of information and we're going to be moving quickly.

 

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So please feel free to put questions in the chat.

 

17:03

At the top here, we're talking about having adequate networks.

 

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So there can be a lot of misalignment between the Medicare and the Medicaid networks.

 

17:11

We need to work on creating a comprehensive network that addresses the needs of the population and overcomes the geographical challenges.

 

17:19

Second here over to the right and critically important is an emphasis on a whole person care model, ensuring that our models are including personalized care planning, interdisciplinary care teams and they're working together to coordinate the different benefits that focus on the individual's needs.

 

17:36

Down at the bottom, ensuring we're compliant with regulations and meeting oversight expectations of federal and state contracts.

 

17:42

Jared mentioned earlier, this is a complex space.

 

17:45

There's a lot of regulations.

 

17:47

The regulations and oversight focuses can shift and change market to market year over year.

 

17:53

CMS focus of late has been really on coordination of care for patients and managing STOH, social determinant of health needs and then making sure that our beneficiaries are satisfied with their experience in the plan.

 

18:07

This sounds simple.

 

18:08

This is very complicated because just when you think you get it, they change it.

 

18:12

So just always keeping an eye on what's going on.

 

18:15

Jared mentioned earlier, staying connected with your local state Medicaid agencies.

 

18:19

They often give a heads up on things that might be coming.

 

18:22

It's a good way to make sure you're staying on top of those regulations.

 

18:26

And lastly, over on the left hand side, working with network partners, making sure they understand how to best care for these dual populations in our PCP space, you're going to have a varying level of ability to successfully manage these population health needs.

 

18:40

And we need to meet them where they are and arm them with education and support so they can care for the patients, coordinate the care and make referrals to community based organizations to meet the needs.

 

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There we go.

 

18:54

So by engaging our community partners and PCPS, D SNPs can improve patient experience and really succeed as plans.

 

19:00

We all know that our community based organizations are going to have the most experience on what's locally available from a resource and opportunity perspective to support our patients.

 

19:09

So we have to work closely with them, help bridge care gaps and identify correct interventions for our enrollees.

 

19:16

Another important step is focusing on our community PC.

 

19:18

PS I mentioned earlier that you're going to have varying levels of experience and ability to manage the population for in the dual space and they're often the first point of contact for our dual's members.

 

19:30

So it puts them in a really good position to identify needs early and deploy care to prevent disease escalation and downstream healthcare utilization for any unmanaged conditions.

 

19:42

We really need to support the PCPS.

 

19:45

We have to give them education.

 

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We have to share data with them, potentially set up financial incentives to really empower them to best support our patients.

 

19:53

So for example, in our DC market, we have an integrated decent population with really robust LTSS waiver requirements.

 

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And we work very, very closely with the PCPS.

 

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We educate them on the different benefits that are available.

 

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We've even created a direct communication channel so they can work directly with our care team when they identify needs.

 

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And this helps remove some administrative burden for them when the patients need access to those LTSS benefits.

 

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It also limits delays in our care team being able to get patients access to those benefits because we're being notified right away and it ensures our patients needs are being met expeditiously to improve outcomes.

 

20:30

So though I can't say enough about how important those relationships are between the health plan and the care teams that the health plan and the network PCPS and community orgs.

 

20:40

So for our next challenge, our third challenge, we're going to talk about integrating and coordinating benefits.

 

20:46

So we've been alluding to this kind of throughout our presentation.

 

20:50

What do we really mean?

 

20:51

Why is this so hard?

 

20:53

Well, it's super important to call out.

 

20:55

This is challenging.

 

20:57

You are bringing together 2 completely different systems.

 

21:00

You're bringing together Medicare, it's one whole system and Medicaid another whole system.

 

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1 is federal, one is state.

 

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They operate differently.

 

21:09

They're funded differently, they have different rules, they have different regulations.

 

21:14

It varies state to state.

 

21:15

It changes year over year.

 

21:17

So it's very challenging, but it's really important because if AD SNP is not coordinating well across all of these spaces, it can result in service duplication and potentially unnecessary spending.

 

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Nobody wants that.

 

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It can also impact our patients and our providers negatively.

 

21:33

Fragmented care without coordination is very frustrating to patients.

 

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It delays us being able to meet their needs.

 

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It can result in them seeking out higher cost settings for their needs, like an Ed.

 

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Another thing we want to try to avoid for providers, the lack of coordination on behalf of the DECENT plan puts the burden on them to navigate these complex rules, these coverage details, and they really struggle with this from a resource perspective and a time allocation perspective.

 

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So that just creates additional challenges, additional care gaps, more service duplication and further fragments the care.

 

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And really we just end up in this vicious cycle.

 

22:10

So being able to coordinate that care as a plan is hugely important.

 

22:17

And it yes, it is difficult, but it is achievable.

 

22:21

There are many opportunities in this space.

 

22:23

I really want to focus here on technology and process for streamlining for DSNAP.

 

22:28

So leveraging technology in the right ways can cut across legacy platforms and businesses that today support Medicare and Medicaid separately.

 

22:38

I'm not going to walk through all the examples on this slide, and there's many more outside of what we have here, but I want to kind of prompt you to think about a couple of things.

 

22:45

So first, using technology to support the exchange of data and information.

 

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Sometimes we can do electronic record interoperability and make sure that data that's captured in one health record is getting into another and vice versa.

 

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So we have a comprehensive set of information on the patients we're managing.

 

23:04

Another way is using analytics to identify and monitor care that's being given to our patients, and then making sure that data is shared across from providers to the care teams at the health plan.

 

23:15

Another thing we want to think about is how we can leverage technology to assess and refine existing workflows.

 

23:21

So processes like prior authorization or claims processing, they can really benefit from technology to boost efficiency and bridge different gaps across platforms that may not communicate with one another today.

 

23:35

So a powerful example I have of technology benefiting a decent care model is in our model, we ensure that our caregivers and our community service providers can give information on patient condition and changes, changes in condition, sorry, to our care teams and our PCPS.

 

23:52

The caregivers in the community are really the eyes and ears of what is going on with our patients.

 

23:57

They are there, they are in the home, they see them every day sometimes.

 

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And having a path for them to share the information to our care teams and our network providers allows all of us to work together, take action in real time, and address any changes in in condition by coordinating benefits to meet their needs in the moment when it's needing to be met before it escalates.

 

24:21

So finally, our fourth challenge, engaging our duals in enrollment and member services.

 

24:27

This is the final challenge we're looking at today, but it is by no means the least important.

 

24:32

Enrolling and engaging members throughout their care journey is essential to success in this space.

 

24:37

Jared mentioned it earlier and I'm going to repeat it because it's really important around only around 1/3 of individuals who are dual eligible are enrolled in a decent plan.

 

24:48

Only 1/3.

 

24:49

So that means 2/3 of people who could be enrolled in DSNP and could benefit from the coordination and support of DSNP are without that help today.

 

24:59

There's many reasons for this low saturation, but I think to address it, we really need to start differentiating DSNP for people who are facing the complicated navigation of all the options out there.

 

25:10

Medicare, Medicare Advantage, Medicaid, all of these things are out there.

 

25:14

They may not understand it.

 

25:16

How do we make DSNP attractive to them?

 

25:19

So for a long time, DSNP has had value based insurance design or B bid as an opportunity to offer additional benefits based on socioeconomic status.

 

25:27

As that program is ends, we're faced with finding other ways to reach these enrollees and show them the benefit of AD SNP over other plans.

 

25:36

Once someone enrolls, the challenge doesn't end.

 

25:39

So CMS has a new rule that allows fully dual enrollees to join or change AD SNP every single month, which means as soon as they enroll, we've got to try to engage them and ensure they're satisfied with their experience.

 

25:51

It's more important than ever so that we can maintain these individuals and keep getting them the care they need.

 

26:00

There are a number of things D SNPs can do to focus on awareness and enrollment.

 

26:04

The biggest one I think is really demystifying D SNP for potential enrollees.

 

26:08

It's confusing.

 

26:09

They may not understand all these options.

 

26:11

So how do we partner with brokers who are the main way seniors choose their Medicare and Medicare Advantage plans?

 

26:17

To make sure brokers understand and can clearly communicate to individuals looking to enroll what they are enrolling in and why one thing may work better for them than another once a member is enrolled.

 

26:29

Secondly, we need to customize our member support.

 

26:31

So I mentioned earlier that we really want to make sure we're getting these individuals engaged once they enroll and keeping them satisfied with their experience because now they're going to be able to move month to month.

 

26:41

So we want to create a smooth experience.

 

26:43

We want to try to build trust and loyalty with members.

 

26:46

We want it to be seamless and easy for them to work with us and for them to feel like they are getting what they need and they're satisfied with how it's going.

 

26:54

And finally, around member materials, we need to make sure they're simple.

 

26:59

Easy to understand, promoting health literacy, not complicated, not confusing.

 

27:04

Easy, easy, easy.

 

27:06

Let's make this as seamless and easy for them as possible.

 

27:08

Because at the end of the day, when members see the benefit they're receiving and are happy with the ease of their experience from an integrated decent model, they're more likely to enroll and more likely to stay enrolled.

 

27:24

So we're at the end of our four challenges.

 

27:26

I know we went through that very quickly.

 

27:27

So please don't be afraid to ask questions.

 

27:31

I do hope we kind of sparked some ideas for you and your organization's.

 

27:36

Before we take any questions, I'm going to quickly recap the four things we went through.

 

27:39

So when we're looking at the de Snip landscape in 2025, we see four key challenges and many associated opportunities focusing on regulatory shifts like Jared talked about tracking the early adopters, working with state Medicaid agencies so we can navigate these shifts, be aware of them and be ready to respond to them.

 

27:59

Whole person care models, I can't say enough about how important this is.

 

28:03

Leveraging our partnerships with the community based organizations and PCPS, bridging care gaps, ensuring that we're really addressing individuals where they are.

 

28:15

It's a seamless experience for them as their needs change.

 

28:19

It's being addressed as in as real time as possible.

 

28:23

Third, care fragmentation.

 

28:25

So how can we use tech to our advantage?

 

28:27

There's this great technology out there.

 

28:29

It's changing and advancing all the time.

 

28:31

How do we use that to optimize our processes?

 

28:34

How do we use that to share data and create a seamless care experience across the continuum?

 

28:39

And then member enrollment and utilization, prioritizing that outreach, making sure individuals understand their options, understand the benefit that decent programs can bring to them as an individual and as a consumer of healthcare in this country.

 

28:53

And then really engaging them in the process and making sure they're feeling satisfied with their experience.

 

29:00

So I'm going to hand it over for some questions.

 

29:03

I think the moderator has that for us.

 

29:06

Thank you so much, speakers.

 

29:08

And at this time, we're going to address some questions that came in during the presentation.

 

29:13

And our first question is if members can switch these snips monthly, what tactics are being explored for retention?

 

29:24

Yeah, Corey, I mean, I'd love for you to chime in on this as well, but right, I think there's probably 2, you know, veins that come in, you know, to mind for me.

 

29:37

So 1 is in terms of kind of, you know, communication and outreach generally, right?

 

29:43

So ensuring that, you know, via, you know, the channels that the health plan has available to them, that they are proactively communicating the appropriate and necessary messages to the, you know, enrollee.

 

30:00

And then I think the second is those direct interactions that they are having, you know, with the caregivers and the care team and you know, leveraging those, again, making sure that the plan has, you know, a plan for what they, you know, need and want to be communicated to the enrollees.

 

30:19

So I think it's kind of, you know, broad communication strategies.

 

30:22

You need to be good on that front in this market, but you also do have these closer, you know, high touch relationships that you may not have, you know, in the traditional market.

 

30:33

And so you want to leverage those as well.

 

30:35

And you kind of, you know, bifurcate efforts across those.

 

30:38

Corey, I, I don't know if there are other things you're saying or things you would want to add.

 

30:43

No, I agree with you.

 

30:44

I think it's all about engagement and experience and engagement.

 

30:49

You know, it's not just something that you're a new member.

 

30:51

You're, you just enrolled and I'm going to try to engage you now and I failed and so I'll send you a letter and say, whoops, sorry, tried to reach you.

 

30:59

Engagement should be actively and trying to engage and actively keeping individuals engaged throughout the care continuum.

 

31:07

These are aging populations.

 

31:10

They're in the Medicaid space, so their needs are going to change as they continue to age, as their conditions progress.

 

31:17

Maybe they don't want to talk to me today, but maybe in six months they need to talk to me.

 

31:22

Things have gotten worse.

 

31:23

Something has happened.

 

31:25

You know, they have a family member who used to help them who no longer can.

 

31:29

So continuing to try to engage them and support them.

 

31:32

So once they're engaged, they have a positive experience and we're making this easy for them and we're meeting their needs and that will help people want to stay with their plan, but developing those relationships and developing that trust throughout the experience.

 

31:48

Thank you.

 

31:49

Our next question is, why do many dual eligibles not enroll in D Snips?

 

31:57

Well, Corey, I feel like you addressed this to a degree already.

 

32:01

So maybe I'll say the same thing, but different.

 

32:06

And I think, you know, it is at, you know, the top level, right?

 

32:14

It's just a consumer awareness issue.

 

32:17

I mean, you've got to think, you know, right, like we're starting the funnel with traditional Medicare versus Medicare Advantage and they're working through those decisions.

 

32:26

And then you're finding, you know, a niche product, decent product within the Medicare Advantage space.

 

32:32

And so there's a lot of consumer awareness and education that, you know, is required here.

 

32:39

But I think, you know, if you have that kind of funnel in your mind also that brings up what, you know, Corey mentioned earlier related to brokers and their, you know, importance and involvement, right?

 

32:52

I am blanking on the numbers off the top of my head, but you know, the majority of Medicare Advantage enrollees continue to do so through brokers.

 

33:01

And so those relationships remain, you know, incredibly important.

 

33:06

And even though we have seen, as I mentioned upfront, you know, meaningful sizable growth in terms of de snip market over the last decade, it's still, you know, a lesser known model as compared to, you know, individual traditional Medicare Advantage from a broker perspective.

 

33:26

And so you've got that broker angle too, which is, you know, I would say like both, you know, just kind of this similar awareness problem is what we're talking about with consumers.

 

33:40

But also just the practical, you know, is the broker equipped to identify, you know, whether the individual's eligible for D SNP?

 

33:51

Do they have, you know, the same level of familiarity and awareness of the D SNP products and plans in their market?

 

33:58

And so you know, the, the practical aspect of, you know, even if you are aware, you know, can you as a broker do what is necessary to you know direct that individual appropriately towards a decent model?

 

34:14

Great.

 

34:14

Thank you both and thank you for the question.

 

34:15

Our next question is, do you have any examples of states that have embraced fully integrated decent programs?

 

34:24

Sure, I'll take that.

 

34:26

There's several states that have done this.

 

34:28

You know for example in Minnesota, they have senior health options.

 

34:32

It's been around for quite some time.

 

34:34

It's all of the benefits into one program.

 

34:38

I don't know if you guys are familiar with these terms, but there's Fighty and Heidi fully integrated D SNP ID is highly integrated D snip.

 

34:45

And basically it means there is one contract that is inclusive of the Medicare and Medicaid requirements, benefits and programs.

 

34:52

So in Minnesota, they have the ability to offer zero premium deductibles, cost sharing.

 

34:58

They have one ID card.

 

35:00

They have that ID card is for everything, Medicare, Medicaid, prescription drugs.

 

35:05

So it's a really holistic approach and there are several states that have done this and are on the path to doing this.

 

35:10

And really, I feel like the outcomes are so much better for the individuals.

 

35:15

They're able to have this streamlined administrative process.

 

35:19

They're not trying to call one phone number for their Medicaid benefits, another phone number for their Medicare benefits.

 

35:24

They're not dealing with two different groups of providers.

 

35:27

Sometimes the networks are different.

 

35:29

So it really brings it all together into one place.

 

35:33

And from a regulatory perspective, and Jared talked about this early on in our presentation, that's one of the reasons that, you know, CMS is kind of saying, let's try to do that, let's try to make this a little easier.

 

35:43

Let's keep them with one contact for all of these things, make sure that people can more easily access their benefits across the two different contracts.

 

35:55

Our next question, how do D snips improve care coordination for dual eligibles?

 

36:03

Well, Corey, I feel like that's what you live and breathe and you know the, you know, big focus for optimum home and community.

 

36:12

So I think I'm going to step back and let you handle that one.

 

36:17

There are many ways that it improves the coordination.

 

36:21

I think you know, Jared mentioned early on, there's several different types of D snips, right?

 

36:24

There's coordination only D snips, then there's integrated D snips.

 

36:27

I talked about two of them just a minute ago, Heidi and Fighty.

 

36:30

But regardless of if you're an integrated D sniper, a coordination only D snip, you're required as an entity, as a program, as a product to coordinate for Medicaid.

 

36:41

So anytime you have an individual you're working with, even if you're a coordination only D SNP and you've identified that they have this need to access additional benefits through their Medicaid program, you're focused on coordinating that need.

 

36:54

I think in an integrated place, the way that it really makes a significant difference is your teams are trained on and able to empowered to access all of the benefits that these people can get.

 

37:06

So now you're looking at everything they could need, everything they could have, and you are empowered to get them access to that, whether it's directly through the provider of that benefit or whether it's through connecting them to a community based organization or APCP to access those benefits.

 

37:24

You're really able to wrap all of the care around them as opposed to kind of focusing on one or the other or having to work with another entity to coordinate that those pieces.

 

37:34

And it improves the care because you're holistically addressing the needs.

 

37:38

You're not just focused on physical health or just focused on mental health.

 

37:41

You're focused on everything.

 

37:43

Social determinants of health, physical health, mental health, functional status, your ability to manage your AD LS, your IAD LS.

 

37:51

Sorry if I'm speaking Greek, but it's really a holistic approach to supporting the individual from a health perspective, from a safety perspective and from an independence perspective.

 

38:06

Thank you.

 

38:07

And our next question is what does CMS look for in model of care reviews?

 

38:16

I can probably, oh, I, I can probably top line, probably the top line that I, I will admit, you know, I'm not intimately familiar, but that is a, you know, very technical question that right, The information exists and we can dig into that.

 

38:35

But you know, the high level based on what I can, you know, speak to without, you know, copious notes in front.

 

38:43

First and foremost, plan describes how it will identify and verify enrollees.

 

38:49

This includes, you know, demographics, unique characteristics of the D SNP population.

 

38:55

Second, the plan must define how it will coordinate care.

 

38:59

As we've been talking about that includes staffing, care management, efforts to work with the community, third, provider network and how it meets the needs of dual populations.

 

39:10

And then 4th, the quality measurement and performance improvement, you know, components that exist within the model of care.

 

39:19

So it's those 4 categories are kind of top line.

 

39:24

And then like I said, given that that is a kind of technical factual quite not kind of it is a technical factual question, you know, you can track down in more detail any any of those individual categories.

 

39:40

Thank you.

 

39:40

Our next question says first, thank you both for taking on this topic.

 

39:45

Jared, you mentioned the shift from historical DSNP growth to now slowing DSNP growth and increased CSNP growth.

 

39:52

What is driving that shift?

 

39:56

Yeah.

 

39:56

So I think, you know, important to put that within context, all the right, the growth, the slowing growth, if you will or the you know.

 

40:09

Weakening growth for C Snips, if you will.

 

40:12

When I, you know, I'm speaking about that, I'm speaking about percentage growth.

 

40:16

And so right, part of that is just the fact that as you know, the D snip market becomes larger, it requires a larger number of individuals for that growth rate to continue, right?

 

40:27

And when you're comparing, you know, 6,000,000 almost individuals in the D snip market and you know, now 675,000 ish folks in the seas to Margaret, right?

 

40:39

It's just, you know, when you, when you talk about the, you know, the denominator that you're working off those growth rates, you know, can look, you know, different just because of that.

 

40:49

So I think that's important to keep in mind, you know, and then, you know, in aggregate, you know, D SNP growth did slow this year compared to the previous couple of years still, you know, 6% I believe in 2024 growth rate.

 

41:06

So you know that growth does still continue to exist.

 

41:09

And like we talked about, there's ample, you know, eligible individuals out there on the C SNP side.

 

41:16

I think that is a little bit of the dynamic that I was speaking to related to Medicare Advantage growth.

 

41:23

You know, in general, it is, you know, the organization's looking for growth in Medicare Vantage, trying to identify what the next frontier is.

 

41:33

And so if you look at that C snip growth, you know, similar to traditional Medicare Vantage, first, similar to it, you know, D snip second, it's United and Humana are the ones who are out there, you know, in front capturing that growth and, you know, skating where the puck is or will be, you know, as the phrase may go.

 

41:54

So it's some of that dynamic.

 

41:57

The thing that big picture will be interesting to watch with C snips is obviously with Secretary Kennedy, RFK junior over top of HHS.

 

42:10

Now he has, you know, significant interests and passion towards the, you know, chronic disease dynamics in this country, chronic disease populations.

 

42:21

And so, you know, I don't want to, you know, project or speculate too much, but it's not hard to see a world where, you know, sneeze snips, you know, receive a significant amount of tension under his administration as a result of that.

 

42:36

You know, I think in many ways that could be a good thing to align, you know, his views with the healthcare industry's views.

 

42:46

Not to get too political.

 

42:48

I think there's great alignment that the chronic disease, you know, dynamics and you know, conditions need to be addressed in our country.

 

42:56

I think there tends to be a bit of misalignment in terms of RF KS approach to how he wants to address that and what I, you know, talk about with healthcare organizations in terms of their views related to evidence in addressing those dynamics.

 

43:10

So CSNIP market will be an interesting one to watch and might be a good place to find alignment between, you know, secretary and you know, health plans and providers in the market.

 

43:24

Thank you so much.

 

43:25

And our next question is what will be changing about open enrollments for D Snaps?

 

43:37

Yeah.

 

43:37

So again, I can kind of top line that.

 

43:40

And then Corey, if you have anything else, So CMS introduced new integrated care special enrollment periods in the 2025 final rule.

 

43:51

We covered a lot today.

 

43:53

I can't remember.

 

43:53

I think we said that somewhere along the lines.

 

43:57

These special enrollment periods allow fully eligible duels to enroll or switch D snips monthly rather than previously, you know that quarterly enrollment periods.

 

44:09

And so CM s s goals there are increased flexibility to improve access and satisfaction among duals by providing them control and choice in that space.

 

44:20

And you know, Corey did talk about, you know, the need to right engage, you know, beneficiaries and you know, a really consistent ongoing fashion as part of that given that, you know, monthly dynamic or that quarterly dynamic shifting to monthly.

 

44:38

And so that's the piece there.

 

44:43

I think from what we've seen from the moderators in the chat, I think that's all the questions that we have in today.

 

44:54

So, you know, with that, I think Corey and I will, you know, make our closing arguments, if you will.

 

45:00

So from my end, first and foremost, just want to say thank you to everyone for taking time out of your day.

 

45:07

We know you're, you know, busy and right significant, you know, significant workloads and other things that you could be doing and you chose to spend some time with us on this important topic.

 

45:22

So, you know, first and foremost, thank you.

 

45:24

And then second, secondly, just again, continue to emphasize the importance of this market and you know, special needs plans, you know, generally as part of the, you know, the trajectory of Medicare Advantage and where the Medicare Advantage space is going.

 

45:43

It's also, you know, interesting to think as we talk about these Snips, as we talk about individuals, we talk about employer Medicare Advantage, right, just becoming really complex if you are a health plan out there to manage your Medicare Advantage business across these different Medicare Advantage, you know, models.

 

46:03

And so, you know, I think increasingly we're hearing health plans, you're right, looking for support from experts in this space that, you know, can help them manage and work across or, you know, excel in certain models that maybe aren't, you know, their organization's historic strength.

 

46:21

And so that's, you know, kind of big picture dynamic that maybe we didn't talk about too much, but that Medicare Vantage management, we put the whole picture together for health plans.

 

46:31

You know, it's buried at this point for health plans, but you can't ignore, you know, really critical market like D SNPs.

 

46:39

So you've got to figure out, you know, how how to play in that space and how to do it.

 

46:43

Well, yes, I'll second what Jairus said.

 

46:47

Thank you so much, everybody for joining us today.

 

46:51

I think it's really important to remember that when you're dealing with Medicare recipients who fall into a dual eligible space, you're dealing with vulnerable population, some of the most vulnerable populations we have in our country.

 

47:05

And while it is difficult and while it is challenging, and while sometimes it feels like you're never going to understand how to coordinate these benefits and what the rules are and the regulations are always changing, if we do it right and if we work hard at it, it is very, very impactful for these people and their families.

 

47:22

And I think we all should embrace this opportunity with this landscape change and pushing towards alignment and integration of these benefits to take advantage of the fact that now we will be empowered to do more and comprehensively care for these individuals.

 

47:36

I think what matters to me most at the end of the day is getting members to understand, getting potential enrollees to understand why these plans are beneficial to them.

 

47:46

Because if they could benefit from them and they don't enroll in them like 2/3 of them do today, then we won't be able to improve their outcomes.

 

47:53

We won't be able to help keep them healthier and safer at home.

 

47:57

We won't be able to coordinate the benefits holistically around them and address their needs as they change and evolve as they age.

 

48:05

And I want everyone to remember, because this is really important to me, that when you do right by your members and your enrollees, you do right by your plan, big picture.

 

48:15

So always keep that member in the center of the story, in the center of your focus, in the center of your goals.

 

48:20

And I promise you, all the rest of it, the finances, the enrollment, the satisfaction, the engagement, it will follow.

 

48:27

Thank you so much and to our speakers, thank you for that great presentation and for sharing your thoughts.

 

48:37

Thank you to the audience for participating in today's webinar.

 

48:40

This concludes today's presentation.

 

48:42

Thank you again and enjoy the rest of your day.