Somewhat lost in the good news about Medicare Advantage plans overall having improved their CMS star quality ratings for 2013 is the continuing tough stars road faced by MA Special Needs Plans (SNPs). Their average rating for 2013 remained about three stars, notes consultant Nathan Goldstein, CEO of Gorman Health Group, LLC, largely because the disadvantaged population they serve has characteristics that do not fit well with the stars rating system.
“I think SNPs are tremendously challenged here,” says Goldstein, citing such problems as beneficiaries who are medically illiterate and face difficulties in even having the transportation to get to providers. That means, he says, SNPs “really struggle” to have an active relationship with beneficiaries, a key to doing well in the star scores. Moreover, they are rated on the same categories as are other MA plans, plus on separate star measures for SNPs. There is also the problem that many of them operate in rural areas in the South and Southeast, where it is difficult to find appropriate providers who will conduct home visits with the beneficiaries.
What do you think is the answer for SNPs looking to improve their star scores, which will be a necessity after the current CMS demonstration program that allows even three-star plans to get a quality bonus ends in 2014? When the remaining program is the one in the health reform law that gives bonuses just for ratings of four stars and above, how will SNPs cope with the MA payment reductions under that same law? Just about everyone thinks SNPs perform a vital role, but how can they stay financially viable?
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