Abstract 4362257: Medicare Advantage Chronic Condition Special Needs Plans (C-SNPs) for People with HF: Better Care or Just Marketing?

Abstract

Background: Medicare patients with cardiovascular disease (CVD) are increasingly enrolling in Medicare Advantage (MA), the private alternative to traditional Medicare. One emerging class of MA plans are the “Chronic Condition-Special Needs Plans” (C-SNPs), which are advertised as specialized plans that provide better access, drug coverage, and quality of care for people with specific chronic conditions, including heart failure (HF). However, there is limited evidence evaluating whether these plans do provide better quality of care for people with CVD or merely reflect a marketing strategy employed by MA plans. Research Question: Are there differences in the quality of care among Medicare patients hospitalized with HF in C-SNPs vs. other conventional MA plans? Methods: Using national 2021-2022 Medicare data, we identified Medicare patients hospitalized for HF and who were enrolled in HF-specific C-SNPs vs. conventional MA plans (HMOs/PPOs). The primary outcome was mortality at 30-days and 90-days from day of hospitalization. Secondary outcomes included 30-day and 90-day hospital readmission rates, observation stays and ED revisits post-discharge. For each outcome, we performed linear regression models adjusting for patient demographics, Elixhauser comorbidities, and included county-fixed effects. Results: The study sample included 198,210 people hospitalized for HF, of which 13,478 (6.8%) were in C-SNPs and 184,732 (93.2%) in conventional MA plans. C-SNP patients were younger, more likely Black or Hispanic, and more likely dual-eligible for Medicaid (Table 1). There were no significant mortality differences between HF patients in C-SNPs vs. other MA plans at 30-days or 90-days (Figure 1). For secondary outcomes, patients in C-SNPs had modestly greater readmission rates at 90-days (Figure 1) and ED revisits at 30-days and 90-days (Figure 2) compared to conventional MA plans. There were no differences in the number of observation days between HF patients in C-SNPs vs. other MA plans at 30-days or 90-days (Figure 2). Conclusions: Despite their designation and marketing for HF patients, C-SNPs do not offer any clinically meaningful benefit over conventional MA plans. Our findings call into question the value of C-SNPs for people with CVD and suggest policymakers should re-evaluate their special designation.