Publicly Reported Quality Performance for Dual-eligible Special Needs Plans, 2010-2019

J Aging Soc Policy. 2023 Jun 22:1-21. doi: 10.1080/08959420.2023.2226309. Online ahead of print.

Abstract

As enrollment increases in Dual-eligible Special Needs Plans (D-SNPs) that exclusively enroll low-income Medicare beneficiaries with Medicaid coverage, better evidence is needed about quality of care in these managed care plans. Using 2010-2019 publicly reported Healthcare Effectiveness Data and Information Set (HEDIS) measures, we found that median HEDIS performance scores were usually slightly worse for D-SNPs than the overall MA program with some reductions in quality performance gaps between 2010 and 2019. D-SNPs had more incomplete performance reporting than MA contracts, especially for measures focused on clinical conditions. Medicare Advantage reporting requirements should require greater transparency about performance in D-SNPs.

Keywords: Dual-eligible beneficiaries; Medicaid; Medicare; managed care; quality of care.