Evaluating the Impact of Dual Eligible Special Needs Plans (D-SNP) on the Rates of Hospitalization and Readmission Among the Beneficiaries in Washington, DC Using a Cross-Sectional Survey

Abstract

According to the Centers for Medicare and Medicaid Services (CMS), inpatient hospitalization remains the sector with the highest level of Medicare FFS spending growth, jumping from $125 billion in 2006 to $141 billion in 2014. A segment of beneficiaries who qualify for both Medicare and Medicaid, also known as dual-eligible beneficiaries are some of the main drivers of this spending growth. Dual eligibles are individuals who qualify for and whose health services are covered by Medicaid and Medicare. They have an option to receive all their benefits through a health plan with the opportunity for enhanced benefits through Special Needs Plans (D-SNP) created as part of the Medicare Advantage Coordinated Care Plan. Dual eligibles experience higher hospitalizations since they tend to be older or younger with disabilities, generally poorer, and have worse health outcomes when compared to similar Medicare-only beneficiaries. Some of the hospitalizations are avoidable presenting opportunities for improved health outcomes and lower healthcare cost. This study, therefore, aimed at examining the impact of D-SNP on the hospitalization and readmission rates among dual eligibles using beneficiary survey. This study is a primary data analysis using a 37-question survey instrument that was administered via telephone over two months across all Washington D.C wards. The sample includes 217 D-SNP members and 112 non-D-SNP members (n=329). Responses from the survey questionnaires were analyzed using univariate, bivariate, and multivariate analyses. Our results using Logistic regression show that beneficiaries enrolled in D-SNP had a 70% lower hospitalization rate when compared to non-enrolled beneficiaries [OR, CI: 0.3 (0.12, 0.62)]. Using Poisson regression, our results show the hospitalization incidence rate ratio (IRR) of beneficiaries enrolled into D-SNP was 40% lower for each hospitalization incident compared to non-D-SNP members [IRR, CI: 0.6 (0.49, 0.73)]. Similar lower rates of 30-day readmission rates was noted with D-SNP members when compared to non-D-SNP members; 50% fewer odds of readmission [OR, CI: 0.5 (0.29, 0.86)] and 70% fewer readmission incidence rate [IRR, CI: 0.3 (0.18, 0.56)]. Our results, therefore, suggest that enrollment of dual eligibles into D-SNP can significantly improve health outcomes, reduce acute inpatient care utilization and lower Medicare spending.