Is Creating a Medicare SNP Strategy Right for You?

With Medicare Advantage enrollment expected to see continued growth in the coming years, many providers are looking at special needs plans (SNPs) as a way to participate in the Medicare Advantage market and take on more risk for the populations they serve. Although SNPs may not be the right fit for everyone, a closer look can help you determine if it could be a viable strategy for your organization.

In summer 2019, CLA hosted a three-part webinar series that covered the background and risk-based elements of SNPs, as well as the operational and financial considerations that position organizations for success. Our professionals were joined by leaders from across the industry to share their experiences planning and implementing SNPs nationwide. Check out our recordings and presentation slides from all three sessions.

Part 1: Medicare Advantage and the Rising Interest in SNPs

Presenter: Jennifer Boese (CLA)

Curious about the sudden popularity of SNPs? In the first part of our series, we take a high-level look at the health care, legislative, and regulatory environment driving this increased interest. By looking into the growth of Medicare Advantage plans, of which SNPs are a subset, we show how SNPs tie into health care’s value transformation to help providers better grasp the new flexibilities that are continuing to emerge. With three basic SNP options available, getting to know the financial, clinical, and operational details can help you determine how a SNP could fit into your organization.

Key takeaways

• How Medicare Advantage functions as a value-based model
• Emerging trends and opportunities in Medicare Advantage
• Financial, clinical, and operational basics of SNPs

Part 2: Key Operational Issues for Success as a SNP

Presenters: Cory Rutledge (CLA), Dr. Scott Rifken (Provider Partners Health Plan)

SNPs are growing at a rapid pace, and much of this growth is attributed to health care operators creating their own plans. In part two of our series, Dr. Scott Rifken shares some of the lessons he has learned while operating SNPs over the past five years. What Dr. Rifken frequently finds is that many operators don’t understand the timeline needed to create a SNP. So during this session, we spend time outlining an 18 – 24 month process for building a SNP to provide a realistic view of the work that goes into introducing these plans.

Key takeaways

• The basic economics of a SNP
• The two-year process for creating a SNP
• The importance of building an appropriate provider network
• How enrollment and hierarchical condition categories scoring drive plan revenue
• How the care model and care coordination utilizing nurse practitioners reduces hospitalizations
• Why investing in technology is critical in monitoring the risk of your plan’s enrollees

Part 3: Reimbursement and Financial Considerations of a SNP

Presenters: Dave Schuh (CLA), Stephen Taylor (CLA), Hank Watson (American Health Partners [AHP])

In part three of our webinar series, we tackle the economics of a SNP, focusing specifically on I-SNPs. Our discussion ranges from organizational structure to highlighting the ancillary or affiliated businesses that work collaboratively to provide care — and consequently share fund flow — through the I-SNP model.

To show the concept of total cost of care and how to manage a premium pool, CLA and AHP illustrate the fund flow for a single enrolled beneficiary, then roll the concepts discussed on this micro level into a macro or plan level model.

Key takeaways

• Why providers should shift to an insurer’s mindset when evaluating the value of a plan
• Key performance levers and how they relate to implementing a successful plan
• How data can help providers understand how they would perform in a total cost of care environment
• Modeling through tools such as CLA Clarity or CLA Intuition^® to help measure key performance indicators

How we can help

With Medicare Advantage plans constantly changing, it can be difficult to know how SNPs fit into your organization’s future. We understand the challenges associated with making changes in your organization, and can come alongside you and key stakeholders in your organization to implement new strategies and help you financially position yourself for the future.