Comparing HEDIS performance of Dual Eligible Special Needs Plans with other coverage types for dually eligible people

Abstract

Abstract People eligible for both Medicare and Medicaid coverage (“dually eligible individuals”) have lower levels of income and assets and often higher health care needs and costs than those eligible for Medicare but not Medicaid coverage. Their 3 most common Medicare coverage options are Medicare Advantage (MA) Dual Eligible Special Needs Plans (D-SNPs), non–D-SNP MA plans, and fee-for-service (FFS) Medicare with a stand-alone prescription drug plan. No prior study has examined clinical quality of care for dually eligible individuals across these 3 coverage types. To fill that void, we used logistic regression to compare these coverage types on 6 HEDIS measures of clinical quality of care that were available for both MA and FFS (constructed from claims files). D-SNPs and non–D-SNP MA plans significantly outperformed FFS for all 6 measures for dually eligible individuals, by approximately 5 percentage points for 2 measures and by 18–34 percentage points for the other 4 measures. For the 4 measures with the greatest advantage over FFS, performance was 3–8 percentage points higher in D-SNPs than in non–D-SNP MA plans.