ATI Advisory has a new issue brief I-SNP Enrollment and Long-Term Care Outcomes in 2023 | Resources for Innovations in Care | ATI Advisory that shows in 2023, Institutional Special Needs Plan (I-SNP) enrollees had lower mortality risk and fewer emergency department visits, hospitalizations, and hospital readmissions than non-I-SNP Medicare Advantage (MA) beneficiaries.

Brian Fuller, managing director, value-based care design and delivery for ATI, said the report “continues to validate through our newest research that I-SNP enrollees experience fewer emergency department visits, hospitalizations, and hospital readmissions than non-I-SNP MA beneficiaries.”

“We were also pleased to see that I-SNP enrollees have lower mortality risk which was an added research metric in this year’s study. These findings confirm our expectation that through intensive care management and a well-defined model of care, I-SNP beneficiaries experience more favorable long-term care outcomes.”

Through funding from the American Health Care Association, ATI examined the association between I-SNP enrollment and healthcare utilization, spending, and quality outcomes for long-term care residents enrolled in Medicare who had one or more nursing facility stays of 90 days or longer during the year.  

ATI noted that these latest findings build on its previous analysis a previous analysis conducted by ATI, which shows a similar association between I-SNP enrollment and favorable long-term care outcomes in 2022.

I-SNPs Perform

For background, I-SNPs are special needs plans that serve MA-eligible individuals who reside in a participating I-SNP facility for 90 days or more, or who reside in the community but need equivalent care as provided in such facilities. Eligible individuals must reside in the I-SNP’s service area, be enrolled in both Medicare Parts A and B, and meet an institutional level of care as determined by an entity independent of the I-SNP.

So, what did the report by ATI find out about the performance of I-SNPs?

“We found that I-SNP enrollment was associated with better outcomes in seven of the nine analyzed measures for nursing facility residents, when compared to Medicare FFS or non-I-SNP MA beneficiaries, after adjusting for covariates,” the report said.

When compared to non-I-SNP MA beneficiaries, the analysis found an association between I-SNP enrollment and lower ED visit rates, all-cause readmissions, and hospitalization rates.

“We also found better outcomes in three quality indicators, namely stage III+ pressure ulcers, a composite measure of infections, and falls with major injury. When compared to Medicare FFS beneficiaries, our analysis found an association between I-SNP enrollment and better outcomes in two quality indicators, namely stage III+ pressure ulcers and a composite measure of infections,” the report said.

Similarly, researchers discovered that I-SNP enrollment was associated with lower mortality risk when compared to Medicare FFS or to non-I-SNP MA populations.

“Conversely, we found that I-SNP enrollment was associated with higher Medicare Part D spending when compared to Medicare FFS or to non-I-SNP MA, and higher prevalence of antipsychotic medications compared to non-I-SNP MA,” the authors said.

Future Work

ATI said there were limitations to its work, and that future analyses of I-SNPs as outlined in the issue brief was needed, such as effect size analysis, clinical significance evaluations, and spillover effect studies.

“These additional analyses could provide more granular insights into the magnitude and clinical relevance of observed outcomes, as well as the broader influence I-SNPs may have on nursing facility environments,” the report said. “Such analyses could identify the mechanisms of I-SNP care management that drive specific improvements and could inform policy decisions to optimize care for the complex needs of individuals who may be served by I-SNPs.”

More Access

The issue brief also listed ways in which the positive outcomes resulting from I-SNPs could expand access to the models of care.

“Given the correlation between I-SNP enrollment and long-term nursing facility resident outcomes, policymakers can explore the impact of expanding access to this program to more facilities and communities,” the report said.

I-SNP enrollment has continued to increase over recent years (around 6 percent total enrollment growth year-over-year from 2021 to 2026). However, in 2026 there was also a continued decrease in the total number of I-SNPs being offered and the number of Medicare Advantage Organizations offering I-SNPs.

“Some of this decrease in plan offerings is due to national organizations consolidating multiple plan offerings into one plan, in addition to national and regional organizations dropping I-SNPs and exiting the market. Furthermore, I-SNP availability is geographically limited: as of 2021, almost 70 percent of nursing facilities did not have any residents enrolled in I-SNPs, and more than 60 percent of U.S. counties had no I-SNP offerings available,” researchers said.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.