Special Needs Plans Improve ESRD Patient Outcomes, Lower Mortality

Chronic condition special needs plans were created to serve the complex needs of patients with conditions such as end-stage renal disease (ESRD), and a new study published in JAMA Network Open demonstrates these plans also improve patient outcomes.

The prevalence of end-stage renal disease is projected to increase over the next decade, in 2030 reaching 11 to 18 percent over its prevalence in 2015.

Special needs plans are Medicare Advantage coordinated care plans designed for individuals who fall under one of three categories—they are institutionalized, dual-eligible, or need chronic disease management for a severe, debilitating condition.

Previous research had identified that ESRD patients spend less in chronic condition special needs plans and indicated that patient outcomes improve as well.

However, researchers wanted to underscore whether patient outcomes were different in a chronic condition special needs plan, so they studied outcomes from about 2,000 patients who were enrolled special needs plans for chronic disease management.

ESRD patients enrolled in chronic conditions special needs plans had lower hospitalization rates and lower mortality rates compared to their counterparts who were not in special needs plans, the researchers found.

The researchers compared the special needs plan enrolled and non-enrolled patients based on dialysis facility and county for both hospitalization rates and mortality rates.

By comparing patients who received care from the same dialysis facility, the researchers expected that the two groups would be similar in care factors that would lead to similar health outcomes.

However, the researchers acknowledged that the fact that those not enrolled in these dialysis facilities were eligible for a special needs plan but chose not to take advantage of it might reflect on the outcomes.

To balance out that potential limitation, the study observed patients by county as well, which would encompass both ESRD patients who were eligible for special needs plans and those who were not eligible.

When comparing between facilities for hospitalization rates, ESRD patients enrolled in special needs plans for chronic disease management saw a hospitalization rate of 11.05 hospitalizations per 100 patient months, or a total of 6,141 hospital admissions over the course of the study.

In contrast, those in the same facilities who were not enrolled in a chronic condition special needs plan saw 12.27 hospitalizations per 100 patient months, or a total of 6,551 hospital admissions over the course of the study.

For mortality rates, when observed by facility, 440 patients enrolled on a special needs plan for chronic disease management died, the equivalent of around 0.79 fatalities per 100 patient months. However, non-enrolled patients saw 543 deaths, equating slightly over one patient death per 100 patient months.

When comparing between counties for hospitalization rates, the patients using a special needs plan for their chronic disease management had 10.38 hospitalizations per 100 patient months or 4,625 admissions in the time period of the study.

Their unenrolled counterparts in the same counties saw 13.49 per 100 patient months, or 6,348 total admissions during the study’s timeframe.

When the study compared mortality rates based on county, there were 337 enrollee deaths, leading to a mortality rate of 0.76 deaths per patient months. Among those not enrolled in a special needs plan for chronic disease management, there were 461 deaths and a mortality rate of 0.99 per 100 patient months.

The study opened up questions for additional research, particularly regarding the influence that special needs plans might have in the Hispanic community. Hispanic people experience high prevalence of ESRD and made up a large part of the demographic for this study.

“Acknowledging the prevalence of Hispanics and African Americans in this study, Cohen et al identified an apparent benefit of C-SNP enrollment for individuals from minority racial and ethnic groups,” the study stated.

“In combination, these data suggest that C-SNP enrollment may provide greater access to care for patients from minority groups with downstream effects on patient health and health care utilization. Additional studies are needed to validate this hypothesis.”

The researchers attributed the lower hospitalization and mortality rates among patients enrolled in chronic condition special needs plans to several possible factors.

These included care team integration, the regularity of dialysis and interdisciplinary nature of the dialysis teams, and potentially the additional services and benefits that special needs plans offer for chronic disease management.

Special needs plans are thought to be useful for other populations outside of those struggling with chronic disease management. For example, some have recommended a special needs plan for the homeless community.

In 2021, patients enrolled in special needs plans will benefit from having one of the lowest premiums among plan types at $25 per month. They are also the most likely plans to have the richest benefits.