Opportunity and Challenges presented by D-SNP

(This article is based on our conversations at Intelliswift Software with our healthcare payer customers, and our consultants who are increasingly helping our customers with their their technology strategy and roadmap to address D-SNP enrollees, and building a strong information technology underpinning to provide a scalable and robust foundation.

It borrows liberally from several excellent articles, studies and analysis of the subject - particularly noteworthy are these two articles:

• 10 Things to Know About Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) - by Salama Freed, Meredith Freed, Jeannie Fuglesten Biniek, Anthony Damico, Nolan Sroczynski, and Tricia Neuman.
• The Future of Medicare Advantage - by Cara Repasky, Anna Buchholtz, Ava Clarke, Sonja Pedersen-Green, and Will Lyle, representing views from 麦肯锡 's Healthcare Practice.)

Let's start with some key facts:

• About 12.9 million people received health coverage under both Medicare and Medicaid in 2021.
• Between 2010 and 2021, the share of dual-eligible individuals enrolled in D-SNPs nearly tripled from 11% to 29%.
• In 2021, nearly 3 in 10 (29%) dual-eligible individuals were enrolled in a D-SNP.

While D-SNP enrollees are a growing part of medicare universe, it also has the most challenges - especially when it comes to member experience. 麦肯锡 analysis shows that plans with higher D-SNP membership have seen their HEDIS performance decrease over the past two years.

Improving efficiency with automation and digital technology

McKinsey's authors rightly identify investing in automation and other digital technologies such as generative AI as the key to improving member experience. Automated Prior Authorization process leveraging AI is a particularly huge area of improvement, with quick and significant rewards. Other areas include customer self-service AI chatbots, targeted member messaging, and automated outreach.

Leveraging Automation and AI technologies also has the added benefit of helping reduce costs, especially administrative expenses. McKinsey's analysis indicates that in 2025, MA payers could face administrative and medical cost increases of $50 per member per month (PMPM), driven by increased healthcare utilization and administrative spend, and $30 PMPM revenue impact due to rate declines. Administrative efficiencies gained from improved digital tools?will help offset these increases and the investments needed to fully integrate Star Rating improvements into the overall MA strategy.

The current political season again puts access to healthcare, and affordability on top of everyone's mind. That's hardly a surprise as we spend $4.5 Trillion annually (17.3% of our GDP). Or, seen another way, after spending the world's highest $13,493 per person our healthcare outcomes leave much to be desired. But Automation, driven by Digital advances and AI in the last decade, we finally may have the tools to address our healthcare woes. Reach out to the Healthcare, Automation and AI practitioners at Intelliswift to see how we can help you in this journey. Check out our healthcare offerings at:

https://www.intelliswift.com/industries/digital-healthcare-technology-solutions