OBJECTIVES: To compare selected healthcare utilization and medication adherence outcomes for Medicare Advantage (MA) beneficiaries with diabetes enrolled in diabetes-related Chronic Condition Special Needs Plans (C-SNPs) versus similar enrollees in non-Special Needs Plan (SNP) MA plans.

METHODS: This study used claims from a large nationally representative claims database augmented by linking patients to publicly available information on SNP plan participation and specialty, if any, and social risk factor characteristics at the near neighborhood level (nine-digit ZIP) on median household size and mean household income. The sample consisted of MA beneficiaries in the study dataset enrolled either in a diabetes-related C-SNP (N=5,100) or no SNP (N=449,581) with at least one documented diabetes diagnosis or at least one fill for an antidiabetic drug in 2015. Five quality measures were computed to compare the diabetes C-SNP patients to non-SNP patients with diabetes: percent of enrollees with at least one primary care physician (PCP) visit, HbA1c test, inpatient admission or readmission; and percent of days covered with antidiabetic medication. A risk adjustment model of each outcome on the non-SNP population was calibrated and applied to the C-SNP population to identify any “C-SNP effect”.

RESULTS: MA beneficiaries enrolled in diabetes-related C-SNPs appear to have experienced improved outcomes compared to beneficiaries enrolled in non-SNP plans. PCP visits were 22 percent higher, diabetes testing was 10 percent higher, diabetes medication adherence was 6 percent higher, and inpatient admissions and readmissions were more than 30 percent lower for diabetes C-SNP enrollees compared to those enrolled in non-SNP plans.

CONCLUSIONS: The evidence suggests that outcomes are better for Medicare beneficiaries who are enrolled in diabetes-related C-SNPs than would have been realized had those individuals enrolled in non-SNP MA plans. These findings are consistent across multiple domains of care: primary care, inpatient utilization, and diabetes management.