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Your DSNP members are missing appointments – are you missing Stars?

Ensure transportation for DSNP members and win back stars

 

Star Ratings items related to the management of chronic and long-term conditions represent nearly half – 14 out of 30 – of all Part C Star Ratings measures. Missed treatments or consultations for chronic conditions threaten patients’ ongoing health and can severely impact Stars Ratings.


In our 2023 Predict Health Medicare Advantage Survey, we found that those who are dually eligible for Medicare and Medicaid (DSNP) report disproportionately higher rates of missing treatments and consultations for their conditions in comparison to their non-DSNP Medicare Advantage counterparts. They have also identified their inability to secure reliable transportation to their appointments as the main barrier to receiving the treatment they require. Care and management of chronic conditions continues to be an area of significant inequity between those with social vulnerabilities and risk factors, such as DSNP members, and those without such risk factors.


Both DSNP and non-DSNP groups report experiencing high rates of the chronic conditions captured in Stars ratings measures (e.g., Osteoporosis or Diabetes). However, of those respondents, only 6.9% of Non-DSNP Medicare Advantage respondents reported having missed any treatments or consultations for their conditions. In contrast, 26.2% of DSNP respondents reported having missed routine treatments or consultations. This gap highlights the need to explore what factors are driving this difference and what plans can do about it.


Figure 1. Missed Treatments for Members Reporting Chronic Conditions



Among members who reported having missed treatment for their chronic conditions, DSNP members were more likely to report experiencing significant obstacles to obtaining care for their chronic conditions than Non-DSNP Medicare Advantage Members (36.2% vs 14.5%).

 

Figure 2. Obstacles to Care between DSNP and Non-DSNP Medicare Advantage Members



Of those members who report experiencing obstacles to receiving consistent treatment, the largest obstacle reported was ‘difficulty getting to appointments’, with a large difference between the rate reported by DSNP members and the rate reported by Non-DSNP Medicare Advantage members. Additionally, DSNP members report higher levels of difficulty with scheduling appointments.


 Figure 3. Distribution of Identified Barriers to Consistent Treatment for Chronic Conditions




These results underscore the importance of ensuring that members, especially those from vulnerable populations, have assistance in both scheduling and accessing reliable transportation to their appointments for their chronic conditions. Providing effective management of chronic conditions requires not just excellent clinical care, but also support for helping members find and access care. When determining plan design and benefits, plans need to account for the transportation and scheduling challenges their members face and work proactively with their more vulnerable populations to ensure they can provide effective and consistent access to care. Arranging reliable access to transportation resources and aid in scheduling appointments, is a small price to pay for the benefit of bridging the health equity gap, boosting star ratings, and improving member experience.

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