National Health Policy Group (NHPG) is a Washington-based health policy group focused on improving policy and practice for frail elders, adults with disabilities, and other Medicare and Medicaid beneficiaries with complex care needs using specialized managed care methods. We work primarily with and through members of the SNP Alliance, established and managed by NHPG since 2003.
The SNP Alliance is a group of leading specialized managed care programs working together to improve quality, cost and care for high-risk/high-need persons. We give priority to improving risk-adjusted payment methods, advancing the integration of Medicare and Medicaid, improving performance measurement, and demonstrating added value through plan collaboration and legislative and regulatory advocacy.
The Promise of SNPs
SNPs are authorized to specialize in care of targeted subsets of the Medicare population. SNPs are the largest specialized managed care provider network in the United States. More than 90% of SNP beneficiaries are dually eligible for Medicare and Medicaid. Click here for a SNP Fact Sheet which summarizes SNP legislative authority and key differences from standard MA plans and for a SNP Alliance Profile Report on SNP member performance, as well as Survey Highlights.
Keys to Success
SNPs must establish new operating methods responsive to the unique care requirements of high-risk/high-need persons. Click to view Gold Standards Framework.
SNPs must establish integrated care networks to optimize total quality and cost performance as a person’s care needs evolve over time and across care settings. SNPs must also work to align Medicare and Medicaid payment methods, program requirements, and oversight for dual beneficiaries with complex care needs.
Click to access integration tools, material and history of their development by the National Chronic Care Consortium.
We have entered a new era of fiscal austerity. Frail elders, adults with disabilities, and other persons with complex care needs are vulnerable to pending cuts in payment. Their numbers are growing and their care is expensive. Many are dually eligible for Medicare and Medicaid. Current operating methods are broken and in need of major repair. Plans specializing in care of these persons hold great promise for improving quality, cost and care. To be effective, plans must: a) receive appropriate risk-adjusted, global payment for all Medicare and Medicaid benefits; b) establish benefits and services of unique importance to those served; and c) reengineer care in relation to persons with multiple, complex and ongoing care needs.