For Special Needs Plans

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. These managed care programs are called Special Needs Plans or SNPs. 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, by design, focus on those individuals with high risk/high need profiles, such as people with multiple chronic conditions, who are low-income, who are residing in a nursing home setting, or who have complex care needs due to disability, behavioral health, or advanced care needs. SNPs represent the largest specialty care networks within managed care programs 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.


Best Practices

The SNP Alliance compiled selected examples of best practices for member organizations offering the following type of SNPs:Institutional (Family Choice), Institutional Equivalent (SCAN), Chronic Condition SNPs for lung and heart disease, ESRD,and diabetes (CareMore) and Severe and Persistent Mental Illness (Brand New Day) and a Fully Integrated Dual Eligible SNP (Commonwealth). Links to these programs are listed below:

  • Brand New Day: Best Practices in Severe and Persistent Mental Illness Care
  • CareMore: Best Practices in Chronic Illness Care
  • Commonwealth Care Alliance: Best Practices in Care for Frail and Disabled Medicare Medicaid Enrollees
  • Family Choice: Best Practices in Care for Nursing Home Residents
  • SCAN: Best Practices in Care for Nursing Home Certifiable Beneficiaries at Home


Contact Us

For further information on NHPG and The SNP Alliance or to explore opportunities for collaboration, please Contact Us.


Breaking NewsGold Star

The SNP Alliance is pleased to announce the hiring of Dr. Cheryl Phillips as its next President and CEO.

The SNP Alliance and Center for Consumer Engagement in Health Innovation Jointly Publish Report: "Special Needs Plans: Focusing on Social Determinants of Health among Duals"


Save the DateGold Star

Mark your calendars for the 2017 Leadership Forum

November 2-3, 2017
The Capital Hilton Hotel
Washington, DC

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 persons 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.