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Homeless Special Needs Plans for People Experiencing Homelessness
JAMA ( IF 51.273 ) Pub Date : 2020-02-13 , DOI: 10.1001/jama.2019.22376
Sachin H. Jain; John Baackes; James J. O’Connell

The US Census Bureau estimated that in 2018, more than 550 000 individuals experienced homelessness on any given day.1 Homelessness is both a recognized cause and a result of health problems. There has been a movement over the past several years to include housing as a health care intervention by several key cities and municipalities, notably, San Francisco, New York, and Los Angeles. Although these programs have had some success with small populations of patients, their reliance on city budgets raises questions about scalability. The creation of a homelessness-focused special needs plan, a type of Medicare Advantage insurance plan aimed at meeting the unique care needs of specific high-need populations, may be an approach through which to sustainably finance health care delivery for homeless individuals. Special needs plans, first authorized by the Centers for Medicare & Medicaid Services (CMS) in the Medicare Modernization Act of 2003, are not widely known, but are a form of Medicare Advantage plans that have quietly increased in popularity and now include almost 3.2 million patients who are enrolled in Medicare in 734 different plans.2 Individuals are eligible if they are eligible for Medicare and meet criteria for inclusion in a plan type. CMS, sometimes in coordination with state Medicaid agencies, administers these plans in partnership with managed care organizations. Special needs plans enable specialized benefit designs for particular chronic conditions (eg, end-stage kidney disease, diabetes, heart disease, chronic obstructive pulmonary disease) or for groups of people with specialized health care needs (patients eligible for both Medicare and Medicaid or patients requiring an institutional level of care). Although special needs plans vary widely in their design, organization, and care delivery models, they are characterized by highly focused clinical model requirements, higher degrees of care coordination, and care that is closely tailored to meet the specific needs of the populations served. These plans are regulated by CMS to ensure patients receive care consistent with predesigned standards. For example, diabetes special needs plans offer specialized benefits, physician choices, and drug formularies to optimize care for individuals with diabetes; institutional special needs plans focus on the specific care needs of patients who are homebound; and dual-eligible special needs plans coordinate benefits for patients who are eligible for both Medicare and Medicaid. Select special needs plan types have been associated with less emergency department use, less hospital use, and fewer readmissions.3
更新日期:2020-02-13

 

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