In case you missed it, new research indicates that seniors and specifically, Medicare Advantage (MA) beneficiaries, who need nursing home-level care may benefit from enrolling in a specialized plan known as an Institutional Special Needs Plan (I-SNP). ATI Advisory released a whitepaper this week that shows I-SNP enrollees had better quality outcomes compared to other Medicare beneficiaries. The whitepaper, Institutional Special Needs Plan (I-SNP) Enrollment and Outcomes in Long-Term Care Settings, compared I-SNP beneficiaries to both Medicare fee-for-service (FFS) beneficiaries and non-I-SNP Medicare Advantage (MA) beneficiaries, studying eight measures to determine outcome differences between populations.
Findings indicate the I-SNP enrollment was associated with:
- Better quality for three of four studied outcomes (pressure ulcers, fall injuries, and infections) compared to Medicare FFS beneficiaries and non-I-SNP MA beneficiaries; and
- Lower acute care utilization, such as lower rates of all-cause emergency department visits, compared to non-I-SNP MA beneficiaries. It also showed lower rates of hospitalizations and 30-day readmissions.
According to the whitepaper:
“I-SNPs provide comprehensive Medicare healthcare services, an individualized plan of care, and care coordination… Our findings provide an exploratory indication that I-SNP enrollment may be associated with better care in managing the complex healthcare needs of MA eligible long-term care residents, given positive observed outcomes across most measures…”
This is not the first study that has shown a positive correlation between I-SNPs and outcomes for Medicare beneficiaries in nursing homes. A 2019 study published in The American Journal of Managed Care resulted in 51 percent lower emergency department use, 38 percent fewer hospitalizations, and 45 percent fewer readmissions for MA I-SNP members as compared to Medicare FFS beneficiaries in nursing homes. And a 2024 study supports findings of decreases in hospitalizations and pressure ulcers.
I-SNPs are a type of MA plan designed for long-term residents of nursing homes or those who live in the community but need a nursing home level of care. I-SNPs offer on-site nurse practitioners in nursing homes to help improve primary care, care planning, and care coordination. Researchers estimate that while the percentage of long-stay nursing home residents enrolled in an I-SNP has quadrupled over nearly 20 years, it is still a small percentage of total nursing home residents. As of early 2025, there were more than 122,000 Medicare beneficiaries in I-SNPs.
“As policymakers, providers, and insurers shift to focus more on value versus volume, I-SNPs are an effective solution to improving quality care for nursing home residents and reducing overall health care costs,” said Nisha Hammel, Vice President of Reimbursement Policy & Population Health at the American Health Care Association and National Center for Assisted Living (AHCA/NCAL). “Long term care residents are a unique population, and I-SNPs – as affirmed in this research – can be an effective model to meet their distinct needs, much more so than traditional Medicare Advantage plans meant for community-dwelling active seniors. We encourage policymakers to break down barriers for providers who want to explore engaging in these plans.”
Providers can continue to learn more about I-SNPs at AHCA/NCAL’s Population Health Summit, which will take place in Atlanta in April. Long term care professionals will have the chance to learn about the framework for evaluating the financial impact of shifting from FFS to more value-based models, what various I-SNP models look like, and operationalizing a vision for an I-SNP. One session will also examine the results of the new ATI Advisory whitepaper.