Table 1. Baseline Characteristics of Beneficiaries in Full-Benefit Dual-Eligible Special Needs Plans (D-SNPs) by Residence in County With Aligned D-SNPs Available in 2021 and 2022.
| Characteristics | Residence in county with aligned D-SNPs availablea | Standardized mean difference (95 CI)c | |
|---|---|---|---|
| No | Yesb | ||
| Beneficiaries, No.d | 1 786 573 | 1 136 919 | NA |
| Beneficiary-years | 2 957 818 | 1 928 959 | NA |
| Local area | |||
| Area deprivation index score, mean (SD)e | 66.8 (26.4) | 43.2 (29.0) | 0.86 (0.86 to 0.86) |
| Rural or micropolitan (vs urban or metropolitan) | 21.9 | 8.1 | 0.38 (0.38 to 0.38) |
| Penetration rate of Medicare Advantagef | 45.1 | 48.2 | 0.26 (0.26 to 0.26) |
| Total enrollment, mean (SD), mo | 11.8 (1.4) | 11.8 (1.4) | 0 (−0 to 0) |
| Type of D-SNPg | |||
| Highly integrated | 26.0 | 48.6 | 0.49 (0.49 to 0.49) |
| Fully integrated | 3.6 | 25.5 | 0.71 (0.71 to 0.71) |
| Coordination only | 70.4 | 25.9 | 0.99 (0.99 to 0.99) |
| Medicare entitlement status | |||
| Age ≥65 y | 55.6 | 72.7 | 0.36 (0.36 to 0.36) |
| Disability | 44.4 | 27.3 | 0.36 (0.36 to 0.36) |
| Demographics | |||
| Age, mean (SD), y | 63.6 (14.3) | 68.3 (13.8) | 0.34 (0.33 to 0.34) |
| Sex | |||
| Female | 63.0 | 62.7 | 0.01 (0 to 0.01) |
| Male | 37.0 | 37.3 | 0.01 (0 to 0.01) |
| Race and ethnicityh | |||
| American Indian or Alaska Native | 0.8 | 0.3 | 0.07 (0.06 to 0.07) |
| Asian or Pacific Islander | 6.1 | 12.2 | 0.22 (0.22 to 0.22) |
| Black | 27.4 | 21.4 | 0.14 (0.14 to 0.14) |
| Hispanic | 15.4 | 33.7 | 0.45 (0.45 to 0.45) |
| Non-Hispanic White | 48.7 | 29.7 | 0.40 (0.39 to 0.40) |
| Otheri | 1.7 | 2.8 | 0.08 (0.08 to 0.08) |
| Health status | |||
| Centers for Medicare & Medicaid Services Hierarchical Condition Categories risk score (version 28), mean (SD)j | 1.6 (1.5) | 1.5 (1.4) | 0.01 (0.01 to 0.02) |
| Long-term institutionalized carek | 1.8 | 1.9 | 0.01 (0.01 to 0.01) |
| Frailty level (for those with a community-dwelling age ≥65 y)l | |||
| Robust (lowest level) | 33.3 | 35.7 | 0.05 (0.05 to 0.05) |
| Prefrailty | 47.6 | 47.3 | 0 (−0.01 to 0) |
| Mild frailty | 14.8 | 13.2 | 0.05 (0.05 to 0.05) |
| Moderate to severe frailty | 4.4 | 3.9 | 0.03 (0.02 to 0.03) |
| Major chronic comorbidities | |||
| Diabetes | 32.6 | 36.2 | 0.08 (0.07 to 0.08) |
| Heart failure | 10.1 | 10.2 | 0 (0 to 0.01) |
| Ischemic heart disease | 13.3 | 14.4 | 0.03 (0.03 to 0.03) |
| Stroke or transient ischemic attack | 3.5 | 3.9 | 0.02 (0.01 to 0.02) |
| Chronic obstructive pulmonary disease or asthma | 24.5 | 22.5 | 0.05 (0.05 to 0.05) |
| Chronic kidney disease | 15.2 | 17.9 | 0.07 (0.07 to 0.07) |
| Neuropsychiatric comorbidities | |||
| Dementia or Alzheimer disease | 4.5 | 6.8 | 0.11 (0.10 to 0.11) |
| Intellectual or developmental disability | 3.2 | 2.1 | 0.07 (0.07 to 0.07) |
| Depression | 21.5 | 21.1 | 0.01 (0.01 to 0.01) |
| Anxiety disorder | 22.4 | 18.1 | 0.11 (0.10 to 0.11) |
| Serious mental illness (bipolar disorder, schizophrenia/psychosis) | 12.8 | 10.1 | 0.08 (0.08 to 0.08) |
Abbreviation: NA, not applicable.
Data are expressed as mean percentages unless otherwise indicated. Available was defined as a county in which at least 1 aligned D-SNP was operating (identified using Applicable Integrated Plan indicator data).
Determined based on the county where they were living during the first month of enrollment. If the county was missing, either the county in a subsequent month or the county identified in the Social Security Administration data was used.
The approach for calculating these data was based on the methods of Austin.33
Included Medicare beneficiaries with at least 1 calendar year (2020 or 2021) of continuous enrollment in Medicare Parts A and B and 1 study year (2021 or 2022) with at least 6 months enrollment in a full benefit D-SNP.
The score is a percentile ranking (range, 1-100); higher values indicate greater deprivation. The score was missing for 269 722 beneficiary-years (5.5% of the total).
Based on July of the study year.
Had at least 6 months of D-SNP enrollment.
Identified from the Research Triangle Institute (RTI) race code.
Combined category from the RTI race codes of “other” and “unknown.”
Missing for 132 beneficiary-years (0.002% of the total).
Defined as 100 days or longer.
Data were available for 1 382 617 beneficiary-years.