Interview: Understanding the C-SNP Product & Opportunity

The way that CMS has developed these plan offerings is really kind of within the special needs category. There are three main types:

• D-SNPs
• C-SNPs
• Institutional Special Needs Plans (I-SNPs)

The way that a C-SNP works is, essentially, you have to have a qualifying chronic condition, and there’s a number of different conditions that CMS outlines.

The vast majority of health plans that are in the C-SNP business are what I’ll call “the bundled C-SNP.” So that’s typically a C-SNP that covers diabetics, chronic heart failure, and cardiovascular disorders. About 80 percent or so of individuals in a C-SNP plan today are in that kind of bundled C-SNP. Then, the 20 percent that are in a different type of plan, there’s kind of a long tail of condition sets, including HIV, cancer, stroke, lung disorders, end-stage renal disease, etc. that can go in a specialized-by-condition product.

The purpose of these plans is really to create both a health plan, but even more so, a member experience and a care management platform that is quite literally custom built for the condition that they have.

The more competitive the industry gets, typically, the more segmented that industry starts to become. And I think we’re kind of the early innings of seeing that segmentation really kick off in Medicare Advantage. Really, the thesis that I personally have, as well as Zing [Health], I think you’re going to continue to see Medicare Advantage get more sub-segmented and really start to think about the member themselves, as opposed to the benefits themselves, and thinking, “How do I design plans and experiences that are very specific to that member and ensure they have a good experience?”

If I’m an individual with chronic conditions, what is better for me to enroll in: a C-SNP plan versus a general enrollment plan versus traditional Medicare? Really, what you’re getting in a C-SNP plan is typically benefits that are designed specifically for you.

Once you’re in that plan, you’re immediately put into a care management process and a member journey that, again, is specific to somebody with that condition set. And so, if you’re an individual with chronic conditions who enrolls in a non-C-SNP, just general enrollment plan, unfortunately, oftentimes, the benefits will not be coordinated perfectly for your condition set … Whereas, in a C-SNP, that’s immediately coordinated from day one.

From a plan design standpoint, the network component works the same for a C-SNP as it does a general enrollment. So, you have an HMO C-SNP, which you have to go in-network to receive that care. You have PPO C-SNPs, which provide much more expansive in- and out-of-network optionality for the member. From a mechanical standpoint, it operates the same as the rest of Medicare Advantage.

What you typically see in a chronic condition member is obviously the number of doctors that they typically see is higher than that of a non-chronic senior. But in addition to that, the number of specialists that they go to see is also typically more expansive. And so, as you think about putting your agent hat on, it’s important as you’re talking to somebody with a chronic condition to do a very thorough needs assessment and truly understand where they are receiving care. What specialists do they see? Cardiologists, nephrologists, endocrinologists? The list goes on and on.

For somebody with a chronic condition, unfortunately, their specialist sometimes becomes pseudo their PCP. They see their specialist so often that, oftentimes, that’s really where they’re receiving more of their general primary care, not a traditional PCP. So, you do have to dig one layer deeper typically than you normally would with a healthy senior, because it is so important to get those doctors in the plan in network, or if not available, make sure that they get into a PPO system option where they can truly go anywhere that they want to receive their care.

This is probably one of the biggest misconceptions or points of unknowns for brokers.

It is a massive market of individuals, seniors, Medicare-eligibles who have a chronic condition. So, the way that I would think about the market size is I’ve seen the overall Medicare eligible market, it’s kind of right around 64, 65 million. Of that, roughly 32 [million] or so are in a Medicare Advantage plan, and we’re sitting kind of right around 49, 50 percent Medicare Advantage penetration that’s continued to go up every single year.

If you look at the demographics across the Medicare-eligible landscape, purely looking at kind of the common condition sets of diabetes, heart failure, cardiovascular, about 44 to 45 percent of seniors qualify with one of those conditions. If you add on your lung disorders that gets it up to about 49 percent…

Half of Medicare eligibles qualify for a C-SNP. If you think about the current enrollment into C-SNP, there are [only] about 500,000 people currently in a C-SNP…

If you have a qualifying condition, you automatically qualify for a one-time Special Enrollment Period. And so, what we like about it is, obviously, it’s got the year-round selling opportunity.

I think this has been historically a pretty big reason why a lot of brokers haven’t fully embraced the C-SNP market.

The reason why agents shied away from C-SNP is historically the process that took place — you’d have to go collect what’s called the Verification of Condition form… [With this process,] the agent is calling the member, the health plan is calling the member and the provider. Oftentimes, there’s a physical fax that is sent from the provider. It’s an archaic process… It’s an odd process for the member …

So, using Zing [Health] as an example, we’ve developed a solution to make sure that this is as seamless of a process as possible for brokers, members, providers, etc.

We built our own auto verification platform, so we are now auto-verifying over 95 percent of C-SNPs … The broker does nothing, the member does nothing, the provider does nothing.

I’d bucket this into really three categories that touch on kind of existing book, but also new marketing efforts.

1. The first point is just asking the question [“Do you have a chronic condition?”]. Fifty percent of the people you’re talking to every single day now likely qualify for a C-SNP … So just ask the question and then understand, if the answer to that is yes, that there’s a very tailored plan specifically for those individuals.

2. Next, how do I target these individuals? One strategy that we’re employing a lot, and we’re seeing a lot of our broker and agent partners employing, is targeted and direct marketing. Thinking about your direct mail strategy differently, thinking about your digital SEO strategy differently, and how do you target individuals who likely have one of these conditions sets? Things as simple as creating an SEO digital strategy around diabetes keywords, heart failure keywords, insulin keywords; we’re seeing a lot of traction by purely just targeting in a market that very few people are targeting.
   
   Also, think about your local field community partnership marketing strategy. Forming a proper go-to market strategy around provider partnerships, specialist partnerships, dialysis clinic partnerships … How do you go one layer deeper and look at your specialist level? Think of cardiologists, pulmonologists, nephrologists, folks who are talking to individuals with chronic conditions every single day, who most of them probably don’t even know these plans exist and they could save a lot of money by changing nothing.

3. The third piece is just understanding where these people are today. Asking, “How do I execute a grassroots marketing and partnerships strategy to really get in front of these people with a plan that is custom built for them?”

I can talk kind of both Zing [Health] specifically, but also just kind of broadly as you think about the season landscape.

C-SNPs are growing very rapidly, but again, they aren’t quite everywhere yet. So, for Zing [Health] specifically, today, we are in Illinois, Indiana, and Michigan. So obviously, I encourage anyone to reach out, either directly to me or go to our website, to get in touch with somebody in your area who could really have a detailed conversation about getting involved with Zing [Health].

Broadly, the way that C-SNP has worked is, historically, a bulk of C-SNP members were really in California and Florida. If you think about why that’s the case, that’s typically where there’s been a high prevalence of risk-bearing providers.

Value-based care has been a thing in Florida and California for decades. It’s only been recently become such a widespread evolution across the rest of the country…

I’m incredibly excited about all the work we’ve done at Zing [Health] to build something different and build a plan that quite literally is purpose built for the individual.

The underserved populations and individuals with chronic conditions haven’t had that great of options designed for them in the past. So, I’m just incredibly excited about what we’re launching both for 2024, but even kind of the future of this company, as we’re one of the fastest-growing health plans in the country right now…

I just personally can’t wait to see what C-SNP looks like in 2027 and 2028. We’ll look back and realize we were kind of in the first or second inning of an exciting evolution in the industry … So, I encourage everyone to take another look at the C-SNP market. There’s a lot here. It’s a massive market. And again, I think, if you don’t talk to your members about this, somebody will. I think having this in your tool chest is just going to be important.