Published on .
With federal rules pushing for better integration of Medicare and Medicaid benefits—and Star Ratings harder to achieve—health plans need more personalized strategies to meet the moment.
Enrollment in Dual Eligible Special Needs Plans (D-SNPs) is growing fast, with numbers tripling in the past decade and now encompassing more than 5 million individuals as of 2023. That number is expected to keep rising as federal and state policymakers work to strengthen benefits and expand access for this historically underserved group.
But the spotlight on D-SNPs isn’t just about scale. It’s about transformation.
As rules change, so do the expectations for D-SNP engagement
In April, CMS issued a final rule requiring insurers to better integrate Medicare and Medicaid benefits into health plan offerings, with the goal of simplifying the member experience and improving outcomes. This regulatory shift signals a growing consensus: delivering quality care to dual-eligible members requires more than benefit provision. It requires a deeper understanding of who these members are, and a smarter, more personalized approach to engagement.
“The policy environment will continue to evolve rapidly, and health plans need strategies to ensure they can continue to serve and best meet the needs of their dual eligible members,” said Allison Rizer, Executive Vice President of Payer Solutions at ATI Advisory and nationally-recognized expert in dual eligible and managed care program and policy design. “This includes better engaging members, understanding state policy priorities and the local market, and growing provider partnerships that advance whole-person, high-value care.”
That’s why we created a practical checklist: 5 Challenges Faced by D-SNPs: And Smart Ways to Resolve Them. This straightforward, actionable document provides a quick resource with essential strategies every plan should be using to “meet the moment”—covering areas like SDOH engagement, data integration, health-literate communication and omnichannel outreach.
Download our checklist for more details about effective strategies to support D-SNP members in improved engagement and adherence.
To use the checklist effectively, it helps to first understand who D-SNP members are and why traditional strategies often miss the mark.
What makes D-SNP members different from other Medicare beneficiaries?
Compared to other Medicare beneficiaries, individuals who are dually eligible for both Medicare and Medicaid are generally more medically complex and more socially vulnerable:
- 38% are under age 65 and qualify due to disability
- 26% live with five or more chronic conditions, and a significant portion have serious mental illness, including depression, bipolar disorder and schizophrenia
- 11% have Alzheimer’s disease or related dementias, and more than half face difficulties with activities of daily living such as bathing, eating or dressing
- 13% reside in institutional settings, compared to just 1% of other Medicare beneficiaries
Essentially, this is not a monolithic population. These are individuals navigating multiple overlapping medical, behavioral and social challenges—conditions that call for a “whole-person” approach to care. The right solution for support is one that recognizes specific individual needs and provides the interventions to address them: understanding that needs vary by individual and change over time.
“Integrated care for dually eligible individuals isn’t just about aligning Medicare and Medicaid benefits—it’s about recognizing the real complexity of their lives,” said Cheryl Phillips, M.D., geriatrician, health policy consultant and past CEO of the Special Needs Plan Alliance. “These individuals often face serious health challenges compounded by limited resources, and unless we meet them with person-centered strategies tailored to their unique needs and environments, we’ll keep falling short of the outcomes we all want to achieve.”
Why it’s difficult for D-SNPs to earn 4+ Stars
As D-SNP enrollment rises, most plans are struggling to meet the quality thresholds that drive performance incentives.
According to a recent Milliman analysis, the average 2024 Star Rating for D-SNP contracts was just 3.34, well below the 4-Star threshold required to qualify for CMS bonus payments. Only 13% of D-SNP contracts earned 4 or more stars, compared to more than half of general Medicare Advantage plans.
One of the biggest hurdles? Member experience measures, particularly CAHPS (Consumer Assessment of Healthcare Providers and Systems), which have played an outsized role in recent years. In 2024, CAHPS and other administrative measures made up 32% of the total Star Rating, meaning a plan’s performance could be significantly impacted by how members perceive access, communication and coordination of care.
And CAHPS scores are where D-SNPs tend to struggle. That’s because members often face low health literacy, fragmented care and inconsistent provider relationships, which can all influence CAHPS responses. While CMS has finalized a reduction in the weight of CAHPS measures beginning in 2026 (impacting the 2027 payment year), they remain a critical factor in the current landscape, especially given non-optimal performance from D-SNPs in past performance years.
The takeaway: until the weighting changes take effect, plans can’t afford to overlook member experience. And even beyond CAHPS, the need for deeper, more personalized engagement strategies isn’t going away.
Improving outcomes for D-SNPs
As CMS and state Medicaid agencies push for tighter integration and greater accountability, plans must re-think their approach to engaging dual-eligible members when it comes to improving Star Ratings, adherence and long-term outcomes.
It starts with recognizing that many current strategies fall short. For example, one-size-fits-all solutions and single-serve outreach efforts don’t reflect the human aspect of healthcare and the fact that people’s needs change over time—especially when they’re managing multiple chronic conditions, living in poverty or struggling with cognitive overload.
The most successful health plans are shifting to data-driven, tech-enabled strategies that incorporate behavioral science barrier resolution and a coordinated, whole-team approach to address the realities of members’ daily lives.
Turning strategy into action
At AdhereHealth, we’ve developed a focused checklist to help health plans take the next step toward smarter, more coordinated D-SNP outreach and support. Whether you’re aiming to improve Star Ratings or enhance member health outcomes, this resource outlines what it truly takes to drive engagement and reach your goals.
“This 5-step checklist will not only better serve the member to understand their needs and barriers to care, but the plan will benefit from improved engagement, improved adherence to treatment plans, and improved clinical and quality outcomes,” added Dr. Phillips.
These aren’t surface-level tactics. They’re high-impact strategies designed to address the complex, real-world barriers dual-eligible populations face. From uncovering SDOH and behavioral obstacles to aligning medical and pharmacy data, each action requires thoughtful execution and often, more resources than internal teams have on hand.
That’s where AdhereHealth comes in. We collaborate with health plans to operationalize these strategies at scale, equipping teams with the specialized expertise, technology and support needed to deliver measurable results.
Ready to take the next step?
Download our checklist: 5 Challenges Faced by D-SNPs: And Smart Ways to Resolve Them and start building a stronger, more integrated approach to care—backed by the right tools and guidance to make it work.
