Dual Eligible Special Needs Plan Enrollee Advisory Committee Support
Dually eligible individuals face unique challenges with care delivery and integration between Medicare and Medicaid. To help make advancements, AIR has partnered with Blue Cross and Blue Shield of North Carolina to implement an enrollee advisory committee (EAC) comprised of Dual Eligible Special Needs Plan (D-SNP) members.
The EAC provides input and advice regarding the quality and accessibility of D-SNP services and supports. Through this work, AIR hopes to improve access to covered services, advance coordination, and reduce health disparities.
Engagement of Dually Eligible Beneficiaries in Health Plan Governance
Governance engagement of Medicaid beneficiaries in plan design and delivery has been a federal statutory requirement since the early 1970s with varying degrees of success. Beneficiary engagement in Medicare, however, is relatively new. In 2023, the Centers for Medicare & Medicaid Services (CMS) took an important step in advancing engagement of dually eligible beneficiaries who are enrolled in a D-SNP.
Because dually eligible individuals tend to have greater health needs and lower incomes than other beneficiaries, they often experience unique challenges with care delivery and integration between Medicare and Medicaid. Additionally, nearly half (49%) of the dually eligible population are members of racial and ethnic subgroups. To help improve care delivery and reduce disparities, CMS now requires insurance companies that offer D-SNPs to establish and maintain EACs comprised of D-SNP members.
AIR’s Work to Engage Dually Eligible Beneficiaries in North Carolina
AIR is supporting the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) D-SNP plan, known as Healthy Blue + Medicare, to implement an EAC. The goals of the EAC are to provide input and advice to Blue Cross NC regarding the quality and accessibility of services and supports provided by the plan and offer ideas and suggestions to improve Medicare managed care, with the hope of leading to better access, outcomes, and satisfaction.
In this role, AIR supports the design and execution of the EAC. The team is responsible for:
- Recruiting and onboarding EAC members, with a focus on meaningful engagement;
- Facilitating meetings;
- Providing technical and administrative support during and between meetings;
- Analyzing meeting minutes and providing recommendations to Blue Cross NC based on the findings; and
- Serving as the main point of contact for EAC members.
Through this work, the AIR and Blue Cross NC teams hope to improve access to covered services, advance coordination of services, and reduce health disparities for the D-SNP population.
