By: Gaby Broeren, Data Analyst for Quality & Sarah Jordan, Cost and Utilization Analyst
Carina Health Network members care for a significant population of Dual Eligible Special Needs Plan (D-SNP) patients, who qualify for both Medicare and Medicaid. In some Carina Medicare Advantage contracts, D-SNP members represent more than half of the total enrolled population.
These patients often face greater medical complexity and social barriers to care, including transportation challenges, housing instability, and financial constraints. Despite these challenges, recent analysis shows D-SNP patients are performing as well as, or better than, their non-D-SNP peers across several key quality measures.
D-SNP Members Quality Performance CY2026
| Measure | D-SNP | Non-D-SNP | Performance |
| Breast Cancer Screening | 61% | 57% | ✅ D-SNP Higher |
| Colorectal Cancer Screening | 68% | 65% | ✅ D-SNP Higher |
| Controlling Blood Pressure | 70% | 68% | ✅ D-SNP Higher |
| Glycemic Status Assessment | 64% | 67% | ⚠️ Opportunity |
| Plan All-Cause Readmissions* | 12% | 8% | ⚠️ Opportunity |
Measure performance reported as of 7/31/26.
While D-SNP members are excelling in preventive screenings and blood pressure control, opportunities remain to improve outcomes for patients with complex chronic conditions. Related measures Kidney Health Evaluation for Patients with Diabetes and Follow-Up After ED Visit for Patients with Multiple Chronic Conditions also revealed poorer performance.
A companion analysis of D-SNP healthcare costs showed that spending is highly concentrated among a small number of medically complex patients. The highest-cost 5% of D-SNP members accounted for approximately 70% of total D-SNP spending. Chronic kidney disease, diabetes, heart failure, COPD, and behavioral health conditions were identified as major contributors to overall costs.
Importantly, many of these high-cost conditions align with the same quality measures identified as opportunities for improvement, particularly kidney health evaluation, diabetes management, readmissions, and post-discharge care coordination.
These findings highlight the importance of continued care coordination, chronic disease management, timely follow-up after acute events, and addressing social barriers that may impact a patient’s ability to receive ongoing care. Chronic disease management and care transition efforts especially can improve patient outcomes while helping address avoidable healthcare costs.
Looking Ahead
The strong performance of D-SNP members in several high-priority “Big Dot” measures demonstrates the impact of focused outreach, care management, and patient engagement efforts. Building on these successes while targeting opportunities in diabetes management, care transitions, and readmission reduction can help further improve outcomes for one of our most vulnerable patient populations.
Be on the lookout for upgrades to monthly and on-demand reports regarding identification of attributed D-SNP patients from Carina! We continue to seek ways to increase performance and ease operational burdens among our member community health organizations.