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2 minute read
Insuring Growth explores the biggest challenges and opportunities facing health insurance leaders, focusing on what executives need to know now.
Chronic Condition Special Needs Plans (C-SNPs) are designed for populations with extremely difficult care and coordination needs. They’re one of the most complex, challenging, and least understood products in Medicare Advantage. For many plans, they’re often unprofitable. But for Jay Davis, Co-Founder and COO of Champion Health Plan, they are an opportunity to transform care, deliver positive outcomes for underserved populations, and drive sustainable growth.
In Episode #2 of Insuring Growth with host and e123 President Brendan McLoughlin, Davis shares what it takes to build a C-SNP that thrives while serving the challenging needs of its members. Champion’s C-SNP plans started with a focus on one of the toughest populations in health care—individuals with end-stage renal disease (ESRD). This group often faces multiple chronic conditions, 12 or more daily prescriptions, and the logistical burden of dialysis treatments that consume hours each week. Add in transportation issues, care coordination gaps, and social determinants of health, and you have a perfect storm of barriers to better outcomes.
How does Champion provide all of this care and coordination profitably? Eliminate unnecessary red tape, align providers in a more meaningful way, and treat the whole patient, not just the condition that qualifies them for the plan. For example, nephrologist visits never require prior authorization because delaying specialty care often leads to an ER visit and a guaranteed hospital admission, so Champion makes it easier for patients to see their nephrologists sooner. The podcast dives into how Champion has built a supportive care system that delivers positive outcomes for patients while reducing the cost of care, including a dramatic reduction in hospital bed days relative to the national average for ESRD patients.
With CMS expanding the definition of chronic kidney disease SNPs to include earlier stages of kidney disease, as well as related conditions like diabetes and cardiovascular disease, Champion sees opportunity to help more people earlier, slow disease progression, and avoid costly hospitalizations. Identifying, engaging, and enrolling eligible members isn’t easy, but Davis shares some tips for success in the podcast.
Actionable Insights for Decision Makers
Davis’ advice goes beyond basic checklists and product training. This conversation is about building the right provider relationships, matching the right agents to the right communities, and designing care models that actually work for vulnerable populations.
Episode #2 is available now, and it’s a must-listen for anyone focused on the future of C-SNPs and Medicare Advantage growth. Stay tuned for Episode #4, when Jay Davis returns with more insights.
Insuring Growth isn’t just another industry podcast. It’s where decision-makers get real, actionable intelligence from leaders who have been there and done it. If you’re interested in being a guest and discussing the challenges facing healthcare and insurance leaders, please reach out to us at podcast@enrollment123.com.
