{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T06:36:06Z","timestamp":1780554966237,"version":"3.54.1"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T00:00:00Z","timestamp":1762646400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T00:00:00Z","timestamp":1762646400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P01 AG032952"],"award-info":[{"award-number":["P01 AG032952"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To estimate the effect of starting a provider\u2010led Institutional Special Needs Plan (I\u2010SNP) arrangement on facility\u2010level enrollment, utilization, and quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>I\u2010SNPs are a type of Medicare Advantage (MA) plan that allows insurers to differentiate their benefits exclusively for long\u2010term residents in nursing homes. Since I\u2010SNPs first became available in 2006, there has been growth in provider\u2010led I\u2010SNPs where nursing homes are financially integrated or partnered with an insurer to operate a plan for their own residents. We used a difference\u2010in\u2010differences design to estimate the effect of starting a provider\u2010led I\u2010SNP arrangement on several facility\u2010level outcomes, including the share of a facility's long\u2010stay residents who were enrolled in an I\u2010SNP, hospitalizations, medication use, pressure ulcers, physical restraints, falls, and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>We used Medicare claims and nursing home resident assessments (2004\u20132021) to identify Medicare long\u2010stay nursing home residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>The start of a provider\u2010led I\u2010SNP arrangement led to a 17.0\u2009percentage point (pp) increase (standard error [SE]: 0.006) in I\u2010SNP enrollment among facility residents within 4\u2009years relative to control nursing homes. We also estimate that the start of a provider\u2010led I\u2010SNP arrangement significantly decreased hospitalizations (\u22121.0\u2009pp, SE: 0.002), increased the use of antipsychotic (0.4\u2009pp, SE: 0.002) and hypnotic drugs (0.3\u2009pp, SE: 0.001), and reporting of pressure ulcers (0.4\u2009pp, SE: 0.002).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Provider\u2010led I\u2010SNPs allow nursing homes to bear financial risk for their residents. These results suggest that this form of risk bearing may successfully reduce utilization (e.g., hospitalizations), but with unclear implications for quality as increased use of sedating drugs and rates of pressure ulcers could either reflect poorer care or retention of sicker patients due to lower hospitalization rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70067","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T07:05:11Z","timestamp":1762758311000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Nursing Homes as Insurers? The Effect of Provider\u2010Led Institutional Special Needs Plans"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3933-8570","authenticated-orcid":false,"given":"Amanda C.","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical and Health Economics USC Mann School of Pharmacy and Pharmaceutical Sciences  Los Angeles California USA"},{"name":"USC Schaeffer Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Michael","family":"McWilliams","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of General Internal Medicine and Primary Care Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Beth","family":"Landrum","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Grabowski","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,9]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"P.ChidambaramandA.Bruns \u201cA Look at Nursing Facility Characteristics Between 2015 and 2023 \u201dKaiser Family Foundation January 5 2024 https:\/\/www.kff.org\/medicaid\/issue\u2010brief\/a\u2010look\u2010at\u2010nursing\u2010facility\u2010characteristics\/."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2401371"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1901896"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2021.11.030"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077558707307569"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20100009.2007.00502.x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1468\u20100009.12594"},{"key":"e_1_2_11_9_1","unstructured":"MedPAC \u201cMedicare Advantage Special Needs Plans \u201dMedPAC 2013 https:\/\/www.medpac.gov\/wp\u2010content\/uploads\/import_data\/scrape_files\/docs\/default\u2010source\/reports\/chapter\u201014\u2010medicare\u2010advantage\u2010special\u2010needs\u2010plans\u2010march\u20102013\u2010report\u2010.pdf."},{"key":"e_1_2_11_10_1","unstructured":"CMS \u201cInstitutional Special Needs Plans (I\u2010SNPs) \u201daccessed May 15 2024 https:\/\/www.cms.gov\/medicare\/enrollment\u2010renewal\/special\u2010needs\u2010plans\/institutional."},{"issue":"9","key":"e_1_2_11_11_1","first-page":"438","article-title":"Managed Care for Long\u2010Stay Nursing Home Residents: An Evaluation of Institutional Special Needs Plans","volume":"25","author":"McGarry B. E.","year":"2019","journal-title":"American Journal of Managed Care"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2014.3018"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2018.07.004"},{"key":"e_1_2_11_14_1","unstructured":"US Centers for Medicare and Medicaid Services \u201cMedicare Advantage\/Part D Contract and Enrollment Data \u201dCenters for Medicare and Medicaid Services September 6 2023 https:\/\/www.cms.gov\/data\u2010research\/statistics\u2010trends\u2010and\u2010reports\/medicare\u2010advantagepart\u2010d\u2010contract\u2010and\u2010enrollment\u2010data."},{"key":"e_1_2_11_15_1","unstructured":"Research Data Assistance Center \u201cData Documentation: Master Beneficiary Summary File (MBSF) Base \u201dResDAC accessed February 28 2023 https:\/\/resdac.org\/cms\u2010data\/files\/mbsf\u2010base\/data\u2010documentation."},{"key":"e_1_2_11_16_1","unstructured":"Centers for Medicare & Medicaid Services \u201cMinimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual \u201daccessed May 14 2023 https:\/\/www.cms.gov\/Medicare\/Quality\u2010Initiatives\u2010Patient\u2010Assessment\u2010Instruments\/NursingHomeQualityInits\/MDS30RAIManual."},{"key":"e_1_2_11_17_1","unstructured":"Research Data Assistance Center (ResDAC) \u201cMedPAR \u201dResDAC accessed June 8 2023 https:\/\/resdac.org\/cms\u2010data\/files\/medpar\/data\u2010documentation."},{"key":"e_1_2_11_18_1","unstructured":"LTCFocus \u201cPublic Use Data Sponsored by the National Institute on Aging (P01AG027296) Through a Cooperative Agreement With the Brown University School of Public Health \u201dLTCFocus accessed April 29 2022 https:\/\/ltcfocus.org."},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jeconom.2020.12.001"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002592"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.14211"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.5530"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.4001"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.14390"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.2165\/00002512\u2010200623040\u201000001"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.1196"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13247"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001763"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxad022"}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70067","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1475-6773.70067","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70067","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:08:32Z","timestamp":1772968112000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.70067"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,9]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1111\/1475-6773.70067"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.70067","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,9]]},"assertion":[{"value":"2025-05-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70067"}}