ATI Advisory study, supported by AHCA/NCAL, shows correlation between I-SNP enrollment and lower rates of hospitalization, emergency department visits, and mortality among nursing facility residents
| Source: ATI Advisory
Washington, DC, May 28, 2026 (GLOBE NEWSWIRE) — New research from ATI Advisory examines the association between Institutional Special Needs Plan (I-SNP) enrollment and healthcare outcomes for long-term care residents enrolled in Medicare Advantage in 2023. The findings show that I-SNP enrollment was associated with better outcomes across seven of nine studied measures, including lower rates of emergency department (ED) visits, hospitalizations, hospital readmissions, pressure ulcers, infections, falls with major injury, and mortality risk. The research was funded by the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL).
ATI’s report, I-SNP Enrollment and Outcomes in Long-Term Care Settings, analyzes 2023 data from the Centers for Medicare & Medicaid Services (CMS) Virtual Research Data Center for Medicare enrollees with one or more nursing facility stays of 90 days or longer. Using multivariate regression analysis, ATI compared I-SNP enrollees to both Medicare fee-for-service (FFS) enrollees and non-I-SNP Medicare Advantage (MA) enrollees across nine outcome measures spanning utilization, quality, spending, and mortality.
Compared to similar non-I-SNP MA enrollees, I-SNP enrollees were:
- 21% less likely to experience death during a nursing facility stay
- 50% less likely to experience an ED visit each month
- 53% less likely to experience an inpatient stay each month
- 27% less likely to experience a 30-day hospital readmission
- 29% less likely to experience pressure ulcers
- 16% less likely to experience infections
- 25% less likely to experience a fall with major injury
Compared to Medicare FFS enrollees, I-SNP enrollees were 6 percent less likely to experience death and showed similarly favorable outcomes on pressure ulcers and infections.
“As policymakers look for ways to improve quality and outcomes in long-term care, this research adds to the growing body of evidence supporting models like I-SNPs,” said Nisha Hammel, Senior Vice President of Reimbursement Policy and Population Health at AHCA/NCAL. “Coordinated care approaches that align financing, care delivery, providers, and clinicians together can lead to better health outcomes and a better care experience for seniors with complex medical needs.”
I-SNPs are MA plans serving enrollees who reside in a participating nursing facility for 90 days or more, or who live in the community but require an equivalent level of care. I-SNPs are required to maintain a Model of Care tailored to each enrollee’s unique needs, deliver care coordination through an Interdisciplinary Care Team, and conduct individualized Health Risk Assessments upon enrollment and annually thereafter.
Despite the favorable outcomes associated with I-SNP enrollment, access to the program remains limited. As of 2021, nearly 70 percent of nursing facilities had no residents enrolled in I-SNPs, and more than 60 percent of U.S. counties lacked an I-SNP offering. The brief calls on policymakers to assess barriers to I-SNP access, examine the dynamics driving recent declines in the number of I-SNPs offered, and explore the potential benefits of expanding the program.
These findings build on a prior ATI analysis showing a similar association between I-SNP enrollment and favorable long-term care outcomes in 2022, contributing to a growing evidence base around coordinated care models for older adults with complex needs in nursing facility settings.
About ATI Advisory
ATI Advisory is a healthcare research and advisory services firm dedicated to system reform that improves health outcomes and makes care better for everyone. ATI guides public and private leaders in solving the most complex problems in healthcare through objective research, deep expertise, and bringing ideas to action.
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