A Dual Special Needs Plan (D-SNP) below 3.0 Stars creates problems that spread quickly across a health plan. Most organizations already understand the financial downside of poor Star Ratings, but the broader impact can be underestimated. Weak D-SNP performance affects retention, provider relationships, care coordination, utilization management, member experience, and regulatory oversight at the same time.
In many cases, low Star Ratings are a coordination problem, not just a quality problem.
D-SNP requirements are becoming more restrictive at the federal and state level. MedPAC reported that nearly half of dually eligible beneficiaries were enrolled in D-SNPs by 2024, but most enrollment still sits in lower-integration models.1 At the same time, Milliman’s 2026 D-SNP analysis highlighted tighter state contracting requirements, aligned enrollment expectations, and growing oversight around integration and D-SNP exclusivity.2
For plans already struggling with performance, these requirements expose weak processes and disconnected teams much faster than before.
Poor D-SNP Performance Starts with Fragmentation
Lack of effort is not the most common cause of low-performing D-SNP programs. They fail because too many departments work independently while serving the same member population.
Quality teams focus on measure performance. Care management focuses on outreach completion. Utilization management focuses on authorization turnaround time. Member services focuses on call metrics. Pharmacy teams focus on adherence campaigns.
Each department hits its own targets while the member experience deteriorates.
This is one reason many remediation strategies stall. Plans add more outreach activity without fixing the disconnect underneath it. Members may receive multiple calls from multiple vendors asking overlapping questions while critical issues stay unresolved. One department may approve transportation while another still lacks updated eligibility information. Behavioral health referrals may operate outside the primary care workflow entirely.
Internally, those tasks appear completed. But from the member’s perspective, the plan feels difficult to work with.
That disconnect is easier to see in D-SNP populations because dual eligible members typically have more complex medical, behavioral, and social needs than standard Medicare Advantage populations.1
Low Star Ratings Create Financial Problems Beyond Bonus Payments
Many organizations still frame D-SNP performance chiefly around quality bonus revenue. That view misses the downstream cost of persistent low performance.
Poor-performing D-SNP contracts can create expensive inefficiencies. Care managers spend time resolving preventable escalations. Member services teams handle repeat calls tied to unresolved issues. Appeals and grievances rise because authorization decisions feel inconsistent or communication breaks down between departments.
Provider abrasion also becomes harder to manage. Physicians and care teams may tolerate prior authorization requirements when processes feel predictable, but trust erodes when turnaround times fluctuate or escalation pathways become tough to access.
These problems eventually affect retention and enrollment growth. Brokers become less confident recommending lower-performing contracts, provider groups become harder to retain, and members become more likely to switch plans during enrollment periods.
The market itself is also becoming more competitive. Milliman reported that national carriers continue dominating D-SNP enrollment while states tighten contracting requirements and aligned enrollment expectations.2 Smaller and regional plans operating below 3.0 Stars might find it harder to compete if inconsistency continues affecting the member experience.
One of the Biggest Failure Points: Transitions of Care
An early warning sign inside a struggling D-SNP plan is weak post-discharge coordination.
Organizations are still relying too heavily on retrospective claims data to identify hospital discharges. So by the time care managers contact the member, critical intervention windows are already lost. Members miss follow-up appointments, delay medication pickups, or leave the hospital without adequate home support.
The strongest D-SNP teams conduct outreach faster. They organize post-discharge workflows around barrier resolution instead of contact completion metrics.
A completed phone call does very little if the member still cannot access transportation, afford medications, schedule follow-up care, or maintain adequate support at home during recovery.
Frontline teams already know which members are at highest risk for readmission. But the bigger problem is that internal systems are preventing timely intervention. Teams may lack real-time admission alerts, pharmacy event visibility, behavioral health coordination, or direct escalation pathways across departments.
Transition management failures become harder to isolate within a single department as oversight expands around utilization, member experience, and care coordination.
UM Problems Spread Quickly in D-SNP Populations
Utilization management failures create broader downstream problems in D-SNP populations because members are interacting with multiple providers, support services, and care settings simultaneously.
Some plans still operate highly manual authorization models that produce repeated documentation requests and inconsistent turnaround times. Others automate too aggressively and remove too much clinical context from decision-making. Neither approach works particularly well for dual eligible populations with high clinical complexity.
When authorization processes become inconsistent, provider trust deteriorates quickly. Those problems eventually affect member experience, grievance volume, and retention.
One issue that continues hurting lower-performing plans is fragmented delegation oversight. Plans may outsource utilization management, behavioral health coordination, member engagement, or appeals processing across multiple vendors without creating unified accountability for the member experience. When breakdowns occur, no single team fully owns the issue. That structure is harder to sustain as CMS and state Medicaid agencies push for tighter Medicare-Medicaid coordination requirements.2
Supplemental Benefits Lose Value When Execution Breaks Down
D-SNP teams are investing heavily in supplemental benefits while underinvesting in execution. Members don’t judge plans based on how benefits appear in marketing materials. They judge plans based on whether services actually work consistently.
Transportation is one example. A transportation benefit has limited value if members struggle to schedule rides reliably, provider offices are not notified about delays, or call center representatives provide conflicting information. The same problems appear across dental access, behavioral health referrals, hearing services, and over-the-counter benefits.
Milliman’s 2026 analysis also noted that many plans reduced supplemental benefit richness because of broader Medicare Advantage financial pressures tied to Star Ratings, Part D redesign changes, and medical cost trends.2 Benefit differentiation narrowing across the market makes execution even more noticeable.
Members recall whether the plan solved problems quickly, customer service representatives could answer questions accurately, and post-discharge support actually worked. And all of these details influence retention.
Medicaid Redeterminations Continue Disrupting D-SNP Performance
Medicaid eligibility instability is also underestimated. Members who temporarily lose Medicaid eligibility often experience immediate disruptions in medication access, transportation, provider continuity, and cost-sharing support. Disruptions create confusion throughout the care experience and frequently trigger downstream grievances or avoidable utilization.
Many health plans still approach redeterminations reactively. They wait until eligibility changes occur before engaging the member.
Stronger models identify instability earlier. Some plans now use predictive monitoring to identify members at high risk for losing Medicaid eligibility before coverage disruptions happen. Others assign dedicated teams specifically focused on renewal support and continuity management.
These interventions take coordination between enrollment operations, member services, care management, and provider communication teams. Without that, members receive conflicting information from multiple departments at the exact moment they need support most.
Workforce Stability Has a Direct Impact on D-SNP Performance
High turnover inside D-SNP teams is also damaging. Members with complex medical and social needs rely heavily on relationship continuity. Frequent staffing changes weaken trust and create inconsistent communication across the care experience.
At the same time, frontline teams are structured around productivity metrics that encourage rushed interactions and repetitive outreach. Some plans are responding by reducing duplicate outreach programs, cross-training teams across functions, and embedding more community-facing support roles within local markets. Others are reassessing caseload structures for high-complexity populations instead of applying standard Medicare Advantage staffing assumptions across D-SNP populations.
For plans sitting at or below 3.0 Stars, the central problem is weak coordination across teams, vendors, and member-facing functions.
If your organization is setting out to improve D-SNP performance over the next several years, you need to focus less on disconnected remediation projects and more on tighter alignment across care management, utilization management, member services, pharmacy support, and Medicaid coordination.
That work takes longer than launching short-term quality initiatives, but it’s more likely to produce durable performance improvement. Need expert support? Contact Clearlink for more information on our clinical and operational management services.
FAQs
Why are D-SNP Star Ratings harder to improve than standard MA plans?
D-SNP populations often have higher clinical complexity, behavioral health needs, and social barriers. Breakdowns in communication or coordination tend to affect multiple parts of the member experience at the same time.
What issue hurts poor-performing D-SNP plans the most?
Transitions of care remain one of the biggest failure points. Delayed follow-up after discharge often drives readmissions, medication gaps, grievances, and member dissatisfaction.
What should D-SNP plans prioritize for 2026 and 2027?
Plans should focus on stronger coordination across Medicare and Medicaid functions, especially around transitions of care, utilization management, eligibility continuity, and delegated vendor oversight.
Sources:
1. Mandated Report: Dual-Eligible Special-Needs Plans, MedPAC
2. Key Insights into 2026 Medicare Advantage D-SNP Landscape, Milliman