Dual eligible special needs plans, or D-SNP, are the fastest growing segment of Medicare Advantage, as insurers increasingly focus on complex populations amid broader margin pressures within the program.
At Becker’s 4th annual Fall Payer Issues Roundtable, Michael Carson, president and CEO of Wellcare at Centene, spoke about the company’s approach to this market, including its expansion into new markets for 2026, the complexities of serving populations with multiple chronic conditions and social barriers, and why sustainable growth matters more than enrollment numbers alone.
An excerpt from his keynote interview is below. Responses have been lightly edited for clarity and length.
Question: We’re in the midst of the Medicare open enrollment period. What’s different this year, and how is Wellcare adapting its strategy for continued success?
Michael Carson: Those of us in the Medicare business know that it’s never just in the moment. It’s what happened up to three years ago that can create the dynamics today. Wellcare had gone through some Stars challenges over the past few years, but in the last two years, we’ve been doing really well with performance measurement.
When you’re looking at the Medicare utilization trends, they have been near double-digit or double-digit trends in utilization, so that creates significant margin pressure as well. And then you have regulatory uncertainty around risk adjustment and around Stars program cut points.
What you’ve seen across the industry is a lot of contraction. We’ve added 51 counties for 2026, and that’s been heavily focused on the duals program. We’re seeing better retention than planned, which is great news for many reasons: experience for the member, experience for us, experience for the provider, Stars, and overall cost. We’re also seeing great performance in enrollment.
But the reality is, we’re in such a challenging margin environment that we can’t overindex on members in an environment where I don’t have the right network. We need to make sure that the appropriate care is there so that we can create a sustainable product. Because at the end of the day, if we overindex, that hampers our ability to provide good benefits and good services to our members to begin with. This is not about wanting to do less, it’s really about where do we find the best ability to bring good things to people.
Q: There’s been industry criticism about the focus on meeting metrics rather than improving care quality, particularly within the Star ratings system. How is Centene navigating this challenge, and what do you think about the current Star ratings process?
MC: It’s a system that is important and needs to be in place, but we need to find a way to better and more nimbly manage it.
Do we have the right measures? Are we taking into account the right sort of demographic and difference in population? Because getting one population to 62% adherence could be a bigger accomplishment than getting a different population to 95% adherence. Those are nuances in different populations that I’m not convinced the Stars program as designed today fully takes into consideration. We need to continue to advocate and think about how we reform to make that better, so that we don’t unintentionally damage the type of benefits that dual-eligible populations need.
Q: Around 47% of Wellcare’s Medicare business will be focused on D-SNP in 2026. What are you seeing in terms of growth for this population, and how is the company positioning itself to meet their complex needs?
MC: There’s almost 13 million dual-eligible beneficiaries now in the country. Many have multiple comorbidities or behavioral health conditions that exacerbate physical health comorbidities. A majority are identified as having food insecurity, and enrollees come from many different cultures, so engaging with the healthcare system can be a challenge. The statistics go on and on in terms of what makes this a really difficult and challenging space. But this presents a huge opportunity for us to do something.
I talk about Centene’s mission in terms of transforming the health of our communities one member at a time. I often say that I’m not sure that there’s another population that is more applicable than a dual-eligible population. When you combine that with Centene being the number one payer for Medicaid beneficiaries and for LTSS and ABD beneficiaries, that means that the Medicare business and our D-SNPs are in a great position to be aligned to succeed and benefit from their growth and serving those members.
We’re really thinking about how we connect the dots between Medicaid and Medicare benefits, along with community resource assets. We want to create a more integrated, transparent ecosystem for the most challenged populations in our communities to help them receive better health outcomes.
Q: Where do you think there’s opportunity for better data-sharing opportunities or better community partnerships in this space?
MC: Operating a business like this and having such passion and commitment for local healthcare and actually being in the community brings about an interesting conundrum: you try to be local, and you need to understand the neighborhood pharmacy and connection points. We have to understand our population and understand the demographics and the ecosystem enough to be able to effectively operate in a local environment. At the same time, if we did that in all the communities around the country, that’s hugely inefficient, and we wouldn’t be able to benefit from scale. That’s the main question: How do you find the right intersection there?
I think about things like member risk stratification. We need to understand things at a member-specific level and then integrate that data. How do we incorporate drivers of health and cultural components of who the member is? How do we need to engage with them?
It speaks to consumerism and what we need to do better as an industry. We need to lean into not just being a claims payment company and really understanding our consumer better.
Q: What do you think other health plan leaders need to know as we head into 2026?
MC: As I think about the challenge of our environment, the fragmentation of our ecosystem, the changing policy components, and the complexity of the members that we serve, it’s really about committing ourselves to being passionate about making it better. It’s really about how we’re trying to make a difference and bring care, better access, and better health outcomes to our communities.
