News & Bulletins Archive

The Hilltop Institute has won a contract from the New England States Consortium Systems Organization for Real Choices Long-Term Care Resource Mapping in the state of Rhode Island. Hilltop’s work will inform the state’s policy making by providing comprehensive information on Rhode Island’s current and projected population requiring publicly-financed long-term supports and services, the state’s institutional capacity, and the availability of community supports and services across the state. The project will also produce a tool for modeling the effects of various options for rebalancing state spending between institutional and home- and community-based services.

Cheryl Powell, senior research analyst at The Hilltop Institute, gave a presentation for the Transportation Association of Maryland’s 20th Annual Fall Conference, Reaching, Teaching, and Serving…Our 20 Year Journey, on October 20 and 21. In the presentation, entitled Maryland Medicaid Non-Emergency Medical Transportation Study, Powell described the study—which evaluated the feasibility of creating a uniform statewide NEMT program in Maryland; any potential cost savings or potential for quality improvement; and the potential impact of the creation of such a program on local health departments—and discussed its findings. Hilltop conducted the study, which was mandated by House Bill 235, on behalf of the Maryland Department of Health and Mental Hygiene. To view the presentation, click here.

The Hilltop Institute’s Director of Long-Term Supports and Services, Cynthia H. Woodcock, and Manager of Health Services Research, Al Adamson, presented a workshop on September 29, 2008, in Boston, at The Spirit of Independence: 24th National Home and Community Based Services Conference, convened by the National Association of State Units on Aging. In the workshop, entitled A Methodology for Projecting a State’s Long-Term Care Costs, they discussed the methodology that Hilltop developed to project long-term care costs in Maryland for 2010, 2020, and 2030; discussed how other states could use that methodology to project future spending; and offered guidelines on how states could facilitate change in their long-term care systems. To view the presentation, click here. To view the full report, click here.

The Hilltop Institute’s executive director, Charles Milligan, was an expert witness in an invitational forum hosted by The Heritage Foundation, on September 24, 2008, that explored innovative models for states’ reform of Medicaid programs and other vehicles for long-term care, paying particular attention to the concerns of the elderly and disabled. Entitled Workable Solutions for Long-Term Care, the forum simulated a Congressional hearing, in which health policy experts presented testimony and then fielded questions from a panel of distinguished members. Milligan presented in the session entitled Private Sector Models in the Context of Medicaid Reform, and focused on emerging opportunities to align Medicare and Medicaid payments and incentives. The goal of this alignment would be to reform Medicaid (and Medicare) to facilitate: the improvement of hospital discharge planning in a way that might avoid or reduce Medicaid-paid nursing facility stays; the improvement of the quality of long-term care services in a way that might avoid unnecessary Medicare-paid hospital admissions and emergency room use; and the promotion of greater flexibility in benefit delivery. To view Milligan’s testimony, click here.

The Hilltop Institute collaborated with the New Mexico Human Services Department in the development of a new coordinated long-term services program that has just received federal approval. The program will serve an estimated 38,000 Medicaid beneficiaries statewide, the vast majority of whom are enrolled in both Medicare and Medicaid (“dual eligibles”). The enrollees who are not dual eligibles will meet a nursing facility level of care even though many are already served in the community. Known as the Coordination of Long-Term Services (COLTS) Program, New Mexico’s model will operate under a Section 1915(b)(c) waiver from the Centers for Medicare and Medicaid Services (CMS), and the state will contract with two managed care organizations (MCOs) that are also Medicare Advantage Special Needs Plans. The state has two major goals in COLTS: to coordinate Medicare and Medicaid services by contracting with MCOs that may serve the beneficiaries in both programs, and to coordinate the full array of Medicaid services in order to promote community-based services where appropriate for the given beneficiary. The program will be implemented on a statewide basis over the next 11 months. Hilltop has been working with New Mexico over the past three years to design the program, develop the waivers, and advise the state on the capitated rate structure.

The Hilltop Institute has just released A Framework for State-Level Analysis of Duals: Interleaving Medicare and Medicaid Data as a resource guide for analysts who plan to integrate data on Medicare and Medicaid service use and costs. The Hilltop Crossover Framework is introduced in the guide as an orienting reference device for linked Medicare and Medicaid claims, and is based on a two-by-two format whereby data are arrayed by category of service-with specific reference to Medicaid crossover claims-in order to highlight the relationships between government programs and service use. The term “crossover” refers to Medicaid claims that reflect Medicare patient liability costs that state Medicaid programs cover on behalf of persons eligible under both programs-“dual eligibles” or “duals,” for short. The guide is also intended as a general introduction to Medicare and Medicaid benefits and attendant relationships for analysts who may be less familiar with one or both programs. To view the bulletin, click here.

The Hilltop Institute’s executive director, Chuck Milligan, gave a presentation on benefit design on August 4, 2008, before the Colorado Centennial Care Choices Program Panel, a governor-appointed expert panel charged with gathering information on the design, benefits, and costs of a Value Benefit Plan for the people of Colorado. Milligan discussed the concept of minimum benefits (a state’s determination of what constitutes “being insured”) and policy implications, such as the balance between a given state’s determination of where to strike a balance between its role to protect its citizens, and its role to respect individual liberty/autonomy to purchase services in the market; the balance between coverage by private insurance and government programs that wrap around those benefits; and the balance between covering more people with leaner benefits, or fewer people with more comprehensive benefits. Milligan then presented alternatives utilized by different states to provide benefits to their uninsured citizens.

The Center for Health Program Development and Management, located on Hilltop Circle at the University of Maryland, Baltimore County (UMBC), was established in 1994 in partnership with the Maryland Medicaid program. The name we chose for ourselves in 1994 reflected the activities that we performed for the Maryland Medicaid agency at that time: developing and managing selected health programs on their behalf. Our work for Maryland Medicaid continues to be fruitful, productive, and mutually beneficial. Over time, our work evolved. We now perform a much wider variety of health services research activities for Maryland Medicaid, as well as for a broad national collection of governmental and non-profit clients. The organizing mission of our work is to utilize analysis to advance the health of vulnerable populations. To view the bulletin, click here.

The Hilltop Institute has issued its first electronic Bulletin about a report it prepared for the Maryland Community Health Resources Commission on School Based Health Centers. The Bulletin is the first formal venue that Hilltop has had for news releases. It will be used to periodically disseminate information about important news from Hilltop and about reports it produces. The Bulletin is sent electronically to the health services community. To view the Bulletin, click here.

The Hilltop Institute, in partnership with the UMBC Department of Public Policy, has received a two-year grant from NIH to study the economics of antipsychotic drug use in Maryland’s Medicaid population. The principal aim of the study is to analyze Maryland’s Medicaid data to identify cost and clinical correlates to specific antipsychotic drug choices of patients with schizophrenia. The analysis will review data spanning the period from 2002-2005, and earlier as feasible for select subpopulations. Dr. Tony Tucker from Hilltop will assist the project by merging Medicare and Medicaid records in order to assess clinical heterogeneity and costs, specifically for persons receiving benefits from both programs (dual eligibles). Senior Research Analyst Michael Abrams, MPH, the project’s co-investigator, will lead Hilltop’s team. Dr. David Salkever, Professor, Department of Public Policy, is the project’s principal investigator.

Cynthia H. Woodcock, M. B. A., has been named director of Hilltop’s Long-Term Supports and Services Unit. In this capacity, she will manage Hilltop’s initiatives in long-term care policy and lead Hilltop’s work on the development of home- and community-based services waiver programs and other integrated long-term care initiatives. In addition, she will continue to manage Hilltop’s contract with the New Mexico Human Services Department, which has focused on launching a new self-directed waiver program and a Medicaid managed long-term care initiative. Under her direction, Hilltop is also assisting with implementation of Maryland’s Money Follows the Person demonstration and carrying out an evaluation of New Jersey’s federal Systems Transformation Grant in long-term care. She succeeds Wayne Smith, who retired last month, and has been with the unit since 2007. Woodcock joined Hilltop in 2004 as a senior research analyst, working with Hilltop’s executive director on strategic planning and new business development.

The Hilltop Institute, in collaboration with the New Mexico Human Services Department, has received a grant to perform an evaluation of the New Mexico State Coverage Insurance program (SCI). The grant is one of 15 nationwide that was awarded through the Robert Wood Johnson Foundation State Health Access Reform Evaluation (SHARE) Initiative. The project will identify factors that have influenced employer participation in the New Mexico SCI program through surveys and analysis of administrative data. The project will not only benefit New Mexico, but will have national significance as well. Other states may face similar operational challenges related to combining public health insurance coverage with commercial-style insurance that requires employer contribution. New Mexico’s experience with its SCI program will provide lessons to other states that implement public/private partnerships or premium assistance programs requiring employer cooperation. This project is a state/university research partnership between New Mexico and Hilltop. Senior Research Analyst Anna Sommers, PhD, at The Hilltop Institute, is the principal investigator for the project. She will lead Hilltop’s project team, which includes Acute Care Policy Director Ann Volpel, MPA, Research Analyst Asher Mikow, MHA, Economic Analysis Director Hamid Fakhraei, PhD, and Research Assistant Laura Spicer. Insure New Mexico! Director Mari Spaulding-Bynon, JD, is co-principal investigator.

The Hilltop Institute is pleased to announce the success of its fifth symposium, Developing Comprehensive Oral Health Policy: Challenges and Opportunities for State Health Policymakers, convened on June 17, 2008. The symposium brought together over 130 policymakers, health services researchers, and health care practitioners, including the nation’s leading oral health policy experts, from across the country to explore three major areas of policy innovation to improve access to and utilization of oral health care: integration of dental and medical service delivery; dental workforce issues; and health education and outreach strategies. The day was divided into four sessions and highlighted by a keynote address, a luncheon address, and concluding reflections. To view the bulletin, click here.

The Hilltop Institute sponsored a day-long symposium to explore three major areas of policy innovation to improve access to and utilization of oral health care: integration of dental and medical service delivery; dental workforce issues; and health education and outreach strategies. The day was divided into four sessions and highlighted by a keynote address, a luncheon address, and concluding reflections. Over 130 policymakers, health services researchers, and health care practitioners from across the country, including the leading experts in the field, participated in the event. Learn more about the symposium.

The Center is collaborating with the Bloomberg School of Public Health at Johns Hopkins University and the UMBC Public Policy Department on an NIMH funded project to study the cost and quality implications of payment for psychiatric services. Diagnosis Related Groups (DRGs) are commonly used to pay inpatient hospitals. However, most of inpatient psychiatric care is paid per diem. The research seeks to improve psychiatric DRGs, with billing and supplemental information from medical records, so that they can be used for payment purposes. The study will also provide insight into hospital quality performance under per case payment. Dr. Hamid Fakhraei is leading the Center’s research team.