Health Care Access & Affordability
Hilltop works to find innovative strategies for expanding access to affordable health care coverage and services with the goal of empowering consumers.
A new federal regulation on hospital price transparency requires hospitals to post their standard charges on their websites as well as the variations in prices for the same procedure or service. Using these data, Hilltop researchers are examining the level of compliance with the new regulation as well as variations in charges for the same procedure or service. See Featured Work section below for more information on a Hilltop study on discounted cash prices—those charges to patients who pay directly out of pocket for hospital services.
Maryland’s Total Cost of Care Model sets a per capita limit on Medicare total cost of care, and the state will eventually have total cost of care targets for Medicaid. The Model also specifies high-priority areas for advancing population health, including substance use disorder, diabetes, and hypertension. Hilltop developed a methodology for calculating and monitoring Medicaid total cost of care and conducts other analyses for Maryland Medicaid related to Model implementation and monitoring.
One of the metrics for Maryland’s Total Cost of Care Model is the 30-day all-cause readmission measure. Hilltop, in partnership with the University of Maryland School of Medicine’s Department of Emergency Medicine, received funding from the Robert Wood Johnson Foundation’s Health Data for Action program to develop and test a measure that assesses hospitals based on the frequency of downstream clinically relevant readmissions (DCRR) as opposed to a blanket 30-day all-cause readmission. The team used commercial health insurance data from the Health Care Cost Institute to develop the DCRR classification algorithm that identified key clinical and demographic predictors of a readmission and allowed for normalization of readmission measures across hospitals. The team is currently comparing the new model with the 30-day readmission measure for their ability to measure true quality effects.
Maryland is 1 of 13 states that operates its own health insurance marketplace. Since the passage of the Affordable Care Act in 2010, Hilltop has performed data analytics and policy analysis for the Maryland Health Benefit Exchange (MHBE), the entity responsible for Maryland Health Connection, the state’s marketplace. Issues examined include continuity of care, value-based insurance design, provider network standards, and strategies for market stabilization. Hilltop developed an out-of-pocket cost calculator for the Maryland Health Connection website to assist consumers with selecting health plans that best meet their estimated health care needs. Hilltop will be updating the calculator at least annually as new data become available. Hilltop is also assisting the MHBE with developing carrier reinsurance accountability reports, which will include data on the costs of the reinsurance program, as well as data on care management programs being implemented by the carriers.
For Maryland Medicaid, Hilltop conducts the annual evaluation of HealthChoice, Maryland’s managed care program that serves 1.2 million individuals with capitation payments totaling almost $6.5 billion annually. We also examine service utilization, costs, and outcomes for special programs or populations, such as the Community Health Pilots for home visiting services and assistance with community integration.
Since January 1, 2021, hospitals in the United States have been required by federal regulation to post a machine-readable data file of standard charges on their websites. Standard charges include the gross charges, payer-specific negotiated rates, de-identified minimum and maximum charges, and the discounted cash price for all items and services provided by the hospital. This was a major step forward in hospital price transparency. Hilltop researchers were interested in learning more about hospital compliance with the new regulation as well as about variations in prices for the same procedure or service. They studied 100 of the largest hospitals in the country to find that 65 of the 100 were unambiguously noncompliant. Hilltop’s researchers also found that prices for the same procedure or service vary widely not only across hospitals, but within each hospital. To investigate prices for emergency room (ER) facility fees, Hilltop researchers assembled a data set of facility fees for ER visits for over 1,600 hospitals from across the country and linked hospital and regional characteristics to ER facility fees charged to self-pay patients. Factors associated with higher (or lower) ER self-pay facility fees are discussed in an article in the July 2022 issue of Health Affairs titled Hospital and Regional Characteristics Associated with Emergency Department Facility Fee Cash Pricing.
Hospital Price Transparency: Will It Lead to Lower Prices?
Low Compliance from Big Hospitals on CMS’s Hospital Price Transparency Rule
Why Hospitals and Health Insurers Didn’t Want You to See their Prices…
How New Data on Hospital “Discounted Cash Prices” Might Lead to Patient Savings
What Price Transparency in Healthcare is Already Showing Us
The Social Science of Hospital Pricing
Healthcare Upside/Down: Pricing Impacting Financially Vulnerable Populations
The Maryland Primary Care Program (MDPCP)—which incentivizes practices to offer advanced primary care services—is a component of the Maryland Total Cost of Care Model. Hilltop developed an algorithm that identifies an individual’s relative risk of avoidable hospitalization, called the Hilltop Pre-AH Model™. In partnership with Chesapeake Regional Information System for our Patients (CRISP), Maryland’s health information exchange, Hilltop is using the model to provide risk stratification scores monthly to primary care practices to assist care coordinators in triaging care. The system went live in October 2019. Learn more about the model. Learn how we developed the model.
Through a COVID-19 Accelerated Translational Incubator Pilot (ATIP) grant, Hilltop is further developing the Hilltop Pre-AH Model™ event prediction algorithms to estimate individual-level risks of hospitalization due to COVID-19 and other communicable diseases for Medicare fee-for-service (FFS) beneficiaries across the state of Maryland. This predictive model will serve as a tool to help health care providers prospectively identify individuals at risk of hospitalization for the current and future pandemics. Read the Hilltop Bulletin and the UMBCNews article.