Hilltop works to find innovative strategies for expanding access to affordable health care coverage and services with the goal of empowering consumers.
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 the HealthChoice program, 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.
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.
Hilltop modeled several options for a state reinsurance program for the MHBE, informing deliberations for HB 1795, Maryland Health Benefit Exchange-Establishment of a Reinsurance Program, which was signed by Governor Larry Hogan on April 5, 2018. The legislation directed the MHBE to apply for a federal §1332 State Innovation waiver to implement the program. The reinsurance program was approved on August 22, 2018, and implemented for the 2019 plan year. The reinsurance program is funded through a combination of federal pass-through funds and an assessment on health plans. As a result of the reinsurance program, monthly premiums decreased by 13 % in 2019, 10 % in 2020, and a further 12% in 2021. The three-year cumulative impact is a rate decrease of roughly 31 % from 2018 premiums. Hilltop assisted the MHBE with drafting the §1332 waiver application, staffing the required public hearings, and compiling and synthesizing public comments.