Rate Setting & Payment Reform

Hilltop is at the forefront of national efforts to find data-driven solutions to complex problems facing state policymakers as publicly funded health care systems transition to new payment models that reward quality and value over volume.

Each year, Hilltop works with the Maryland Department of Health to develop risk-adjusted capitation payments for managed care organizations (MCOs) participating in HealthChoice, Maryland’s Medicaid managed care system. Hilltop conducts financial analyses to inform HealthChoice payment policy, develop capitation rates for MCOs, conduct financial monitoring of MCOs, and assist the Department with capitation rate recovery. Hilltop manages a collaborative process—recognized nationally for its transparency and cost-effectiveness—involving Department officials, managed care organizations, and an actuarial firm responsible for certifying rates.

To meet federal total cost of care requirements in the next iteration of the Maryland all-payer model, the Department is considering accountable care organizations (ACOs) for Marylanders enrolled in both Medicare and Medicaid (“dual-eligible beneficiaries”). Hilltop is conducting demographic, geographic, and financial analyses to support ACO development.

Featured Work

Medicaid Eligibility Graphic

The Hilltop Institute conducted an analysis of the demographics, service utilization, and expenditures of Maryland’s dual-eligible population. The analyses focus on Medicare beneficiaries in Maryland who also receive full Medicaid benefits. The findings, published in a chart book and three reports provide an overview of how this population accesses health care services, the types of services used, and where the services are provided.

Staff Experts

Duane Glossner

Duane Glossner

Director, Rate Setting

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Ian Stockwell

Ian Stockwell

Director, Aging and Disability Studies

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