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, MCOs, and an actuarial firm responsible for certifying rates.