Below is a listing of select Hilltop publications and presentations. You can search by type, topic, date, and/or title. The search function searches for key words in both the title and the publication summary. Click on the publication’s title below to go to its summary.
Accessibility Notice: Publications released before April 24, 2026 have not been remediated for Section 508 compliance.
Leigh Goetschius, PhD, Danielle Barefoot, MEd, Fei Han, PhD, Ruichen Sun, MS, and Morgan Henderson, PhD, co-authored this article published in The American Journal of Managed Care.
The authors discuss the results of Hilltop’s large-scale risk predictive model based on administrative claims and conclude that the model can predict severe type 2 diabetes events for the Medicare FFS population in Maryland.
In 2014, the state of Maryland partnered with the Centers for Medicare and Medicaid Services (CMS) to modernize its unique all-payer rate-setting system for hospital services to improve the overall health of Maryland residents by increasing health care quality and reducing the cost of care. In service of providing better care at lower costs, The Hilltop Institute at UMBC, in partnership with the Maryland Department of Health, has developed predictive risk stratification models to identify patients at high risk for potentially preventable health care utilization that can be used to help target care resources to the patients who need them most.
This document strives to explain the intended use, technical implementation, and model performance of the Hilltop Pre- Models as of January 2026. The Pre- Models are a suite of prediction tools spanning the Pre-AH Model, Pre-DC Model, and Pre-HE Model. This document will be updated as the models are updated or when new models become operational, and significant changes will be noted in the documentation edit history table and in the text when necessary.
The Hilltop Pre-HE Model—which generates the rankings for the Hospice Eligibility and Advanced Care Planning (Pre-HE) scores—is designed to support proactive advanced care planning discussions by estimating a patient’s risk of eligibility for hospice. The Pre-HE Model provides risk scores and reasons for risk for all attributed beneficiaries of Maryland Primary Care Program (MDPCP) practices every month in order to identify patients that are potentially appropriate for hospice care and to provide care teams with information that can guide the sensitive and difficult conversations about end-of-life care with patients and their families.
The Hilltop Pre-DC Model—which generates the rankings for the Severe Diabetes Complications (Pre-DC) scores—is designed to facilitate the active management of type 2 diabetes by estimating individuals’ risk of incurring inpatient admissions or emergency department (ED) visits for severe diabetes complications. The Pre-DC Model provides risk scores and reasons for risk for all attributed beneficiaries of Maryland Primary Care Program (MDPCP) practices every month to help care teams proactively identify high-risk individuals and allocate scarce care management resources.
The Hilltop Pre-AH Model—which generates the rankings for the Avoidable Hospitalizations (Pre-AH) scores—is designed to assist providers by allowing them to easily identify patients at a high risk of incurring an avoidable inpatient hospitalization or emergency department (ED) visit. The Pre-AH Model provides risk scores and reasons for risk for all attributed beneficiaries of Maryland Primary Care Program (MDPCP) practices every month to help care teams make informed decisions about how to direct scarce care coordination resources to the individuals who will benefit from them the most.
This document summarizes the answers to frequently asked questions about the Hilltop Pre- Model risk scores that are available in the Maryland Primary Care Program (MDPCP) and Multi-Payer CRISP reporting suites—Avoidable Hospital Events (Pre-AH), Severe Diabetes Complications (Pre-DC), and Hospice Eligibility (Pre-HE). It covers information related to the meaning of each of the risk scores, the differences between them, how they are intended to be used, their predictive performance, and where to go to find more information.
This chart book explores service utilization and expenditures for dual-eligible beneficiaries (individuals who are eligible to receive both Medicare and Medicaid services)—with a focus on full-benefit dual-eligible beneficiaries—of all ages who received services in calendar years (CY) 2018 through CY 2022.
The Maryland Department of Health (Department) is responsible for evaluating the quality of care provided to eligible enrollees by contracted managed care organizations (MCOs) through the Maryland Medicaid Managed Care Program, known as HealthChoice. HealthChoice operates under a Centers for Medicare & Medicaid Services (CMS) 1115 waiver of the Social Security Act and Code of Maryland Regulations (COMAR) to serve Marylanders on Medicaid. Guiding principles for HealthChoice’s operations are to provide quality healthcare that is equitable, patient-focused, prevention-oriented, coordinated, accessible, and cost-effective.
Federal regulations require the Department to contract with an external quality review organization (EQRO) to provide annual, independent reviews for assessing quality, access, and timeliness of care. This independent review ensures services provided to enrollees meet the standards governing the HealthChoice program in the Code of Federal Regulations (CFR) and COMAR. The Department contracts with Qlarant to meet federal regulations; evaluate quality, access, and timeliness of care; and validate encounter data.
Hilltop performed Activity 3 of this evaluation, which is included in Appendix A of Qlarant’s report.
This report describes the services The Hilltop Institute provided to the Maryland Department of Health under their Master Agreement. The report covers fiscal year (FY) 2025 (July 1, 2024, through June 30, 2025). Hilltop’s interdisciplinary staff provided a wide range of services, including Medicaid program development and policy analysis; HealthChoice program support, evaluation, and financial analysis; long-term services and supports program development, policy analysis, and financial analytics; and data management and web-accessible database development.
This is the fourth annual review of the integration requirements for Medicare Advantage dual eligible special needs plans (D-SNPs) completed for the Maryland Department of Health. The goal of D-SNP integration, which became effective in calendar year (CY) 2021, is to help improve coordination of care transitions for individuals who are dually eligible for Medicare and Medicaid. This review covers key findings from the fourth year of implementation.