View this timeline to see the process Hilltop followed to develop and implement the Hilltop Pre-AH Model.

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This infographic describes the Hilltop Pre-AH Model, its development, and its use.

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This chart book, prepared for the Maryland Department of Health, compares the FY 2020 Medicaid reimbursement rates of Maryland and its surrounding states with Maryland’s Medicare fee schedule for CY 2019 for the Baltimore region. The surrounding states included in this study are Washington, DC; Delaware; Pennsylvania; Virginia; and West Virginia. Physician fees comprise three components: physician’s work, practice expense, and malpractice insurance expense.

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In 1997, Maryland implemented HealthChoice—a statewide mandatory Medicaid and Children’s Health Insurance Program (CHIP) managed care program—under authority of a waiver through §1115 of the Social Security Act. The provisions of the Affordable Care Act (ACA) that went into effect in 2014 marked another milestone by extending quality coverage to many more Marylanders with low income by calendar year (CY) 2018. Over 20 years after its launch, HealthChoice covered close to 90 percent of the state’s Medicaid and Maryland Children’s Health Program (MCHP) populations.

The Hilltop Institute, on behalf of the Maryland Department of Health (the Department), evaluates the program annually; this evaluation covers the period from CY 2014 through CY 2018.

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In response to the nation’s opioid epidemic, an increasing number of states are applying for and receiving Medicaid Section 1115 demonstration waivers for substance use disorders. The Centers for Medicare and Medicaid Services (CMS) created this opportunity under the authority of section 1115(a) of the Social Security Act for states to draw down federal Medicaid payments for facilities with greater than 16 beds that provide short-term residential treatment, which are otherwise prohibited through the Institution for Mental Disease (IMD) exclusion. Waiving the IMD exclusion allows states to offer short-term residential treatment, thereby offering the entire continuum of addiction treatment services to their Medicaid members based on widely accepted standards for evidence-based care.

This research was supported by the Robert Wood Johnson Foundation’s Research in Transforming Health and Health Care Systems program, which is administered by AcademyHealth. Hilltoppers Cynthia Woodcock, Alice Middleton, David Idala, and Matthew Clark co-authored this report, which describes the experiences of two early adopters of IMD waivers, Maryland and Virginia, in terms of their implementation and impact on the addiction treatment system for Medicaid members.

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The Maryland Primary Care Program (MDPCP) is a key element of the Total Cost of Care (TCOC) All-Payer Model, an agreement between the Centers for Medicare & Medicaid Services (CMS) and the state of Maryland. The MDPCP is a voluntary program that provides funding and support for the delivery of advanced primary care throughout the state. It allows primary care providers to play an increased role in the prevention and management of chronic disease, as well as in the prevention of unnecessary hospital utilization.

As an important part of supporting providers in their care management efforts, the MDPCP will provide to participating practices risk scores of their attributed beneficiaries according to each patient’s risk of incurring a potentially avoidable hospitalization or emergency department (ED) visit. Accordingly, The Hilltop Institute, in conjunction with the Maryland Department of Health, has developed the Hilltop Pre-AH (Predicting Avoidable Hospitalizations) Model™ in order to operationalize these risk scores. These patient-level risk scores are provided to participating medical practices on a monthly basis via the MDPCP portal on the Chesapeake Regional Information System for our Patients (CRISP) unified landing page.

This document aims to explain the intended use, technical implementation, and model performance of the Hilltop Pre-AH Model™ as of January 2020. It will be updated as future versions of the model become operational.

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This provides a brief look at the Hilltop Pre-AH Model™, a risk prediction model that uses a variety of risk factors derived from Medicare claims data to estimate the probability that a given patient incurs an avoidable hospital event in the near future. These risk scores are intended to assist Maryland Primary Care Program (MDPCP) practices with the identification of beneficiaries that have a high risk of incurring an avoidable hospitalization or emergency department event. The Pre-AH Model™ risk scores, used in conjunction with provider clinical guidance, can facilitate a more efficient and impactful allocation of practices’ care management resources.

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This report describes the services The Hilltop Institute provided to the Maryland Department of Health (the Department) under the Master Agreement between Hilltop and the Department. The report covers fiscal year (FY) 2019 (July 1, 2018, through June 30, 2019). 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.

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Hilltop Senior Policy Analyst Charles Betley, MA, helped organize and participated on a panel titled Tobacco Costs: Present and Future Measurements and Effects at the 2019 Fall Research Conference of the Association for Public Policy Analysis and Management (APPAM) held in Denver, Colorado November 7-9, 2019. In his presentation, Betley talked about how policy studies are judged, based on both policymakers’ interests and researchers’ scientific directive. He then discussed the innovative methodology of the study: the use of state Medicaid claims data to estimate the costs of tobacco use to a state Medicaid program. Findings gleaned by this methodology are more timely and accurate than the use of national estimates alone.

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This annual report, written for the UMBC community, provides an overview of key projects and staff accomplishments for FY 2019.

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Hilltop continues to work remotely, so please reach us by email. You can find our team members’ email addresses by going to their bios located on the Teams page of our website.