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) 2020 (July 1, 2019, through June 30, 2020). 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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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 June 2020. It will be updated as future versions of the model become operational.

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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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The Medicaid Long-Term Services and Supports in Maryland Chart Book, Volume 1, The Autism Waiver is the first in a series that explores service utilization and expenditures for Medicaid-funded long-term services and supports in Maryland. This chart book provides information about Maryland Medicaid participants who received services through the Autism Waiver in fiscal years (FYs) 2012 to 2016.

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This chart book is the second in a series that explores service utilization and expenditures for Medicaid-funded long-term services and supports in Maryland. It provides information about Maryland Medicaid participants who received services through the Brain Injury Waiver in fiscal years 2012 through 2016. The Brain Injury Waiver provides services to individuals aged 22 through 64 years with a brain injury diagnosis who require a specialty hospital or nursing facility level of care.

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This chart book is the third in a series that explores service utilization and expenditures for Medicaid-funded long-term services and supports in Maryland. It provides information about Maryland Medicaid participants who received services through the Medical Day Care Waiver in fiscal years 2012 through 2016. The 1915(c) Medical Day Care Waiver provides medical day care services to persons aged 16 and over who are eligible for Medicaid and who meet a nursing facility level of care.

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This chart book is the fourth in a series that explores service utilization and expenditures for Medicaid-funded long-term services and supports in Maryland. It summarizes demographic, service utilization, and expenditure data for Model Waiver participants for fiscal years 2012 through 2016. The Model Waiver allows individuals with medically complex needs and a chronic hospital or nursing facility level of care to received needed services in their homes.

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This chart book is the fifth in a series that explores service utilization and expenditures for Medicaid-funded long-term services and supports in Maryland. The focus of this chart book is on Medicaid HCBS, with one chapter dedicated to illustrating Maryland’s efforts at providing these services to an increasing number of Medicaid recipients who may otherwise be served in institutions.

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This chart book is the sixth in a series that explores utilization and expenditures for Medicaid‐funded LTSS in Maryland for fiscal years (FYs) 2012 through 2016. The focus of this chart book is on Medicaid nursing facility services, with one chapter that illustrates Maryland’s efforts at providing home and community‐based services (HCBS) to an increasing number of Medicaid recipients who may otherwise be served in nursing facilities.

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Hilltop staff presented at the 2019 AcademyHealth Annual Research Meeting (ARM). On June 3, Senior Director of Analytics and Research and Chief Data Scientist Ian Stockwell, PhD, presented this poster, which summarizes the work he led to identify factors found in clinical and functional assessment tools that increase the risk of a future nursing home (NH) admission and apply those risk-scoring coefficients to individuals on Maryland’s Home and Community-Based Services (HCBS) waiting list.

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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.