Hilltop staff presented at the 2018 AcademyHealth Annual Research Meeting (ARM) in Seattle in June. Senior Policy Analyst Shamis Mohamoud, MA, gave this podium presentation, which provided an overview of Hilltop’s evaluation of the Maryland Health Home Program.

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The Heroin and Opioid Emergency Task Force, established by Maryland Governor Larry Hogan, recommends that the Maryland Department of Health review Maryland Medicaid rates for substance use disorder (SUD) services every three years. This chart book reviews SUD services provided by the Maryland Medicaid program from CY 2012 to CY 2016 and compares the rates with those of Delaware, Pennsylvania, Virginia, West Virginia, and Washington, DC.

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On March 29, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule on Medicaid and Children’s Health Insurance Programs; Mental Health Parity and Addiction Equity Act of 2008; the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations (MCOs), the Children’s Health Insurance Program (CHIP), and Alternative Benefit Plans (ABPs) (https://www.gpo.gov/fdsys/pkg/FR-2016-03-30/pdf/2016-06876.pdf). This rule provides new requirements for Medicaid and CHIP compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equality Act of 2008 (MHPAEA) and the Affordable Care Act (ACA). Final MHPAEA regulations for group health insurance plans were issued in 2013. Much of this final rule extends the MHPAEA requirements for group health plans to Medicaid MCOs, CHIP, and ABPs, with exceptions and changes as applicable to address the unique aspects of state Medicaid mental health (MH) and substance use disorder (SUD) delivery systems. This document provides a high-level summary of the rule and highlights the changes to the proposed rule.

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Alcohol misuse has been identified as a major public health problem in the United States. However, although not yet widely adopted, alcohol screening and brief intervention (SBI) in the primary care setting has been shown to reduce problematic alcohol consumption.

In order to facilitate SBI for alcohol misuse, Research Circle Associates (RCA), a Maryland-based research firm, obtained a Small Business Technology Transfer (STTR) grant to develop a computerized SBI for use in the primary care setting. The Interventionaire© is a software system used to create and administer patient-based behavioral screening questionnaires and provide normative feedback to patients immediately upon completion of the questionnaire. Following successful proof-of-concept work in Phase I of the STTR, RCA contracted with The Hilltop Institute to conduct a qualitative analysis to address one specific aim of a larger Phase II implementation study: identify staff-perceived barriers to implementing the Interventionaire© in the primary care setting.

This report not only identifies staff-perceived barriers to implementing a computerized alcohol SBI tool in a primary care setting, but also identifies potential facilitators and explores anticipated advantages and disadvantages to implementation.

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At the request of the Maryland Department of Health and Mental Hygiene (DHMH), The Hilltop Institute conducted a series of analyses on the health care utilization of Maryland’s full-benefit Medicare-Medicaid dual-eligible beneficiaries. Together, these analyses provide an overview of how this population accesses health care services, the types of services being used, and where the services are provided.

This report examines full-benefit dual-eligible beneficiaries with mental health conditions in Maryland during calendar year (CY) 2012, including number and type of mental health conditions; demographics and county of residence; emergency department use; and Medicare and Medicaid expenditures and service days.

Related publications: Maryland Full-Benefit Dual-Eligible Beneficiaries’ Use of Medicare and Medicaid Services Preceding and Following a Medicare Inpatient Stay, Characteristics of Maryland Full-Benefit Dual-Eligible Beneficiaries with Three or More Inpatient Stays, and The Maryland Dual-Eligible Beneficiaries Chart Book.

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This report provides what are believed to be the most detailed estimates of opioid (including heroin) abuse, dependence, and treatment in Baltimore City from July 1, 2013, to June 30, 2014. Hilltop wrote this report with financial support from Behavioral Health System Baltimore (BHSB).

 

Hilltop found that, as of June 30, 2014, there were 24,887 unique individuals with opioid-related morbidity in Baltimore City, and 59 percent of those individuals received at least one form of standardized outpatient treatment in the 12 months leading up to that date. This seemingly high rate of treatment engagement is believed to be inflated because it is based on a medical treatment sample rather than a broader population sample. Additionally, the use of just a single service represents a “low bar” definition/threshold for adequate provision of care. Accordingly, these results suggest that at least 41 percent of Baltimore City residents have opioid-related morbidity absent adequate care.

 

This report further details rates of different levels of care for opioid-related problems, including inpatient and emergency department (ED) service use, and puts forth regression results that estimate the extent to which different factors correlate with engagement in standard opioid treatment.

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Hilltop Senior Research Analyst and UMBC Public Policy PhD candidate Michael T. Abrams, MPH, gave the 2015 Judith A. Shinogle Memorial Fellowship lecture at UMBC. Abrams discussed the research projects—spearheaded by Shinogle before her tragic death in 2012—that he and UMBC researchers are conducting to inform policy decisions about health care and treatment for adults with serious mental illness, and children with asthma. He also discussed his dissertation research, which focuses on the impact of news coverage on the dissemination of prescription drug warnings issued by the U.S. Food and Drug Administration.

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Hilltop staff made several presentations at the 2015 AcademyHealth Annual Research Meeting (ARM) held June 13 through June 15 in Minneapolis. Senior Research Analyst Michael T. Abrams, MPH, presented this poster at an ARM poster session on June 15.

This poster considers cross-sectional correlates to inpatient psychiatric admissions among Medicaid youths (aged 2-19) and further describes admitting diagnoses connected to such admissions, as well as repeat hospitalizations experienced by this population. The main findings were that foster care youths appear to have particularly high rates of such hospitalizations, and especially so at higher ages. Additionally, the poster shows that depressive, bipolar, and externalizing diagnoses are coincident with most (79% of)  hospitalizations.

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Hilltop staff made several presentations at the 2015 AcademyHealth Annual Research Meeting (ARM) held June 13 through June 15 in Minneapolis. Senior Policy Analyst Shamis Mohamoud, MA, delivered this podium presentation at the State Health Research and Policy Interest Group Meeting.

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Health Homes are intended to improve health outcomes for individuals with chronic conditions by providing patients with an enhanced level of care management and care coordination. The goal of this report is to provide a description of Medicaid enrollees’ participation in the Maryland Health Home program and their interactions with the health care system during the first year of program implementation.

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