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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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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In 1997, HealthChoice—Maryland’s statewide mandatory Medicaid and Children’s Health Insurance Program managed care program—became operational as a waiver of standard federal Medicaid rules, under authority of §1115 of the Social Security Act. The Centers for Medicare & Medicaid Services approved subsequent waiver renewals in 2005, 2007, 2010, 2013, and 2016. The Maryland Department of Health continually monitors HealthChoice performance on a variety of measures across the demonstration’s goals, culminating in an annual evaluation. This report—the 2019 annual evaluation—includes data from calendar year (CY) 2013 through CY 2017.

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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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Hilltop staff presented at the 2019 AcademyHealth Annual Research Meeting (ARM). Director of Health Reform Studies Laura Spicer, MA, and Senior Policy Analyst Alexis Smirnow, MPH, gave this podium presentation about the potential of implementing Small Business Health Options Program (SHOP) in Maryland at the State Health Policy Interest Group Meeting on June 1.

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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) 2018 (July 1, 2017, through June 30, 2018). 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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This chart book outlines the demographics and service utilization for individuals enrolled in the Maryland Medicaid Dental Program who received services in calendar years 2012 through 2016. Individuals who qualify for dental services include those enrolled in Medicaid fee-for-service or a HealthChoice managed care organization.

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This chart book compares the Medicaid reimbursement rates of Maryland and its surrounding states with Maryland’s Medicare fee schedule. The surrounding states included in this study are Pennsylvania; West Virginia; Virginia; Washington, DC; and Delaware.

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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.