B. Health Care Access & Affordability (The Hilltop Institute, UMBC)
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Item One Year Later, Where Are The 'Transparency In Coverage' Compliance Studies?(Health Affairs, 2023-09-19) Henderson, Morgan; Mouslim, MorganeItem The Hilltop Pre-HE Model™: Hospice Eligibility & Advanced Care Planning Fact Sheet(The Hilltop Institute, 2023-04-01) The Hilltop InstituteThe 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.Item The Hilltop Pre-DC Model™: Severe Diabetes Complications Fact Sheet(The Hilltop Institute, 2022-09-01) The Hilltop InstituteItem The Hilltop Pre-AH Model™: Avoidable Hospitalizations Fact Sheet(The Hilltop Institute, 2023-03-01) The Hilltop InstituteThe 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.Item The Hilltop Pre- Models: In Brief(The Hilltop Institute, 2023-04-01) The Hilltop InstituteThe Hilltop Pre- Models are risk prediction models developed by The Hilltop Institute at UMBC that use a variety of risk factors derived from Medicare claims data to estimate the event risk that a given patient incurs a given outcome in the near future. As of November 2022, there are three such prediction models in production for the Maryland Primary Care Program (MDPCP) population: the Hilltop Pre-AH Model™, which generates the “Avoidable Hospitalizations (PreAH)” scores; the Hilltop Pre-DC Model™, which generates the “Severe Diabetes Complications (Pre-DC)” scores; and the Hilltop Pre-HE Model™, which generates the “Hospice Eligibility and Advanced Care Planning (Pre-HE)” scores. These risk scores are displayed in the MDPCP Prediction Tools area on Chesapeake Regional Information System for our Patients (CRISP).Item The Economic Impact of Medicaid Expansion in Mississippi, 2023-2028: Technical Report(The Hilltop Institute, 2022-01-11) The Hilltop InstituteEnacted in 2010, the Affordable Care Act (ACA) gave states the option to expand their Medicaid programs by extending eligibility to almost all adults under age 65 with income below 138% of the federal poverty level (FPL). As of December 2021, Mississippi was 1 of 12 states that has not expanded its Medicaid program. In order to provide state policymakers with the latest available evidence on the potential impact of Medicaid expansion, the Center for Mississippi Health Policy commissioned The Hilltop Institute to conduct a study on the likely effects of Medicaid expansion on Mississippi’s Medicaid program, state budget, wider economy, and providers. This technical report presents the findings of this study in full detail. A summary report is also available.Item The actual, long-term cost of intentional injury care among a cohort of Maryland Medicaid recipients(Wolters Kluwer, 2023-03-01) Dezman, Zachary D.W.; Thurman, Paul; Stockwell, IanBACKGROUND Intentional injury (both self-harm and interpersonal) is a major cause of morbidity and mortality, yet there are little data on the per-person cost of caring for these patients. Extant data focus on hospital charges related to the initial admission but does not include actual dollars spent or follow-up outpatient care. The Affordable Care Act has made Medicaid the primary payor of intentional injury care (39%) in the United States and the ideal source of cost data for these patients. We sought to determine the total and per-person long-term cost (initial event and following 24 months) of intentional injury among Maryland Medicaid recipients. METHODS Retrospective cohort study of Maryland Medicaid claims was performed. Recipients who submitted claims after receiving an intentional injury, as defined by the International Classification of Diseases, Tenth Revision, between October 2015 and October 2017, were included in this study. Subjects were followed for 24 months (last participant enrolled October 2017 and followed to October 2019). Our primary outcome was the dollars paid by Medicaid. We examined subgroups of patients who harmed themselves and those who received repeated intentional injury. RESULTS Maryland Medicaid paid $11,757,083 for the care of 12,172 recipients of intentional injuries between 2015 and 2019. The per-person, 2-year health care cost of an intentional injury was a median of $183 (SD, $5,284). These costs were highly skewed: min, $2.56; Q1 = 117.60, median, $182.80; Q3 = $480.82; and max, $332,394.20. The top 5% (≥95% percentile) required $3,000 (SD, $6,973) during the initial event and $8,403 (SD, $22,024) per served month thereafter, or 55% of the overall costs in this study. CONCLUSION The long-term, per-person cost of intentional injury can be high. Private insurers were not included and may experience different costs in other states. LEVEL OF EVIDENCE Economic and Value Based Evaluations; level III.Item Risk Score Specifications and Codebook for The Hilltop Institute’s Pre- Models, Version 1.1(The Hilltop Institute, 2023-04-27) The Hilltop InstituteIn 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 November 2022. The Pre- Models are a suite of prediction tools spanning the Pre-AH Model™, Pre-CH 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. This first section of the codebook provides a short introduction; the second section provides a general overview of data sources, training methodology, and scoring methodology; the third section provides specific details on the performance and operations of each model within the Hilltop Pre- Models suite; and the fourth section presents limitations.Item Novel Methodology Identifying Target Sites for School-Based Health Centers (SBHCs) toward Closing Health and Educational Equity Gaps(The Hilltop Institute, 2023-06) The Hilltop InstituteItem Medicaid Long-Term Services and Supports in Maryland: FY 2016 to FY 2020, Nursing Facility Services. A Chart Book.(The Hilltop Institute, 2022-10-01) The Hilltop InstituteThis chart book explores utilization and expenditures for Medicaid-funded long-term services and supports (LTSS) in Maryland for state fiscal year (FY) 2016 through FY 2020. 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.Item Medicaid Long-Term Services and Supports in Maryland: CY 2015 to CY 2019, Maryland Dual-Eligible Beneficiaries. A Chart Book.(The Hilltop Institute, 2023-01-05) The Hilltop InstituteThis 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 (CYs) 2015 through 2019.Item Maryland School-Based Health Center Program Needs Assessment(The Hilltop Institute, 2022-12-09) The Hilltop InstituteThe Maryland Department of Health (MDH) engaged The Hilltop Institute and Aurrera Health Group to conduct a landscape needs assessment of the state’s School-Based Health Center (SBHC) Program. The assessment will inform the Program’s strategic priorities, growth, and structure as it transitions from the Maryland State Department of Education (MSDE) to MDH. The assessment includes an analysis of the status of SBHCs in Maryland, geographic areas that may benefit from establishing SBHCs, and recommendations for program implementation and SBHC funding allocation.Item Maryland Department of Health Master Agreement Annual Report of Activities and Accomplishments: FY 2022(The Hilltop Institute, 2023-03-01) The Hilltop InstituteThis 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) 2022 (July 1, 2021, through June 30, 2022). 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.Item Integration Requirements for Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) Annual Program Review, CY 2021(The Hilltop Institute, 2022-11-11) The Hilltop InstituteThis is the first 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 improve coordination of care transitions for individuals who are dually eligible for Medicare and Medicaid. To meet this goal, D-SNPs are required to notify the state designees (e.g., supports planners) of Medicare hospital and skilled nursing facility (SNF) admissions when members receive long-term services and supports (LTSS) through a home and community-based services (HCBS) waiver or state plan program. This review describes key findings from the first year of implementation, focusing on aggregate trends.Item Evaluation of the Maryland Medicaid HealthChoice Program: CY 2017 to CY 2021(The Hilltop Institute, 2023-06-30) The Hilltop InstituteItem Assistance in Community Integration Services (ACIS): CY 2021 Review(The Hilltop Institute, 2023-01-31) The Hilltop InstituteThe ACIS pilot program began in late 2017 with the goal of reducing unnecessary health services use among Medicaid beneficiaries by providing tenancy and housing case management services through four lead entities (LEs) located in Baltimore City and Cecil, Montgomery, and Prince George’s Counties. The program is targeted for adults who meet the U.S. Department of Housing and Urban Development’s head of household definition. The pilot program is authorized under Maryland’s §1115 HealthChoice Waiver.Item Medicaid Expansion in Mississippi: A Literature Review(The Hilltop Institute, 2021-04-27) The Hilltop InstituteItem Medicaid Expansion Studies: Why Do Net Cost Estimates Differ So Much?(2022-06-06) Henderson, MorganItem Evaluation of the Maryland Medicaid HealthChoice Program: CY 2016 to CY 2020(The Hilltop Institute, 2022-06-30) The Hilltop InstituteIn 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 2016 through CY 2020.Item HILLTOP Pre-AH MODEL(The Hilltop Institute, 2022-07) The Hilltop Institute