The 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).
The 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.
The Hilltop Pre-DC Model™—which generates the rankings for the Severe Diabetes Complications (Pre-DC) scores—is designed to facilitate the active management of type 2 diabetes by estimating individuals’ risk of incurring inpatient admissions or emergency department (ED) visits for severe diabetes complications. The Pre-DC 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 proactively identify high-risk individuals and allocate scarce care management resources.
The 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.
This annual report, written for the UMBC community, provides an overview of key projects and staff accomplishments for FY 2024.
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. Over 25 years after its launch, HealthChoice covers close to 90% of the state’s Medicaid and Maryland Children’s Health Program (MCHP) populations. Since the inception of HealthChoice, the Maryland Department of Health (the Department) has requested and received seven §1115 waiver renewals.
The Hilltop Institute, on behalf of the Department, evaluates the program annually; this evaluation covers the period of calendar year (CY) 2018 through CY 2022.
Policy Analyst Advanced Morgane Mouslim, ScM, DVM, presented this poster at the 2024 AcademyHealth Annual Research Meeting (ARM) held June 29 – July 2 in Baltimore.
On April 10, 2024, Hilltop Deputy Director Alice Middleton was one of three speakers at a session of the University of Baltimore-sponsored Rosenberg Dialogue Series, titled Fixing Unintended Pandemic Medicaid Policy Consequences: Lessons Learned and Insurance Coverage Implications for Recipients. In the session, speakers discussed the national context and state variations in qualifying disenrolled persons for coverage, Maryland Medicaid experiences with this policy complication for continuous enrollment, and generating data and information for evidence-based decisions.
As Mississippi is actively considering expanding its Medicaid program, Hilltop created this informational brief to capture key facts regarding Medicaid policy options as they apply to a potential Medicaid expansion in Mississippi.
As Mississippi is actively considering expanding its Medicaid program, Hilltop created this informational brief to capture key facts regarding Medicaid work requirements as they apply to a potential Medicaid expansion in Mississippi.