News & Bulletins Archive

Hilltop Senior Research Analyst Michael T. Abrams, MPH, presented a paper at the Tenth Workshop on Costs and Assessment in Psychiatry on March 27, 2011, in Venice, Italy. The international workshop was organized in collaboration with the World Health Organization (WHO), the World Psychiatric Association (WPA), and national governmental institutions, such as the US NIMH, the UK Department of Health, and the Italian Ministry of Foreign Affairs. Abrams’ presentation, entitled Correlates to Antipsychotic Medication Switching among U.S. Medicaid Clients with Schizophrenia, described a method of summarizing administrative data to quantify switching events among persons with schizophrenia who use common medications for treating that illness. The work also explored demographic and drug type correlations to such medication switching. David S. Salkever, PhD, Professor of Public Policy at UMBC, was a co-author on this work.

Salkever and Abrams presented a second paper at this same conference entitled Antipsychotic Switching and Heterogeneity in Treatment Costs for Persons with Schizophrenia in the Maryland Medicaid Program. This study examined cost impacts of different antipsychotic drugs used to treat persons with schizophrenia, and furthermore considered the impact of switching medication vs. stable therapy. The work included comparisons of standard ordinary least squared (OLS) regressions with instrumental variable approaches to consider the differential impacts of individual antipsychotics, as well as conventionals vs. atypicals. For more information, contact Michael Abrams.

The Hilltop Institute co-sponsored an AARP Solutions Forum entitled Launching Insurance Exchanges: What Are States Doing? on April 4, 2011, in Washington, DC. The forum explored the variety of ways states are moving ahead with plans for the launch of state insurance exchanges as part of the Affordable Care Act. Hilltop’s former Executive Director Chuck Milligan gave an overview of key issues: structuring governance and oversight; avoiding adverse risk selection; determining plan selection/participation; integration with public programs and private market; helping individuals and employers navigate; protecting the public (transparency and rewarding and improving quality of care); and funding of exchanges. To view a webcast of the forum, click here.

Hilltop Deputy Director Michael Nolin participated in a panel discussion entitled Health Reform 2011: Where are we now? at the Annual Meeting of the American Society of Public Administrators on March 14, 2011, in Baltimore, Maryland. In his presentation, which focused on Maryland’s reform efforts, Nolin gave an overview of Maryland’s reform preparation process and described the Maryland Health Care Reform Coordinating Council (HCRCC) and the work Hilltop performed as staff for the HCRCC; described Hilltop’s financial modeling tool that determined that Maryland could save $829 million in implementing federal health reform; and discussed the major health reform issues that remain unresolved. To view the presentation, click here. To learn more about Hilltop’s financial modeling tool, contact Michael Nolin.

Hilltop Executive Director Charles Milligan traveled to Columbus, Ohio, on February 23, 2011, to give two presentations to decision makers. Milligan discussed opportunities to better serve persons dually eligible for Medicare and Medicaid (dual eligibles) in his presentation to the Ohio Association of Health Plans and the Ohio Association of Area Agencies on Aging (O4A) entitled Innovations in Integrated Care. He discussed the importance of integrating long-term services and supports for this population; the results of Hilltop’s research on Medicare/Medicaid cross-payer effects for dual eligibles that found that Medicare and Medicaid financing do not align to promote home and community-based services (HCBS) and that the HCBS waiver is only cost-effective (at the individual level) for Medicaid when it truly avoids a nursing home placement; and new opportunities for states under the Affordable Care Act to better serve dual eligibles. To view the presentation, click here. To view a press release on the presentation, clickhere . To access Hilltop’s reports on Medicare/Medicaid cross-payer effects, click here. To view a video clip of Milligan discussing this issue, click here.

Also on February 23, Milligan gave a presentation entitled Medicaid Basics in an Era of Health Reform to two groups—Ohio state legislators and their staff, and other stakeholders—sponsored by the Health Policy Institute of Ohio. In this legislative briefing, Milligan gave an overview of Medicaid and discussed budget tools used by states to manage Medicaid programs, which are important for lawmakers to understand when developing and assessing budget and program proposals. Milligan also addressed the implications of federal health reform for state Medicaid programs and the changing state/federal relationship. To view the presentation, click here.

The Hilltop Institute’s Health Services Policy and Research Director Cynthia Boddie-Willis, MD, MPH, was a discussant at an Institute of Medicine (IOM) report dissemination workshop, entitled For the Public’s Health: The Role of Measurement in Action and Accountability, on February 17, 2011, in Washington, DC. Boddie-Willis participated in a discussion on the interface between clinical care and public health, which addressed recommendations #4 and #5 of the first report of the IOM Committee on Public Health Strategies to Improve Health.

The Maryland Health Care Reform Coordinating Council (HCRCC) released its final report on January 10, 2011. The report is the result of the HCRCC’s efforts since March 2010, when it was created by Maryland Governor Martin O’Malley to make recommendations regarding Maryland’s implementation of the Affordable Care Act (ACA). This final report sets forth a blueprint for Maryland’s implementation of health care reform and includes an overview of the ACA, with a description of the findings of the HCRCC, which were published in its interim report released in July 2010. It also: describes the already-established foundation for reform in Maryland; summarizes the work and process of the HCRCC; identifies the major challenges and opportunities presented by implementation; identifies the necessary investments to ensure success; and identifies 16 recommended short- and long-term action items on how federal reform can be implemented most effectively. The HCRCC was co-chaired by the Honorable Anthony G. Brown, Lieutenant Governor of Maryland, and John M. Colmers, Secretary of the Maryland Department of Health and Mental Hygiene. The lead staff for the HCRCC were Charles Milligan, Hilltop’s executive director, and Alice Burton, principal at Riverside Consulting, LLC. Beyond providing various forms of staff support, Hilltop’s researchers conducted an in-depth analysis of the provisions of the ACA and developed a financial model to project Maryland’s costs and savings associated with implementing health reform. To learn more about the HCRCC and view the interim and final reports, click here. To learn more about Hilltop’s financial model, contact Charles Milligan.

The Hilltop Institute’s Hospital Community Benefit Program released its first issue brief, entitled Hospital Community Benefits after the ACA: The Emerging Federal Framework. The brief provides historical background on federal hospital community benefit policy; outlines the new requirements described in the Affordable Care Act (ACA); and identifies new challenges and opportunities for state and federal decision makers as they begin to develop responses to the new federal requirements. The issue brief is the first in a series, funded by the Robert Wood Johnson Foundation, to be published over three years. To view the bulletin, click here. To view the issue brief, click here.

The Hilltop Institute at UMBC has just released a new issue brief entitled Overcoming Interagency Data-Sharing Barriers: Lessons from the Maryland Kids First Act that describes interagency data-sharing barriers that researchers and state officials encountered as they implemented and evaluated the Maryland Kids First Act outreach initiative. The brief provides an overview of strategies used to identify uninsured children who are eligible for public insurance programs; an update on Maryland’s tax-based outreach program, including a description of the interagency data-sharing barriers encountered and their resolution; a discussion of new data-sharing and outreach opportunities outlined in the Affordable Care Act (ACA); and a discussion of lessons for other states. To view the bulletin, click here. To view the issue brief, click here.

The findings of a Hilltop research project that identified factors associated with small group employer participation in New Mexico’s State Coverage Insurance (SCI) program have been published in an article in the December 9, 2010, online issue of HSR Journal. Entitled Small Group Employer Participation in New Mexico’s State Coverage Insurance Program: Lessons for Federal Reform, the article discusses administrative and cost issues that small employers considered when deciding whether to participate in the SCI program. It concludes that administrative and cost barriers to participation in SCI reported by employers suggest that the tax credit offered to small businesses under new federal provisions, which merely offsets the employer portion of premium, could be more effective if accompanied by additional supports to businesses. The study was partially funded by a grant to Hilltop and its partner, the New Mexico Human Services Department, from the Robert Wood Johnson Foundation State Health Access Reform Evaluation (SHARE). To view the article, click here. Findings of the study were also published in two issue briefs: one from Hilltop (click here) and one from SHARE (click here).

Hilltop Deputy Director Michael Nolin participated on a panel at the National Conference of State Legislatures (NCSL) Fiscal Leaders Seminar on December 9, 2010, in Phoenix, Arizona. The session, entitled State Fiscal Implications of Federal Health Reform, addressed what states are doing to examine the expected state fiscal implications of the Affordable Care Act. The panel discussed the areas where increased and decreased costs to Vermont and Maryland are anticipated and the assumptions and factors used to come to those conclusions. Nolin’s presentation discussed the financial analysis that Hilltop performed for the Maryland Health Care Reform Coordinating Council, which determined that Maryland would save $829 million in the next ten years by enacting federal health reform. To view the presentation, click here. To learn more about Hilltop’s financial modeling tool, contact Michael Nolin.

Hilltop Executive Director Charles Milligan gave a presentation before the Medicaid and CHIP Payment and Access Commission (MACPAC) at its monthly commission meeting on December 10, 2010, in Washington, DC. The presentation, entitled Medicaid and Medicare Resource Use For Dual Eligibles in Maryland, addressed the issue of coordinating long-term care for persons eligible for both Medicare and Medicaid (dual eligibles). In his presentation, Milligan discussed Hilltop’s research on Medicare/Medicaid cross-payer effects that found that Medicare and Medicaid financing do not align to promote home and community-based services. To view the presentation, click here. To learn more about Hilltop’s research on Medicare/Medicaid cross-payer effects, click here.

Hilltop Executive Director Charles J. Milligan was the luncheon keynote speaker for the University of Illinois Institute of Governmental and Public Affairs (IGPA) State Summit 2010: Reforming Medicaid in Illinois on December 7, 2010, in Champaign, Illinois. Milligan’s keynote address, entitled Transforming Medicaid in an Era of Health Reform: State Efforts to Thrive While Hoping to Survive, discussed economic trends and Medicaid; health reform; budget tools; and the changing state/federal relationship. The presentation deals with national trends and could be helpful to all states as they struggle with ensuring access to health services in a difficult economic environment. To view the presentation, click here.

Hilltop Director of Clinical and Quality Management Annette Snyder, PhD, and Senior Research Analyst Michael Abrams, MPH each made presentations at the 138th American Public Health Association (APHA) Annual Meeting held November 6 through 10, 2010, in Denver, Colorado. Snyder’s presentation, entitled The Impact of Selected Demographic, Mental Health and Geographic Measures on Discharge From Nursing Homes Among Working-Age Adults in Maryland, discussed a study that examined factors associated with discharge to the community for working-age adults admitted to Maryland nursing homes over a 5-year period. The study found that the strongest factors related to discharge to the community were an individual’s expressed preference for discharge and perceived support for community discharge. To view the presentation, click here. Abrams made a presentation entitled Cervical Cancer Screening and Gynecologic Visit Rates for Medicaid Enrollees with Mental and Substance Use Disorders. Abrams discussed the findings of a study that assessed PAP screening and gynecological visit rates experienced by women with non-affective psychosis versus other women with substance use disorder (SUD), bipolar or unipolar depression, or the absence of any of these illnesses (controls). The study found that women with psychosis or depression were more likely to receive PAP screening versus controls; and women with SUD with or without psychosis demonstrated reduced screening rates. In addition, Abrams presented a poster on another study, entitled Alternative and “Off-Label” Uses of Antipsychotic Medications in Medicaid, which used Medicaid administrative data from a single state (Maryland) and year (7/2000 to 6/2001) to estimate rates of alternative uses for antipsychotics. This study found a substantial alternative use of antipsychotics, especially for mood disorders and suggested distinctive patterns for the most experienced mental health care providers in alternative use of these medications.

The State Health Access Reform Evaluation (SHARE) has released an issue brief, entitled Participation in the New Mexico State Coverage Insurance (SCI) Program: Lessons from Enrollees. This is the second of two issue briefs that present results from a study of small business participation in SCI conducted by The Hilltop Institute. The study identifies the characteristics of non-sponsored enrollees in SCI and shares lessons learned about employer sponsorship of enrollees in SCI and similar public/private partnerships. To view the bulletin, click here.

Hilltop Executive Director Charles Milligan participated in a meeting for congressional and federal staff hosted by the National Health Policy Forum on October 29, 2010, in Washington, D.C. This meeting, the seventh of the Focus on Reform series providing an in-depth look at various components of the Affordable Care Act (ACA) and related implementation and operational issues, was entitled Medicaid Long-Term Services and Supports (LTSS) Provisions in PPACA. The session provided an overview of the Medicaid LTSS provisions enacted as part of the ACA, including the Community First Choice and Section 1915(i) state plan options; and the balancing incentive payments (BIP) and Money Follows the Person (MFP) programs, among others. Speakers described the provisions; strategies being employed by the Centers for Medicare & Medicaid Services (CMS) to assist states implement the various options, and opportunities and challenges facing states in implementation of the provisions. In his presentation, Milligan discussed the growth in Medicaid expenditures for LTSS; presented the results of a Hilltop study of Medicare/Medicaid cross-payer effects that found that Medicare and Medicaid financing do not align to promote home and community-based services (HCBS); described state and federal opportunities and barriers; and forecasted the take-up of LTSS options in the ACA. To view the presentation, click here.