This is the third 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 help improve coordination of care transitions for individuals who are dually eligible for Medicare and Medicaid. This review covers key findings from the third year of implementation.
Hilltop researchers Morgan Henderson, PhD, and Morgane Mouslim, DVM, SCM, published this article in the August 2024 issue of The American Journal of Managed Care. The first research of its kind, the piece compares the two different federally mandated sources of public, freely available health services price transparency data (insurer and hospital) for prices for maternity-related services negotiated between Blue Cross & Blue Shield of Mississippi and 26 Mississippi hospitals. Drs. Henderson and Mouslim examined the procedure code overlap for these pricing data sources, and then, for overlapping procedure codes, assessed price congruence. They found low levels of overlap: only 16.3% of hospital-billing code combinations appear in both data sources. However, for the overlapping observations, price concordance is high, with 77.4% of prices matching to the penny. The relatively low degree of overlap between the two pricing data sources indicates significant administrative misalignment between these pricing files; however, the strong concordance of overlapping prices suggests that these data sources are capturing pricing information from the same underlying contracts, as intended. This study is part of the ongoing research conducted by The Hilltop Institute on price transparency.
Hilltop researchers Morgan Henderson, PhD, Leigh Goetschius, PhD, and Fei Han, PhD, co-authored this article published in Medical Care.
Predictive models have proliferated in the health system in recent years and have been used to predict both health services utilization and medical outcomes. Less is known, however, on how these models function and how they might adapt to different contexts. The purpose of the current study is to shed light on the inner workings of a large-scale predictive model deployed in 2 distinct populations, with a particular emphasis on adaptability issues.
Senior Policy Analyst MaryAnn Mood, MA, gave a podium presentation at the 2024 AcademyHealth Annual Research Meeting (ARM) held June 29 – July 2 in Baltimore.
This chart book explores utilization and expenditures for Medicaid-funded LTSS in Maryland for state fiscal year (FY) 2018 through FY 2022. 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.
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.
Data Scientist Advanced Leigh Goetschius, PhD, gave this podium presentation at the 2024 AcademyHealth Annual Research Meeting (ARM) held June 29 – July 2 in Baltimore.
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.
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.
Principal Policy Analyst Christine Gill, PhD, presented this poster at the 2024 AcademyHealth Annual Research Meeting (ARM) held June 29 – July 2 in Baltimore.