News Archive
Hilltop Participates in Heritage Foundation Forum
The Hilltop Institute’s executive director, Charles Milligan, was an expert witness in an invitational forum hosted by The Heritage Foundation, on September 24, 2008, that explored innovative models for states’ reform of Medicaid programs and other vehicles for long-term care, paying particular attention to the concerns of the elderly and disabled. Entitled Workable Solutions for Long-Term Care, the forum simulated a Congressional hearing, in which health policy experts presented testimony and then fielded questions from a panel of distinguished members. Milligan presented in the session entitled Private Sector Models in the Context of Medicaid Reform, and focused on emerging opportunities to align Medicare and Medicaid payments and incentives. The goal of this alignment would be to reform Medicaid (and Medicare) to facilitate: the improvement of hospital discharge planning in a way that might avoid or reduce Medicaid-paid nursing facility stays; the improvement of the quality of long-term care services in a way that might avoid unnecessary Medicare-paid hospital admissions and emergency room use; and the promotion of greater flexibility in benefit delivery. To view Milligan’s testimony, click here.
Hilltop Collaborates with New Mexico in Development of New Coordinated Long-Term Services Program
The Hilltop Institute collaborated with the New Mexico Human Services Department in the development of a new coordinated long-term services program that has just received federal approval. The program will serve an estimated 38,000 Medicaid beneficiaries statewide, the vast majority of whom are enrolled in both Medicare and Medicaid ("dual eligibles"). The enrollees who are not dual eligibles will meet a nursing facility level of care even though many are already served in the community. Known as the Coordination of Long-Term Services (COLTS) Program, New Mexico's model will operate under a Section 1915(b)(c) waiver from the Centers for Medicare and Medicaid Services (CMS), and the state will contract with two managed care organizations (MCOs) that are also Medicare Advantage Special Needs Plans. The state has two major goals in COLTS: to coordinate Medicare and Medicaid services by contracting with MCOs that may serve the beneficiaries in both programs, and to coordinate the full array of Medicaid services in order to promote community-based services where appropriate for the given beneficiary. The program will be implemented on a statewide basis over the next 11 months. Hilltop has been working with New Mexico over the past three years to design the program, develop the waivers, and advise the state on the capitated rate structure.
Hilltop Presents at Colorado’s Centennial Care Choices Program Panel
The Hilltop Institute’s executive director, Chuck Milligan, gave a presentation on benefit design on August 4, 2008, before the Colorado Centennial Care Choices Program Panel, a governor-appointed expert panel charged with gathering information on the design, benefits, and costs of a Value Benefit Plan for the people of Colorado. Milligan discussed the concept of minimum benefits (a state’s determination of what constitutes “being insured”) and policy implications, such as the balance between a given state’s determination of where to strike a balance between its role to protect its citizens, and its role to respect individual liberty/autonomy to purchase services in the market; the balance between coverage by private insurance and government programs that wrap around those benefits; and the balance between covering more people with leaner benefits, or fewer people with more comprehensive benefits. Milligan then presented alternatives utilized by different states to provide benefits to their uninsured citizens.
Hilltop Hosts Fifth Symposium on Health Policy
The Hilltop Institute sponsored a day-long symposium to explore three major areas of policy innovation to improve access to and utilization of oral health care: integration of dental and medical service delivery; dental workforce issues; and health education and outreach strategies. The day was divided into four sessions and highlighted by a keynote address, a luncheon address, and concluding reflections. Over 130 policy makers, health services researchers, and health care practitioners from across the country, including the leading experts in the field, participated in the event. Click here to learn more.
Hilltop to Collaborate with New Mexico on State Health Reform Evaluation
The Hilltop Institute, in collaboration with the New Mexico Human Services Department, has received a grant to perform an evaluation of the New Mexico State Coverage Insurance program (SCI). The grant is one of 15 nationwide that was awarded through the Robert Wood Johnson Foundation State Health Access Reform Evaluation (SHARE) Initiative. The project will identify factors that have influenced employer participation in the New Mexico SCI program through surveys and analysis of administrative data. The project will not only benefit New Mexico, but will have national significance as well. Other states may face similar operational challenges related to combining public health insurance coverage with commercial-style insurance that requires employer contribution. New Mexico’s experience with its SCI program will provide lessons to other states that implement public/private partnerships or premium assistance programs requiring employer cooperation. This project is a state/university research partnership between New Mexico and Hilltop. Senior Research Analyst Anna Sommers, PhD, at The Hilltop Institute, is the principal investigator for the project. She will lead Hilltop’s project team, which includes Acute Care Policy Director Ann Volpel, MPA, Research Analyst Asher Mikow, MHA, Economic Analysis Director Hamid Fakhraei, PhD, and Research Assistant Laura Spicer. Insure New Mexico! Director Mari Spaulding-Bynon, JD, is co-principal investigator.
Cynthia Woodcock to Direct Hilltop’s Long-Term Supports and Services Unit
Cynthia H. Woodcock, M. B. A., has been named director of Hilltop’s Long-Term Supports and Services Unit. In this capacity, she will manage Hilltop's initiatives in long-term care policy and lead Hilltop's work on the development of home- and community-based services waiver programs and other integrated long-term care initiatives. In addition, she will continue to manage Hilltop's contract with the New Mexico Human Services Department, which has focused on launching a new self-directed waiver program and a Medicaid managed long-term care initiative. Under her direction, Hilltop is also assisting with implementation of Maryland's Money Follows the Person demonstration and carrying out an evaluation of New Jersey's federal Systems Transformation Grant in long-term care. She succeeds Wayne Smith, who retired last month, and has been with the unit since 2007. Woodcock joined Hilltop in 2004 as a senior research analyst, working with Hilltop's executive director on strategic planning and new business development.
Hilltop Receives Grant to Study the Economics of Antipsychotic Drug Use in Maryland’s Medicaid Population
The Hilltop Institute, in partnership with the UMBC Department of Public Policy, has received a two-year grant from NIH to study the economics of antipsychotic drug use in Maryland’s Medicaid population. The principal aim of the study is to analyze Maryland’s Medicaid data to identify cost and clinical correlates to specific antipsychotic drug choices of patients with schizophrenia. The analysis will review data spanning the period from 2002-2005, and earlier as feasible for select subpopulations. Dr. Tony Tucker from Hilltop will assist the project by merging Medicare and Medicaid records in order to assess clinical heterogeneity and costs, specifically for persons receiving benefits from both programs (dual eligibles). Senior Research Analyst Michael Abrams, MPH, the project’s co-investigator, will lead Hilltop’s team. Dr. David Salkever, Professor, Department of Public Policy, is the project’s principal investigator.
Hilltop Issues First Bulletin
The Hilltop Institute has issued its first electronic Bulletin about a report it prepared for the Maryland Community Health Resources Commission on School Based Health Centers. The Bulletin is the first formal venue that Hilltop has had for news releases. It will be used to periodically disseminate information about important news from Hilltop and about reports it produces. The Bulletin is sent electronically to the health services community. To view the Bulletin, click here.
Center Presents at NGA Center for Best Practices Workshop
The Center’s Executive Director, Chuck Milligan, participated in a panel discussion entitled How To Determine the Minimum Set of Required Benefits at a workshop conducted by the National Governors Association (NGA) Center for Best Practices on March 27, 2008. The workshop, Defining Benefit Packages in Health and Medicaid Reform, addressed how states could define and develop benefit packages which address the unique needs of their Medicaid beneficiaries. Milligan’s presentation discussed how different policy approaches affect a state’s determination of the minimum set of benefits that it mandates, as well as cost implications for the state and for the beneficiaries. To view the presentation, click here.
Center to Collaborate on Study of Payment for Psychiatric Services
The Center is collaborating with the Bloomberg School of Public Health at Johns Hopkins University and the UMBC Public Policy Department on an NIMH funded project to study the cost and quality implications of payment for psychiatric services. Diagnosis Related Groups (DRGs) are commonly used to pay inpatient hospitals. However, most of inpatient psychiatric care is paid per diem. The research seeks to improve psychiatric DRGs, with billing and supplemental information from medical records, so that they can be used for payment purposes. The study will also provide insight into hospital quality performance under per case payment. Dr. Hamid Fakhraei is leading the Center's research team.
Center Presents at State Coverage Initiatives National Meeting
The Center's Executive Director Chuck Milligan and Director of Acute Care Policy Ann Volpel participated in separate panel discussions at the National Meeting for State Coverage Initiatives that was held February 6-8, 2008 in Nashville, Tennessee. Milligan participated on a panel addressing emerging issues in the Medicaid and SCHIP programs and gave a presentation on recent directions in broad national policy, their implications for states, trends in state activities, and reforms approved by CMS under the Deficit Reduction Act and Section 1115 Waiver programs. Volpel participated on a panel discussing how states have attempted to address access and affordability in the small group market and gave a presentation on the two reports the Center completed on marketing state coverage programs. To view the reports, click here.
Center Presents Benefits of Coverage for Children to Idaho Legislative Committee
The Center's Executive Director, Chuck Milligan, presented information on the benefits of pursuing health insurance coverage for children and adolescents in Idaho on January 9 at the Cover Idaho Kids Coalition Meeting and Research Discussion. Funded by the Robert Wood Johnson State Coverage Initiatives program administered by AcademyHealth, these presentations gave an overview of research and literature that shows the positive relationship between health insurance coverage and good health outcomes. Milligan discussed the benefits of coverage to the child, the family, the community, and the system: that insurance coverage allows children and their families to access health care earlier, which can prevent more serious health problems and illnesses, thereby avoiding the need to use more expensive services, such as emergency rooms. Laura Spicer, a research assistant at the Center, reviewed the literature for the presentations.
Center receives funding for study entitled "Medicaid Long-Term Care Programs: Simulating Rate Setting and Cross-Payer Effects."
The Center, in partnership with the MD Department of Health and Mental Hygiene (DHMH), has received funding from the Robert Wood Johnson Foundation Changes in Health Care Financing and Organization (HCFO) program to conduct a two-year study on the interactive effects of Medicare- and Medicaid-provided services, particularly with respect to rate-setting for coordinated/integrated programs of care for those who are enrolled under both programs (duals). The Center’s Tony Tucker headed up the development of the grant application and will serve as a co-principal investigator. Judy Kasper of Johns Hopkins University will also serve as a co-investigator. Tricia Roddy at DHMH will serve as the formal project director, which will ensure that the grant funds will generate matching federal funds to conduct the study.
Center's Analysis Suggests Treatment for Heroin Addiction is Cost Effective
The Center conducted a study to determine if the expansion of buprenorphine as a strategy for battling opioid addiction is cost-effective. Commissioned by the Baltimore City Health Department and funded by the Annie E. Casey Foundation, the study used Medicaid data to examine health care service utilization differences between opioid addicts who were treated for their addiction versus those who went untreated, reviewed the literature, and estimated clinical and financial benefits and costs. The study's results supported the value and effectiveness of opioid maintenance therapy (OMT), and suggested that expanding treatment access has the potential to reduce both individual suffering and the overall societal burden associated with opioid dependence without increasing the cost of medical care. The research also indicated that expanding OMT has the potential to save the publicly financed health care system money by reducing heroin-associated morbidity in Medicaid and other insured and uninsured populations. Researchers estimated the cost savings and found that Baltimore City could save over $4,000,000.00 per year if utilization of OMT were expanded. To view the study's five reports, click here.
Chuck Milligan Presents at Conference about Medicare Special Needs Plans (SNPs)
Chuck Milligan gave a brief presentation on October 18 at the Center for Medicare Advocacy's conference, Medicare Advantage Special Needs Plans: A Beneficiary Perspective. The conference brought together beneficiary advocates, health policy advocates, researchers, SNP providers, Centers for Medicare and Medicaid Services (CMS) officials, and Congressional staff. The conference proceedings were anchored by three background papers, two of which were written by Chuck Milligan and Cynthia Woodcock. Invitees discussed and framed a set of recommendations to present to Congress and CMS. To view Chuck's presentation on connecting SNPs with state Medicaid programs, click here. To view the conference details and other materials, click here.
Center Disseminates Summary on Mental Health Symposium
The Center has produced a summary for the mental health symposium it hosted on June 12. This piece highlights the day's proceedings, including a summary of each speaker's presentation and overarching themes. Click here to read more on the events of Moving Forward: Designing and Financing Mental Health Services in an Era of Transformation.
Center Hosts Symposium on Mental Health Services
On June 12, 2007, the Center for Health Program Development and Management sponsored a symposium examining the evolving mental health system, how efforts to diffuse evidence-based practices and better coordinate services across agencies and branches of medicine are paying off, and the extent to which Medicaid managed care and other newer programming and financing strategies are helping transform the system. Click here for the program and presentations.
Center Co-Hosts Forum on Emergency Department Use
On June 7, 2007, the Center for Health Program Development and Management, together with the UMBC Department of Public Policy, sponsored a public policy forum examining emergency room services in Maryland. Click here for the program and presentations.
Ann Volpel to Direct Acute Care Policy Unit, March 22, 2007
Effective immediately, Ann Volpel has been selected to direct the Center's Acute Care Policy Unit. Ms. Volpel, who joined the Center as a research analyst in 2001, will now be responsible for directing the Center's work on Medicaid managed care policy, financing, and performance assessment, working with Maryland and other states. She will also manage the Center's work related to behavioral health and state coverage initiatives. She succeeds John O'Brien, who left the Center in January to join the Maryland Health Services Cost Review Commission.
Medicaid Commission Recommendations, November 28, 2006
The Center for Health Program Development and Management has been providing strategic and analytical support to the federal Medicaid Commission and assisting with preparation of the Commission's final report. On November 16, 2006, in Washington, Chuck Milligan, the Center's executive director, delivered this presentation as part of the discussion of the Commission's final report and recommendations:
Chairman's Mark and Proposed Amendments
http://www.aspe.hhs.gov/medicaid/nov06/Recommendations.pdf
Todd Eberly Receives Dissertation Award, September 8, 2006
Todd Eberly, a senior research analyst at the Center, has received the 2006 Annual Dissertation Award from the National Association of Schools of Public Affairs and Administration (NASPAA) for his dissertation entitled, Managing the Gap: Evaluating the Impact of Medicaid Managed Care on Service Use and Disparities in Health Care Access. Dr. Eberly examined whether racial and ethnic minorities experience disparate access to preventive health services in Maryland Medicaid and whether Maryland 's transition to Medicaid managed care had an impact on disparities. He received a Ph.D. in Public Policy from UMBC this past spring.
Click here for the Policy Brief on Dr. Eberly's Dissertation
Click here for Dr. Eberly's Dissertation.
Medicaid Commission Presentations, September 6, 2006
Chuck Milligan, executive director of the Center for Health Program Development and Management, delivered these presentations to the federal Medicaid Commission in Washington, D.C., on September 6, 2006:
Medicaid Systemswide Administration
CPS Medicaid Undercount Update, August 31, 2006
A survey of Maryland Medicaid beneficiaries conducted by the Center in 2005 found a significant discrepancy in Medicaid enrollment between state records and the Current Population Survey (CPS) administered by the U.S. Census Bureau. To address the CPS undercount, the Center recommended that the Census Bureau alter the 2005 CPS survey instrument to include "Medical Assistance" as an alternative name for the Maryland Medicaid program. This is the name by which Medicaid is known to most Maryland Medicaid enrollees. The 2005 CPS, released August 29, 2006, reports a 15 percent increase in Maryland Medicaid enrollees, along with a slight decline in the number of uninsured Marylanders. While the CPS still reports a significant undercount in Maryland Medicaid enrollees, the undercount is now in the range of the national average (20%-25%). The increase in the number of Medicaid enrollees and the decrease in the number of uninsured are in line with estimates presented in the Center's report.
To see the 2005 CPS released on August 29, 2006, click here.
AcademyHealth Presentations June 24-25, 2006
Center staff gave two presentations at the AcademyHealth 2006 Annual Research Meeting in Seattle , Washington . Todd Eberly, Ph.D., senior research analyst, delivered this presentation to the Child Health Services Research Meeting on June 24, 2006:
Chuck Milligan, executive director of the Center, delivered this presentation at the session entitled, "Medicaid Reform: What's Working and What's Not?" on Sunday, June 25, 2006:
Medicaid Reform: Policy Roundtable Discussion
Keynote to Florida Medicaid Conference, June 1, 2006
Chuck Milligan delivered the keynote address to the 5 th Annual Medicaid Research Conference in Tallahassee , Florida , on June 1, 2006.
Medicaid Consumer-Directed Health Purchasing (as explained by Yogi Berra)
Health Insurance Symposium on June 13, 2006
The Center for Health Program Development and Management will host a one-day symposium on June 13, 2006, entitled The Changing Health Insurance Market: Implications for Public Policy and for State Government Purchasers. Click here for more information or contact Joyce Meyers at 410.455.6377 or jmeyers@hilltop.umbc.edu .
Medicaid Commission Presentation, May 17, 2006
Chuck Milligan, executive director of the Center for Health Program Development and Management, delivered this presentation to the federal Medicaid Commission in Dallas on May 17, 2006:
Medicaid Commission Presentation, March 14-15, 2006
Chuck Milligan, executive director of the Center for Health Program Development and Management, delivered this presentation to the federal Medicaid Commission in Atlanta on March 14, 2006:
Long-Term Care: Overview and Summary of Reform Proposals
Medicaid Commission Presentation, January 25, 2006
Chuck Milligan, executive director of the Center for Health Program Development and Management, delivered this presentation to the federal Medicaid Commission at its meeting in Washington on January 25, 2006:
Summary of Medicaid Reform Proposals: Eligibility Provisions
Axford Forum Coming to UMBC, January 18, 2006
On January 18, 2006, the Center will convene Ian Axford fellows and invited guests at UMBC for a one-day forum. Established in 1995, the Ian Axford Fellowships in Public Policy give outstanding American professionals opportunities to study, travel, and gain practical experience in public policy in New Zealand . Health care, the environment, taxes, ethnic diversity, and education are but a few of the topics that Axford fellows have investigated. The program has provided a unique opportunity to American policy professionals to engage in innovative thinking and explore diverse policy perspectives on a wide variety of topics.
This will be the first time that Axford fellows have come together. The agenda for the forum features presentations by the three 2005 Axford fellows who have recently returned to the United States.
- Dena Ringold of the World Bank examined how programs might be tailored to better address the range of disparities faced by indigenous peoples and other vulnerable populations, such as the 15 percent of New Zealanders who are also Maori.
- Nick Johnson of the Center on Budget and Policy Priorities studied New Zealand 's Working for Families program. He explored the relationship between fiscal and tax policy in meeting the needs of low-income populations while promoting efficient labor markets.
- John O'Brien of the Center for Health Program Development and Management at UMBC investigated the complexities of measuring and rewarding performance in health care delivery systems.
Click here to visit the Center's Axford Foum Page.
Reports by Axford fellows are available here.
Former Axford fellows will serve as responders, and the program will be placed in context with remarks by Robert Reischauer , President of The Urban Institute and former chair of the Ian Axford Fellowships selection committee; John Wood , New Zealand Ambassador to the United States; Annette Dixon , the World Bank's Director of Strategy and Operations for Europe and Central Asia Region; and Peter Watson , CEO of the Dwight Group and current chair of the Axford selection committee. Discussion among forum participants is expected to generate fresh insights and novel approaches to public policy that otherwise might not be considered.
Medicaid Commission Presentations, October 26 - 27, 2005
Chuck Milligan, executive director of the Center for Health Program Development and Management, delivered these presentations to the federal Medicaid Commission at its meeting in Washington on October 26-27, 2005:
Medicaid Eligible Populations
The Medicaid Acute Care Delivery System
The Medicaid Long-Term Care Delivery System
Quality and Information Technology in Medicaid
Medicaid Program Administration - Financing, IT, and Fraud and Abuse
New Issue Brief Coming Fall 2005
Academy Health has commissioned an issue brief entitled "Turning Medicaid Beneficiaries into Purchasers of Health Care: Critical Success Factors for Medicaid Consumer-Directed Health Purchasing." It will examine factors states should consider when launching Medicaid reforms such as those proposed in Florida, South Carolina, and West Virginia. The Center is collaborating with Academy Health's State Coverage Initiatives, a program of The Robert Wood Johnson Foundation, to prepare the issue brief.
Chuck Milligan Presents to Medicaid Commission, August 17, 2005
On August 17, 2005, Chuck Milligan , executive director of the Center for Health Program Development and Management, delivered a presentation to the Medicaid Commission. This presentation provided background information on the requirements and restrictions in the Medicaid program, and it touched on where flexibility does and does not presently exist.
To view Mr. Milligan's presentation, click here .
Chuck Milligan Testifies to Senate Finance Committee, June 28, 2005
On June 28, 2005, Chuck Milligan, executive director of the Center for Health Program Development and Management, testified to the Senate Finance Committee at the invitation of Senator Charles Grassley, committee chairman. Mr. Milligan discussed state Medicaid financing arrangements, such as intergovernmental transfer (IGT) and upper payment limit (UPL) arrangements that involve public hospitals and nursing facilities, as well as Medicaid school-based reimbursement. Click here for Mr. Milligan's written testimony and here for his oral testimony.
Michigan Medicaid: Relative Cost Effectiveness of Alternative Service Delivery Models, April 2005
In a Medicaid study required by Michigan's legislature, the Center evaluated whether capitated managed care involving multiple managed care organizations (MCO) is cost effective, when compared to three alternative delivery systems: fee-for-service, primary care case management, and a capitated managed care program involving a single statewide MCO. The Center's analysis concluded that the state of Michigan would save between $28 million and $129 million in state funds in FY 2006 when the current capitated program involving multiple MCOs is compared to all of the alternative delivery systems. The exact amount of savings that Michigan will achieve depends on the size of the managed care rate increase in FY 2006, and on which alternative delivery system is under consideration.
To review the report, click here.
Impact of the Medicare Prescription Drug Benefit on Home- and Community- Based Services Waiver Programs, April 2005
Home- and community-based services waiver programs enable many individuals dually eligible for Medicare and Medicaid to avoid nursing homes. But access to prescription drugs may be impeded when drug coverage is transferred from Medicaid to Medicare in January 2006, threatening the ability of dual eligibles to remain in the community. The Center examined the likely impact of the new Medicare drug benefit in Maryland and recommends federal policy remedies.
To review the Issue Brief, click here.
Strategies for Assessing Health Plan Performance on Chronic Diseases: Selecting Performance Indicators and Applying Health-Based Risk Adjustment, March 2005
As Medicaid managed care programs mature, states are looking to refine their methods for measuring and improving the performance of participating health plans. This report serves as a guide for Medicaid agencies who want to develop a performance measurement program using administrative data to evaluate the care provided to enrollees with chronic diseases. The report identifies potential performance indicators that are associated with improved medical outcomes and demonstrates the application of diagnosis-based risk adjustment to performance measurement by profiling six health plans.
To review the report, click here.
The Center for Health Program Development and Management Partners with the State of New Mexico
The Center is pleased to announce a new partnership with the New Mexico Human Services Department and New Mexico State University . The Center will assist New Mexico in developing and evaluating new Medicaid policies and programs. Initial work will focus on consumer-directed services and managed long-term care.