News & Bulletins Archive

Hilltop Senior Research Analyst Michael T. Abrams, MPH, and Policy Analyst Carl H. Mueller, MS, are co-authors of a new study published in the Journal of Pediatrics titled Transcranial Doppler Screening of Medicaid-Insured Children with Sickle Cell Disease. The work was conducted in collaboration with researchers at Johns Hopkins and University of South Carolina medical schools under the direction of David G. Bundy, MD.The study found that letters to parents and doctors of children with sickle cell disease (SCD) did not succeed in increasing their use of a simple screening technique (transcranial Doppler imaging: TDI) for stroke risk, even as children with SCD are known to be at markedly heightened risk for stroke. The research, conducted largely at The Hilltop Institute, used Medicaid administrative data to identify a calendar year 2010-2011 cohort of individuals aged 2-16 years with SCD. Researchers measured 6-month post-letter TDI use in a group of 117 subjects whose parents and doctors were sent letters, and in a comparison group of 433 subjects who were not targeted by that mailing. Pre-intervention, annualized screening in the full SCD cohort (n=829) was just over 23 percent. Six-month follow-up on those who did not receive screening in the pre-intervention period was 7.2 percent in the group receiving the mailing and 8.6 percent in the comparison group. This difference was non-significant after adjusting for numerous covariates. Accordingly, this work reveals that a single mailing to parents and providers is not a sufficient method for increasing TDI use in youth with SCD. One important correlate that did emerge from this work is that specialist visits (e.g., to a hematologist) did significantly increase the use of TDI irrespective of the mailing. This incidental finding suggests that referral to a sickle cell specialist is more effective than referral for a specific procedure to address this serious illness, at least in terms of receiving important preventative screening. For more information, contact Hilltop team lead Michael Abrams (

The full reference for this work is: Bundy, D. G., Abrams, M. T., Strouse, J. J., Mueller, C. H., Miller, M. R., & Casella, J. F. (2015). Transcranial Doppler screening of Medicaid-insured children with sickle cell disease. Journal of Pediatrics, 166(1), 188-90. doi: 10.1016/j.jpeds.2014.09.018.

The pubmed citation and abstract can be accessed here:

On December 31, 2014, the Internal Revenue Service (IRS) published final rules implementing the “Additional Requirements for Charitable Hospitals” section of the Affordable Care Act (ACA). These rules relate to tax-exempt hospitals’ community health needs assessments (CHNAs); financial assistance policies (FAPs); and hospital charges, billing, and collection practices.

Read the Bulletin for a summary of the rules.

On December 5, 2014, Hilltop, together with the UMBC Department of Public Policy, the Maryland Institute for Policy Analysis and Research, CareFirst, and LifeBridge Health, sponsored a public policy forum describing how hospitals and health care providers in Maryland are adapting to the new all-payer model, and the likely effect on the populations that hospitals serve. Click here for the program and presentations.

Hilltop Senior Policy Analyst Stephanie Cannon-Jones, MPP, gave a presentation at the 25th Annual State of the States in Head Injury Conference on October 28, 2014 in Philadelphia, PA. Cannon-Jones’ presentation, Medicaid Expenditures for Persons with Brain Injury while Residing in a Nursing Facility, described the key findings of a study that examined Medicaid expenditures and service utilization patterns of Maryland Medicaid-eligible beneficiaries with a brain injury diagnosis who resided in nursing facilities.

On October 23, 2014, Hilltop held a special event to celebrate its 20th anniversary. Over the years, Hilltop has grown to become one of the most highly regarded university-based health policy research organizations in the country. The event featured Bruce Vladeck, PhD, as the keynote speaker.

Read the Bulletin.

Hilltop Hospital Community Benefit Program Director Gayle Nelson gave a presentation at the National Academy for State Health Policy’s 27th Annual State Health Policy Conference on October 8, 2014, in Atlanta, Georgia. In her presentation, titled Leveraging Hospital Community Benefit Requirements, Nelson discussed hospital community benefits and various approaches states could use to leverage them to improve population health.

Hilltop Director of Special Studies Ian Stockwell, PhD, gave a presentation at the National Association of States United for Aging and Disabilities’ National Home & Community Based Services Conference in Arlington, Virginia, on September 18, 2014.  In the presentation, titled The Use of Clinical and Functional Assessment Instruments, Stockwell discussed selection and use of assessment tools—which can have a broad effect across program and policy areas—and how this selection and use can help realize the potential to pull individual-level information together to form a complete picture of a program population.

Hilltop Hospital Community Benefit Program Director Gayle D. Nelson, JD, MPH, gave a presentation to the steering committee of the Milbank Memorial Fund-supported Reforming States Group (RSG) at their meeting in Chicago, Illinois, on August 27, 2014. In her presentation, titled Hospital Community Benefit: A Policy Lever for States, Nelson discussed hospital community benefit and the cost of tax exemption; using hospital community benefit as a policy lever; and avenues interested policymakers could explore with respect to their own states’ community benefit landscapes. The RSG is a bipartisan group of state health policy leaders from both the Executive and Legislative branches who, with a small group of international colleagues, have been gathering since 1992 to share information, develop professional networks, and commission joint projects–all in the service of bringing evidence to bear to improve population health.

The Hilltop Institute’s Hospital Community Benefit Program has received a two-year grant from the Kresge Foundation to continue to provide timely information on emerging trends and important issues related to community benefit.

Read the Bulletin.

Hilltop Hospital Community Benefit Program Director Gayle D. Nelson, JD, MPH, was part of a panel that presented at an Association of State and Territorial Health Officers (ASTHO) webinar on June 24, 2014, titled Community Health Needs Assessments [CHNAs]: A Tool for Achieving Health Equity. The webinar was attended by state and territorial health officials, their leadership teams, directors of state offices of health equity/minority health and primary care, and partner organizations. Nelson’s presentation, Advancing Health Equity through the CHNA/Implementation Strategy Process, discussed how public health agencies can utilize the CHNA/implementation strategy process to promote health equity and identified key steps in the process for advancing this goal.

Hilltop Policy Analyst Jessica Skopak, JD, PhD, presented a poster at the 22nd Annual Meeting of the Society of Prevention Research, Comprehensive and Coordinated Prevention Systems: Building Partnerships and Transcending Boundaries held, May 27-30, 2014, in Washington, DC. Skopak’s poster, titled Using “The CDC Guide” to Strengthen Partnerships and Inform Evaluation Planning for the Maryland Asthma Control Program, described Hilltop’s evaluation of the partnership component of the Maryland Asthma Control Program. To view the poster, click on the title.

Hilltop staff made several presentations at the 2014 AcademyHealth Annual Research Meeting (ARM) held June 8 through June 10 in San Diego. Director of Medicaid Policy Studies David A. Idala, MA, made a presentation titled Non-Emergent Emergency Department Use among Adults with Disabilities in a session titled What Can We Learn from Patients with High Costs and High Utilization? Senior Policy Analyst Laura A. Spicer, MA, presented a poster titled Evaluating Continuity of Care between Medicaid and ExchangesSenior Research Analyst Michael T. Abrams, MPH, presented two posters: Hospital Costs for Persons with Mental Health or Substance Use Disordersand Transcranial Doppler Screening of Medicaid-Insured Children with Sickle Cell Disease.Hilltop Deputy Director Michael A. Nolin, MA, presented a poster at the State Health Policy Interest Group meeting on June 7 titled Matching with Medicaid Data to Increase Benefits and Access and Improve Health Outcomes. To view the presentations, click on the titles.

Hilltop’s Hospital Community Benefit Program has just released the ninth issue brief in its series, Hospital Community Benefits after the ACA. This brief, Addressing Social and Economic Factors that Shape Health, continues the program’s examination of state-level community benefit oversight by focusing on the ten states that require hospitals to develop implementation strategies.

Read the Bulletin.

Hilltop Senior Research Analyst Michael T. Abrams, MPH, co-authored two articles published in the April 2014 issue of Psychiatric Services. The articles are both based on a study of low-income young adults (aged 18-26) discharged from an inpatient psychiatric event, a marker for serious mental distress. Identifying Young Adults at Risk of Medicaid Enrollment Lapses after Inpatient Mental Health Treatment discusses a study that identified antecedents to Medicaid enrollment lapses in the year following discharge. Such lapses are undesirable because they suggest absence of medical attention that is especially indicated in the wake of an inpatient psychiatric stay. Medicaid Lapses and Low-Income Young Adults’ Receipt of Outpatient Mental Health Care after an Inpatient Staydiscusses a second study that estimated the impacts of Medicaid enrollment disruptions on access to mental health services in the same year following inpatient discharge. That study found that Medicaid disruptions correlated with reduced outpatient mental health service utilization and lower medication possession ratios. Jointly, these articles offer information to policymakers and others regarding the reasons and the potentially negative health care consequences of insurance discontinuities for young adults with substantial (albeit emerging) mental health needs. Such young adults represent an important subset of persons who should gain broader access to medical care coverage via the Affordable Care Act.

In collaboration with a team that includes researchers at Johns Hopkins and UMBC’s Department of Public Policy, researchers at The Hilltop Institute have published a new peer-reviewed article in the AcademyHealth journal eGEMstitled Estimating Causal Effects in Observational Studies Using Electronic Health Data: Challenges and (some) Solutions. Researchers used Medicaid and Medicare administrative data to study the impact of the Medicare prescription drug program, Part D (first implemented in 2006), on persons with serious mental illness (SMI). Such a study is important because persons with SMI are medically vulnerable and because a large proportion of their prescription drug health care coverage shifted from state to federal responsibility as a result of the Part D program. The published study describes propensity score methods to “match” persons with Medicare and Medicaid coverage (dual eligibles) to persons with similar demographic and health profiles who are only engaged in Medicaid. Such matching is necessary to balance the selected samples so that they are comparable for inference testing. The suggested citation for this work appears below, and the full article can be viewed here: For more information about this work, please contact Hilltop Senior Policy Analyst, Michael Abrams at

Stuart, E. A., DuGoff, E., Abrams, M., Salkever, D., & Steinwachs, D. (2013). Estimating causal effects in observational studies using electronic health data: Challenges and (some) solutions. eGEMs (Generating Evidence & Methods to improve patient outcomes), Vol. 1, Iss. 3, Article 4. DOI: 10.13063/2327-9214.1038