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Vol. 4, No. 3, 2014

HAC-POA Policy Effects on Hospitals, Other Payers, and Patients

The CMS Hospital-Acquired Conditions-Present on Admission (HAC-POA) policy resulted in improved hospital safety culture, increased staffing teamwork, more thorough coding documentation, and improved adherence to clinical guidelines within the first three years of implementation. Financial impact of the policy to hospitals and insurers was viewed as minimal.

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The HCBS Taxonomy: A New Language for Classifying Home- and Community-Based Services

Researchers applied the home- and community-based services (HCBS) taxonomy to claims in Medicaid Analytic eXtract (MAX) data, and showed how it allows for detailed analysis of HCBS spending and service at the state, service, and person levels.

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Potential Medicaid Cost Savings from Maternity Care Based at a Freestanding Birth Center

Low-risk, Medicaid, pregnant women who receive care by midwives at birth centers could reduce costs to the Medicaid program compared to usual obstetrical care. The authors estimate that birth center care could save an average of $1,164 per birth (2008 constant dollars), or $11.6 million per 10,000 births per year.

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Costs and Clinical Quality Among Medicare Beneficiaries: Associations with Health Center Penetration of Low-Income Residents

Researchers calculated Medicare spending and clinical quality, and compared those outcomes in Hospital Referral Regions (HRRs) with high versus low “health center penetration.” HRRs with high penetration by health centers had 9.7% lower Medicare spending ($926 per person) than HRRs with low health center penetration, and no difference in clinical quality outcomes.

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Risk Transfer Formula for Individual and Small Group Markets Under the Affordable Care Act

Authors describe how individual and small group health insurance plan risk scores are combined with factors for the plan allowable premium rating, actuarial value, induced demand, geographic cost, and the statewide average premium in a formula that calculates transfers among plans under the Affordable Care Act. Then they show how each plan factor is determined, how the factors relate to each other, and illustrate numerical simulations to show the risk transfer formula operating as anticipated in hypothetical scenarios.

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John Kautter, Gregory C. Pope, Melvin Ingber, Sara Freeman,Lindsey Patterson, Michael Cohen, and Patricia Keenan
John Kautter, Gregory C. Pope, and Patricia Keenan
Gregory Pope, John Kautter, Musetta Leung, Michael Trisolini, Walter Adamache, and Kevin Smith