Health Care Delivery Models and Nursing Practice
According to Kos (2019), healthcare delivery models focus on financing, providing, localization, and regulation of health care. Examples of these models include the Bismarck, Beveridge, out-of-pocket, and national health insurance models (Kos, 2019). The best healthcare model is one that ensures increased access to healthcare services at cost-effective prices (Kos, 2019). This paper examines changes implemented to reform the health care system of the USA and identifies the role of the nurse in this reformed system.
The Affordable Care Act (ACA)
The Affordable Care Act (ACA) was enacted in 2010. ACA is a law aimed at achieving comprehensive reform in the US healthcare system (McIntyre & Song, 2019). The law has three major goals. The first one is to make affordable health insurance available to a larger population. This is accomplished by reducing costs for households whose incomes fall between 100 percent and 400 percent of the federal poverty level (Chait & Glied, 2018). The second goal is the expansion of the Medicaid program to include adults whose income is lower than 138 percent of the federal poverty level (Mazurenko et al., 2018). The third goal is to advocate for innovativeness in the healthcare delivery systems to minimize healthcare costs (Chait & Glied, 2018).
The other provisions of ACA aim at increasing insurance protection of the consumer, advocating for preventive health, and improving the quality of care. Consumer insurance protections are increased by removing lifelong monetary caps on coverage and expanding coverage to include children with underlying conditions (McIntyre & Song, 2019). Additionally, insurers cannot rescind coverage unless it was obtained by fraudulent means (McIntyre & Song, 2019). ACA established the Prevention and Public Health Fund to facilitate promotive and preventive health services. Provisions such as healthcare informatics, healthcare research, and Medicare and Medicaid care coordination aim to improve the quality of healthcare (McIntyre & Song, 2019).
Findings demonstrate that the implementation of the ACA increased access to healthcare services. Data from 2016 indicated that approximately 20 million Americans had accessed health insurance after the implementation of the ACA (Chait & Glied, 2018). Accordingly, the percentage of uninsured people dropped to about 9 percent. The increased access to healthcare is attributed to the expansion of Medicaid and the elimination of existing limitations (Chait & Glied, 2018). An example of such as limitation is the coverage of children with underlying conditions. Financial protection was achieved by significantly lowering out-of-pocket healthcare costs (Chait & Glied, 2018).
The ACA has a significant impact on nursing practice, including its responsibilities and roles. ACA advocates for coordination and a continuum of care to increase the quality of care. Nurses, as key stakeholders in patient care, are required to uphold care coordination that entails proper scheduling of tasks to ensure patient safety. Care coordination is important due to the increase in access to healthcare services (Luther et al., 2019). The other aspect is innovativeness to minimize healthcare costs. The role and responsibilities of nurses transformed to embrace nurse informatics. Nurse informatics entails the use of informational technology and computerized systems to process patient data to enhance patient safety (Peltonen et al., 2019). ACA increased transformational leadership in nursing practice to support innovativeness, minimize healthcare costs, and ensure patient safety.
Quality Measures and Pay for Performance
According to Pandya et al. (2020), quality measures are used to assess the efficiency of service delivery to patients. This is done by comparing specific outcomes against established national or state benchmarks (Pandya et al., 2020). This enables healthcare facilities to assess and determine underperforming indicators. By so doing, relevant interventions are put up to address the underperformance and increase the quality of care (Pandya et al., 2020). Better quality of care is associated with an improvement in patient outcomes.
According to Pandya et al. (2020), pay for performance links insurance reimbursements to the outcomes of specific metrics. This includes patient outcomes, the use of evidence-based practices, and the level of patient satisfaction. This is a value-based model that requires healthcare providers to uphold quality practices to achieve better patient outcomes (Pandya et al., 2020). Underperformance in metrics can lead to penalizations and decreased reimbursements. The Centers for Medicare and Medicaid Service have adopted this value-based approach through various programs, such as the hospital-acquired condition reduction program (Pandya et al., 2020).
Quality measures and pay for performance impact nursing practice by requiring them to deliver quality services. Nurses should use evidence-based practices to improve patient outcomes. Nurses should monitor the quarterly and annual reports on nursing-sensitive indicators to identify metric performance. Thereafter, they should research and use evidence-based practices to address underperforming metrics. By so doing, the quality of care increases, and better patient outcomes are achieved.
Professional Nursing Leadership and Management Roles
Nurses are involved in various professional leadership and management roles. They include organizing, staffing, scheduling, directing, and delegation (Luther et al., 2019). Organizing entails formulating tasks and determining how they are to be executed. It enables nurses to allocate tasks to different stakeholders. Staffing entails recruiting and training qualified personnel to maintain competency (Luther et al., 2019). Scheduling entails planning tasks by generating timetables. This helps to enhance accountability among staff members. Directing entails effective delegation, open communication, staff motivation, performance appraisal, and feedback delivery (Luther et al., 2019). Directing ensures that the workforce is working in harmony toward the fulfillment of common goals (Luther et al., 2019).
Organizing, staffing, scheduling, directing, and delegation can help to promote patient safety and respond to emerging trends. Proper staffing that involves recruiting competent staff, staff ratio optimization, and staff training ensures that the task force has relevant skills and knowledge (Luther et al., 2019). This is key to evidence-based practice to increase the quality of service delivery and achieve better patient outcomes. Organizing, scheduling, and directing are important to respond to emerging trends. Proper organization helps to develop strategies to address the issues, whereas directing ensures that the strategies are implemented in their entirety.
Emerging Trends
The emerging trends in healthcare include an increase in chronic diseases, pandemics, and technological trends. Technological trends increase the efficiency of healthcare service provision. Examples of the trends include telehealth technologies such as remote patient monitoring and mobile health (Columbiasouthern.edu, n.d.). Chronic diseases such as cancer, diabetes, and hypertension are on the rise. This is attributed to urbanization and sedentary lifestyles. Chronic disease has a significant economic impact on the patients and their states. Pandemics over the past decades have revealed a lack of preparedness and response globally (Columbiasouthern.edu, n.d.). Comprehensive response plans to address pandemics should be developed (Columbiasouthern.edu, n.d.).
Nursing practice will evolve and focus on research within the next five years. This will be in collaboration with members of other disciplines. The research will enable them to establish appropriate plans and interventions to deal with chronic diseases and pandemics. Nursing roles will focus on transformational leadership. This will focus on innovation, technological trends, and evidence-based practices. Embracing technological trends such as telehealth will improve care coordination and ensure a continuum of care. Evidence-based practices will ensure that the best techniques are used to manage and prevent chronic diseases and pandemics.
Conclusion
Various changes have been implemented to reform the healthcare system in the USA. An example is the ACA, which focuses on making affordable health insurance available, expanding the Medicaid program, and advocating for innovativeness in the healthcare delivery systems (McIntyre & Song, 2019). The ACA improved care coordination among nurses. Quality measures and pay for performance help to improve patient outcomes. Nurse roles such as organizing, staffing, scheduling, and directing can help to improve patient outcomes.
References
Chait, N., & Glied, S. (2018). Promoting Prevention under the Affordable Care Act. Annual Review of Public Health, 39, 507–524. https://doi.org/10.1146/annurev-publhealth-040617-013534
Columbiasouthern.edu. (n.d.). Emerging Trends in Health Care Administration for 2022. https://www.columbiasouthern.edu/blog/blog-articles/2022/january/emerging-trends-in-healthcare/
Kos, M. (2019). Introduction to Healthcare System. In The Pharmacist Guide to Implementing Pharmaceutical Care. Springer International Publishing. https://doi.org/10.1007/978-3-319-92576-9
Luther, B., Barra, J., & Martial, M. A. (2019). Essential Nursing Care Management and Coordination Roles and Responsibilities: A Content Analysis. Professional Case Management, 24(5), 249–258. https://doi.org/10.1097/NCM.0000000000000355
Mazurenko, O., Balio, C. P., Agarwal, R., Carroll, A. E., & Menachemi, N. (2018). The effects of Medicaid expansion under the ACA: A systematic review. Health Affairs, 37(6), 944–950. https://doi.org/10.1377/hlthaff.2017.1491
McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS Medicine, 16(2), 10–12. https://doi.org/10.1371/journal.pmed.1002752
Pandya, A., Soeteman, D. I., Gupta, A., Kamel, H., Mushlin, A. I., & Rosenthal, M. B. (2020). Can Pay-for-Performance Incentive Levels be Determined Using a Cost-Effectiveness Framework? Circulation: Cardiovascular Quality and Outcomes, July, 436–445. https://doi.org/10.1161/CIRCOUTCOMES.120.006492
Peltonen, L.-M., Pruinelli, L., Ronquillo, C., Nibber, R., Peresmitre, E. L., Block, L., Deforest, H., Lewis, A., Alhuwail, D., Ali, S., Badger, M. K., Eler, G. J., Georgsson, M., Islam, T., Jeon, E., Jung, H., Kuo, C. H., Sarmiento, R. F. R., Sommer, J. A., … Topaz, M. (2019). The current state of Nursing Informatics – An international cross-sectional survey. Finnish Journal of EHealth and EWelfare, 11(3), 220–231. https://doi.org/10.23996/fjhw.77584
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