Health Care Delivery Models and Nursing Practice.

This article provides a historical overview of nursing models of care for acute and critical care based on currently available literature. Models of care are defined and their advantages and disadvantages presented. The distinctive differences between care delivery models and professional practice models are explained. The historical overview of care delivery models provides a foundation for the introduction of best practice models that will shape the environment for acute and critical care in the future. Health Care Delivery Models and Nursing Practice.

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Introduction

The United States health care system has historically been fragmented, with a lack of coordination or misalignment of incentives that spawn ineffective allocation of resources. Fragmentation adversely influences health care cost, quality, and outcomes. The paper discusses how the Affordable Care Act as a current law intended to reform aspects of the United States health care delivery system and the nurses’ role within the reformed health care system. Health Care Delivery Models and Nursing Practice.

A current or emerging health care law introduced to reform or restructures some aspect of the health care delivery system

The ACA is a current health reform legislation that has several provisions aimed at resolving underlying problems in the way health care is delivered and reimbursed in the United States. The ACA introduced a wide range of reform projects, including bundled payments models, accountable care organizations (ACOs), and value-based purchasing. According to Obama (2016), before the ACA, fee -for -service (FFS) payments systems dominated the United States health care system. Under FFS, health care professionals and organizations were reared for delivering care more efficiently, but organizations and professionals who improved the quality of care were not rewarded. Health Care Delivery Models and Nursing Practice. The ACA adopted d value-based systems of payment in Medicare that link FFS reimbursements to the efficiency and quality of the care delivered by providers.  In addition, the ACA has shifted the system toward alternative models of reimbursement that hold health care organizations liable for patient outcomes such as ACOs and bundled payments models.  ACOs are population-based models that make payments based on the outcomes achieves by health care providers for the care they provide to their patients. Health Care Delivery Models and Nursing Practice.

The reforms brought about by the ACA mandate nurses to go on with innovation, coordination of care, and transformation leadership as they have a major stake in providing quality care, containing healthcare costs, and improving patient access to care. According to Cleveland et al. (2019), ACOs focus on communication, preventive care, and stewardship of resources to prevent waste. Here, nurses increasing quality through assessment of resources and healthcare goals of patients and identification of the need for consultations with other providers and referrals.  Through providing direct care or coordinating care, nurses are fundamental in maximizing the monetary return to and via ACOs. Bundled payment models make only one reimbursement for all the services delivered during a clinical episode. Health Care Delivery Models and Nursing Practice.

How quality measures and pay for performance affects patient outcomes

Improving quality is the aim of all healthcare systems and that is why health care systems have strongly focused on evaluating and redesigning the systems themselves and work processes so as to reduce cost and deliver safe care that results in optimal patient outcomes.  The idea behind P4P is that so as to improve the quality of care they deliver, health care providers are offered a chance to have their reimbursement raises when they attain predetermined quality benchmarks.  4P4 encourages providers to compete for quality get a financial incentive, instead of being rewarded for providing more services (Peluso et al., 2019). Health Care Delivery Models and Nursing Practice.

For P4P to reduce the cost of health care, processes are required to connect service, patient, and synchronization of care within the fragmented parts of healthcare.  According to Cleveland et al. (2019), nurses are in a powerful position to connect, gauge and re-engineer processes in the health system.   Nurses assume roles in leadership as informaticians, care coordinators, and case managers whereby they direct changes in processes along with evidence-based interventions needs for accurately measuring and reporting quality measures. Health Care Delivery Models and Nursing Practice.

Professional nursing leadership and management roles that have arisen

Clinical nurse leader (CNL), nursing care manager, and care coordinator are professional nursing leadership and management roles that have arisen to regulate healthcare costs and improve quality of care. According to Cleveland et al. (2019), the CNL role has been developed to address transforming the healthcare delivery system.  CNL is knowledgeable in outcomes measurement, coordination of care, interprofessional communication, quality improvement, risk assessment, and evidence-based practice implementation.  These expertise areas are vital to the successful ACA implementation.Health Care Delivery Models and Nursing Practice.

Bundled payments, which have been introduced as a result of quality development, require care organization across the continuum through patient case management.  Nurses who play the role of care coordination establish goals and prioritize care with families and patients, educating and coaching patients, and synchronizing and assessing care that is delivered by other health care providers. . By forming a transformational partnership with families,   nurse care coordinators may capitalize on their effectiveness by matching the goals of patients and families with healthcare team goals, to attain illness and health management (Cleveland et al., 2019).Health Care Delivery Models and Nursing Practice.

Coordination of patient-centered care by clinical team members enhances outcomes via self-management support, transitions of care, telehealth, ongoing communication, managing chronic and acute conditions, and facilitating coordination among the health delivery system and health care providers.  Case managers coordinate every aspect of their patients’ care in partnership with interdisciplinary team members. Nursing case managers lead case management, which is a major driver in the delivery of value-based healthcare (Sailsman et al., 2018).

Emerging trends and ways in which the practice of nursing and nursing roles will transform

Focusing on wellness and prevention rather than on the treatment of an illness are emerging trends that will transform nursing practice and roles within the next five years.   The reformed health care system is moving away from focusing on illness towards a care system that prioritizes prevention and wellness. Health Care Delivery Models and Nursing Practice.This implies nurses need to focus on preventive and wellness-focused assessments and health and wellness education programs as well programs for addressing social or environmental triggers of preventable diseases.  According to Salmond and Echevarria (2017), at individual and organizational levels, wellness implies the nurse thinking about the patient beyond the present event and putting into consideration what must be done or evaluated to maximize the wellness of an individual. Health Care Delivery Models and Nursing Practice.

Conclusion

The ACA is a current health care law with several provisions aimed at resolving underlying problems in the way health care is delivered and reimbursed in the United States. The ACA introduced a wide range of reform projects, including bundled payments, accountable care organizations (ACOs), and value-based purchasing, all of which aimed at improving the quality of care,  patient outcomes,  reducing costs. The reforms brought about by the ACA mandate nurses to go on with innovation, coordination of care, and transformation leadership as they have a major stake in providing quality care, containing healthcare costs, and improving patient access to care. Health Care Delivery Models and Nursing Practice.