Health Care Delivery Models and Nursing Practice.

Introduction

The health care delivery system in the United States has historically been fragmented and uncoordinated, emphasizing interventions rather than comprehensive health management and prevention. The cost of health care has been on the rise and quality of care has been law. Health Care Delivery Models and Nursing

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The Affordable Care Act ( ACA) is a current health care law introduced to reform some aspects f the health care delivery system. The paper discusses how the ACA has reformed the U.S health care delivery system and the role of nurses within this changing environment.

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

The Affordable Care Act (ACA) is a care law designed to reform numerous aspects of the U.S. health care delivery system. The Affordable Care Act authorized a wide range of reform projects, entailing bundled payments, value-based purchasing, and Accountable Care Organizations. According to Obama (2016), before the introduction of the ACA, fee-for-service systems of payment dominated the health care system. FFS imposed penalties on healthcare professionals and organizations who delivered efficient care but failed to reward professionals and organizations who improved care quality. The ACA has transformed the payment system for health care in numerous significant ways. The ACA changed rates paid to providers of Medicare services along with providers of Medicare Advantage plans for better alignment with the real costs of offering care.Health Care Delivery Models and Nursing Practice.

The ACA has also moved the health care system towards alternative models of payment, which make health care entities liable for outcomes. These models are; bundled payment models and ACOs. Bundled payments make a single reimbursement for services that a provider delivers during a clinical episode. ACO is a population-based model that base reimbursement on the outcomes of health care organizations and professionals to achieve for all the care of their patients (Obama, 2016).Health Care Delivery Models and Nursing Practice.

Reforms in reimbursement along with the increase of the level of care during an incident of an illness have caused stakeholders to cautiously analyze value-based opportunities. Cleveland et al. Health Care Delivery Models and Nursing Practice.(2019) indicate that the ACA puts an obligation on nurses to continue being care coordinators, innovative and transformational leaders as key stakeholders in the delivery of cost containment, patient access improvements, and quality advances. Salmond and Echevarria, (2017) emphasize that nurses have a vital role in healthcare reform and demand for affordable, accessible, patient-centered, safe, and quality health care.Health Care Delivery Models and Nursing Practice.  For delivery of these outcomes, nurses must understand the way nuts practice must be considerably diverse to deliver quality care, and passionately and proactively become engaged in the reform. These reforms will necessitate an enhanced or new set of skills on population care and wellness, with a transformed focus on care coordination, patient-centered care, quality improvement, and data analytics.Health Care Delivery Models and Nursing Practice.

How quality measures and to pay for performance affect patient outcomes

Improvement in the quality of care is the basic aim of any healthcare system.  Healthcare systems place their focus on assessment and redesign of the systems and work processes in order to ensure health care costs are reduced, care to deliver is safe and patient outcomes are optimal.  According to Peluso et al. (2019), the aim of the Pay for Performance model (P4P) model is to drive health care organizations and professionals in this direction. P4P programs intend to improve the quality of care that is delivered, while given the providers the opportunity to get higher reimbursements when they attain preset quality benchmarks.Health Care Delivery Models and Nursing Practice.

P4P affects patient outcomes by providing quality care that is family and family-centered and cost-efficient.  Cleveland et al (2019) indicate that four domains of evaluations are applied in the VBP model: clinical care, safety, cost reduction, and efficiency; and community and person engagement to establish the performance level of a healthcare agency. Quality measures and P4P affect nursing practice by requiring nurses to provide cost-effective and quality care and improving patient outcomes.  The responsibilities and expectations of nurses are to utilize VBP or P4P model to directly link payment to quality.  Nurses remain in a unique position to shape healthcare because of their closeness to the bedside, team approach, and knowledge of patients both in the hospital and within the community (Cleveland et al., 2019).Health Care Delivery Models and Nursing Practice.

Professional nursing leadership and management roles that have arisen

The reformed health care system has given rise to the roles of care coordinator, case manager, and nurse informatics According to Cleveland et al.Health Care Delivery Models and Nursing Practice. (2019), for Value-Based Purchasing to generate reductions in health care costs, processes are essential to connect service, care, along with coordination of care via the numerous fragmented parts of healthcare. Nurses are uniquely positioned to connect, gauge, and re-engineer processes in the health care system. At this point, nurses offer leadership in roles as informatics experts, care coordinators, and care managers by directing changes in process and evidence-based practice essential to measure and provide precise reports of the quality measures. Outcomes connected with these roles go beyond the reduction of health care costs through improvement of outcomes and urging systems to further push for safety and quality initiatives.Health Care Delivery Models and Nursing Practice.

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

Addressing chronic care needs and preventive care are emerging trends that will transform the nursing practice and roles of nurses in the next five years. The emphasis of nursing practice will on interventions that will avert acute disease and delay the progression of illness and will be accomplished by an interprofessional team model. Health Care Delivery Models and Nursing Practice.According to Salmond and  Echevarria (2017),  as the care system shifts its focus from illness to prevention and wellness,  nurses are tasked with preventive and wellness-focused assessments, health and wellness education programs,   as well as programs addressing social or environmental conditions that trigger medical conditions and care problems.Health Care Delivery Models and Nursing Practice.

At the individual and organizational levels, wellness implies nurses thinking the patient further than the present incident (office or hospital) and reflecting on what must be done or assessed to maximize the wellness of an individual. Nurses will also be required to practice from a patient-centered approach which implies recognizing that patients, but not health care providers, understand themselves well and recognizing that can is achievable when nurses integrate patients and their families into making care decisions and focusing on what is of significance to patients (Salmond & Echevarria, 2017).Health Care Delivery Models and Nursing Practice.

Conclusion

The ACA is an influential law that has transformed the United States health care delivery system. The law has introduced programs that have compelled health care providers and organizations to deliver quality and cost-effective care. In the reformed systems, nurses are expected to assume roles to increase value, improve care, and advance health through new ways of practicing.Health Care Delivery Models and Nursing Practice.