Health Care Delivery Models and Nursing Practice.

Examine changes introduced to reform or restructure the U.S. health care delivery system.  Discuss action taken for reform and restructuring and the role of the nurse within this changing environment.Health Care Delivery Models and Nursing Practice.

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Include the following:

1. Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.Health Care Delivery Models and Nursing Practice.
2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
3. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.Health Care Delivery Models and Nursing Practice.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Health Care Delivery Models and Nursing Practice

A current health care law introduced to reform the health care delivery system

The Affordable Care Act (ACA) is an existing health care law designed to reform numerous aspects of the health care delivery system.  The law focuses on encouraging health care providers to move away from volume-based care to value-based care and developing resources for the improvement of the health care system. There are various important ways in which the law has transformed how health care is delivered and reimbursed. The ACA has deployed pay for performance/value-based payment systems that link FFS payments to the efficiency and quality of delivered care. The law also transformed payment rates to providers of Medicare Advantage Plans and Medicare services to ensure they better aligned with the real costs of care provision (Obama 2016).

The law also has several policies aimed at sensing and averting fraud in health care, entailing increased scrutiny of organizations that pose a huge risk of fraud before they are enrolled in Medicaid and Medicare, heavy penalties for offenses involving losses of more than one million dollars and additional financing for efforts for curbing fraud. More importantly, the law is shifting the health care system toward alternative models of payment where health care organizations are held liable for outcomes, entailing accountable care organizations (ACOs) and bundled payment models (Obama, 2016). Health Care Delivery Models and Nursing Practice.

The reformed health care delivery system under the ACA obliges nurses to continue transformational leadership, innovation, and coordination of care as key stakeholders in providing cost-effective and quality care. According to Cleveland et al (2019), the ACA changed the focus of healthcare quality from a disease-specific and patient-centered approach to the management of health with a focus on preventive and primary care.  Nurses have a crucial responsibility of providing constituents of health transformation as leaders in informatics, care coordination, and care management

How quality measures and pay for performance affect patient outcomes

Pay for performance (P4P) is a payment scheme for providers that offer financial penalties or incentives to providers who meet specific quality measures along with patient satisfaction outcomes. P4P programs affect patient outcomes by helping drive the behavior of health care systems and providers to improve the quality of delivered care, minimize avoidable utilization of costly health care services, and lead to improvements to health outcomes of patients (Cleveland et al., 2019).Health Care Delivery Models and Nursing Practice.

P4P has significant impacts on nursing practice. For P4Pto generate reductions in cost, processes are essential to connect patients, care coordination, and services within and via the numerous segments of healthcare. Nurses have power and are better positioned to link measures and also re-engineer processes within the health system.   In this situation, nurses, assume leadership roles as care coordinators, case managers, and informatics specialists through directing changes in processes and evidence-based practices essential to measure and report these quality measures in an accurate way. Nurses have the responsibility of improving health outcomes via activities like reporting quality, managing chronic diseases and coordinating care; implementing activities to avert hospital readmission,  implementing activities of minimizing medical errors and improving patient safety; and implementing health promotion and wellness(Cleveland et al., 2019).Health Care Delivery Models and Nursing Practice.

Professional nursing leadership and management roles that have arisen

The introduction of the ACA reconfigured how health care is delivered and led to the emergence of new and extended nurses’ roles under the novel models of care delivery. The professional nursing leadership and management roles that have emerged include clinical nurse leader (CNL), and care coordinator roles. According to Joseph and Huber (2015), CNL influences individuals to attain goals. Clinical leadership involves innovation at care point and improvements in care practices of individual nurses and organization processes to attain safety and quality of health care outcomes.  Novel multidisciplinary models of care which  involve the delivery of care  in  multiple settings including community, inpatient and ambulatory settings necessitate  reliable nurse leaders

As care has been moving toward outpatient settings and population management, the role of care coordinator has arise as a novel twist on case management as well as a novel professional nursing practice model. Nurses have the responsibility of coordinating care for a population or group of patients. The care coordinator role has emerged in conjunction with changes to medical homes centered on the patient and ACOs and changes in reimbursements that have put transformed focus on care management, care coordination, along with prevention strategies (Joseph & Huber, 2015).  According to Salmond and Echevarria (2017), care coordination takes place at the crossroads of healthcare settings, providers, and patients and depends on integrative activities communication along with mobilization of proper resources and individuals. Each patient requires care coordination since it acts as a bridge that enhances coherence and management of the fragmented health system.Health Care Delivery Models and Nursing Practice.

An emerging trend and two ways in which the practice of nursing and nursing roles will transform

Preventive care is an emerging trend that will change nursing practice and transform the role of nurses in the next five years. Instead of focusing on the treatment of illnesses, nurses will be required to encourage patients to lead healthy lifestyles that avert the emergence of health issues. As such, nurses will see a rise in coordination with other professionals such as psychologists, physical therapists, and nutritionists. According to Salmond and Echevarria (2017), at the system level, there will be a change from a care system that concentrates on health conditions to one that concentrates on prevention and wellness. This implies that nursing interventions will focus on evaluations focused on prevention and wellness, health education, and wellness programs, as well as programs to address social or environmental triggers of preventable conditions. At the individual nurse level, wellness implies thinking about the client further than the present event and reflection on assessments that should be done or assesses to maximize the wellness of an individual.Health Care Delivery Models and Nursing Practice.

Trends in Health Care: A Nursing Perspective
Read Chapter 2 in Trends in Health Care: A Nursing Perspective.
URL:
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/trends-in-health-care_a-nursing-perspective_1e.php

Health Reform Act: New Models of Care and Delivery Systems
Read “Health Reform Act: New Models of Care and Delivery Systems,” by Haas, from AAACN Viewpoint (2011).
URL:
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104846661&site=eds-live&scope=site

Nursing and Health Reform
Read “Nursing and Health Reform,” located on the Wound Ostomy and Continence Nurses Society website.
URL:
https://c.ymcdn.com/sites/www.wocn.org/resource/resmgr/AdvocacyPolicy/PPACA_and_Nursing_-_Nursing_.pdf

What Is Pay for Performance in Healthcare?
Read “What Is Pay for Performance in Healthcare?” located on the NEJM Catalyst website.
URL:
https://catalyst.nejm.org/pay-for-performance-in-healthcare/

Health Care Delivery Models and Nursing Practice.