Week 2 Discussion: The Health Care System, Part 2
Week 2 Discussion: The Health Care System, Part 2
As addressed in Week 1, many different policies and reform efforts have influenced health care delivery over the past century. Consider for a moment the health care reform efforts during the 1960s and the implementation of Medicare and Medicaid. How did these reform initiatives become policy? What challenges do these programs face today? What problems did they solve, and what new problems have arisen?
The Centers for Medicare & Medicaid Services (CMS) continue to have a strong influence on the health care system and health care policy through financial incentives and reimbursement policies. For example, to improve continuity of care, Medicare is offering financial incentives to health care providers that become accountable care organizations.
This week, you will have an opportunity for an authentic experience as you bring a health care issue of concern to the attention of your state or national politician. You will also consider the unintended consequences that may arise as a result of reform policy, such as the individual mandate.
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Learning Objectives
Students will:
- Analyze key health care reform legislation to determine positive results and potential unintended consequences
- Assess reform-related issues for health care
Learning Resources
Required Readings
Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach (8th ed.). McGraw-Hill.
- Chapter 5, “How Health Care is Organized – I: Primary, Secondary, and Tertiary Care”
- Chapter 6, “How Health Care is Organized – II: Health Delivery Systems”
The PPACA of 2010 encourages the formation of accountable care organizations (ACOs) to improve the quality and efficiency of health care delivery. An ACO is a group of health care providers who coordinate care for their Medicare patients and share the financial incentives of health care improvement gains.
This article provides information on the importance of health care provider organizations taking steps to become accountable care organizations (ACOs) and provides examples of systems that have historically functioned in this capacity. The authors also provide steps for developing and transitioning to an ACO structure.
Institute of Medicine. (2010). The future of nursing: Leading change, advancing health.
This report discusses how nurses can and should play a fundamental role in meeting the challenges of increased demand for health care brought about by the implementation of the 2010 Affordable Care Act. In addition, it stresses the need for nurses to be partners with other health professionals and assume leadership roles in redesigning health care in the United States.
This report brief highlights the four key recommendations from the Robert Wood Johnson and Institute of Medicine The Future of Nursing: Leading Change, Advancing Health report. The recommendations focus on nursing practice, education and training, partnerships with other healthcare professionals, and workforce planning and policymaking.
Required Media
Walden University, LLC. (Executive Producer). (2011). Healthcare policy and advocacy: Reforming health care delivery: Accountable care organizations. Baltimore: Author.
Note: The approximate length of this media piece is 7 minutes.
In this media presentation, Dr. Kathleen White explains the structure of accountable care organizations (ACO) and discusses the benefits and challenges of becoming an ACO.
Optional Resources
Fisher, E. S., & Shortell, S. M. (2010). Accountable care organizations: Accountable for what, to whom, and how. JAMA: Journal of the American Medical Association, 304(15), 1715–1716.
Fisher, E. S., Staiger, D. O., Bynum, J. W., & Gottlieb, D. J. (2007). Creating accountable care organizations: The extended hospital medical staff. JHealth Affairs, 26, w44-w57. doi:10.1377/hlthaff.26.1.w44–57
McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., & Fisher, E. S. (2010). A national strategy to put accountable care into practice. Health Affairs, 29(5), 982–990.
Discussion: Unintended Consequences of Health Care Reform
The PPACA of 2010 fostered new provisions for health care and the structure of health care delivery. The individual mandate to obtain insurance is one provocative provision. While this provision attempts to increase access to health care, it raises questions on how the existing system could sustain the potentially large influx of newly insured individuals.
Another provision calls for new models of health care provider organizations to ensure delivery efficiency and continuity of care. In this week’s media presentation, Dr. Kathleen White discusses the accountable care organization, which comprises a group of providers coordinating care across a variety of institutional settings. Yet becoming an accountable care organization may present a number of challenges.
This week’s Discussion builds on Week 1, continuing the examination of those societal and organizational contexts that influence health care reform. The unintended consequences of reform policy on the health care system are also considered.
To prepare:
- Review this week’s media presentation and the other Learning Resources focusing on how reform may lead to improved quality, greater access, and reduced cost of care. Also think about the unintended consequences that may arise as a result.
- Consider the information presented about the individual mandate and accountable care organizations. What are some questions or concerns you might have regarding the individual mandate? What are the pros and cons associated with becoming an accountable care organization?
- With posting instructions in mind, select either the individual mandate or accountable care organizations as the focus of your Discussion this week.
By Day 3
Post a cohesive response that addresses the following:
- In the first line of your posting, identify the topic you have selected—either the individual mandate or accountable care organizations. With regard to this topic, describe one or more positive results that could be achieved, and one or more unintended consequence(s) that organizations or individuals may experience.
- Briefly evaluate issues on the topic that may be a consideration for the organization you work in and the nursing profession.
Read a selection of your colleagues’ postings.
By Day 6
Respond to at least two of your colleagues in one or more of the following ways:
- Ask a probing question, substantiated with additional background information, evidence or research.
- Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
- Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
- Validate an idea with your own experience and additional research.
- Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
- Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 2 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 2 Discussion
Assignment 1: Issues in Health Care Reform (Interview)
According to the AACN (2006), “Political activism and commitment to policy development are central elements of professional nursing practice” (p. 13). Throughout this course, you will hone the skills and competencies required for this type of involvement in policy.
Research is an essential step in the process of acquiring the skills and competencies, and interviews are one form of research that can serve as a valuable source of information. As such, this Assignment (which you will start this week, and submit by the end of Week 9) provides an opportunity for you to identify a health reform issue of interest and discuss the issue with a state or national politician (or their aide).
To prepare:
- Identify a state or national politician (state representative or legislator, senator, congressman, governor, etc.), or aide, whom you would like to interview regarding current issues in health care reform.
- As soon as possible, contact the individual’s office to request a meeting. Keep in mind that it may be difficult to get on their calendar, so plan accordingly. You may conduct the interview in person or by phone.
- In advance of the interview, ask yourself:
- What health care policy issue is important to me personally?
- What issue do I want to bring to this person’s attention?
- With this in mind, develop your list of questions for the interview around your selected health policy issue. In addition, you may wish to include questions related to health care reform:
- What are your constituents most concerned about regarding health care reform?
- What are the trade-offs associated with recent health care reform policy?
By Day 7 of Week 9
To complete:
- Write a 3- to 4-page paper providing a summary and analysis of the interview and the health care reform issues you discussed.
Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from appropriate Learning Resources and additional scholarly sources as appropriate. Refer to the Publication Manual of the American Psychological Association to ensure that your in-text citations and reference list are correct. Due by Day 7 of Week 9.
Week in Review
This week, you analyzed key health care reform legislation for positive results and potential unintended consequences and assessed reform-related issues for health care.
Next week, you will investigate the process of creating health care policy beginning with agenda setting and the policy proposal.
Name: NURS_8100_Week2_Discussion_Rubric
| Excellent | Good | Fair | Poor | ||
| RESPONSIVENESS TO DISCUSSION QUESTION
Discussion post minimum requirements: *The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct. |
Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*. |
Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*. |
Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*. |
Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*. |
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| CONTENT KNOWLEDGE | Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course. |
Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course. |
Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course |
Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course. |
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| CONTRIBUTION TO THE DISCUSSION | Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature. |
Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature |
Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas. |
Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas |
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| QUALITY OF WRITING | Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints. |
Points Range: 5 (16.67%) – 5 (16.67%)
Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;. |
Points Range: 4 (13.33%) – 4 (13.33%)
Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints. |
Points Range: 0 (0%) – 3 (10%)
Discussion postings and responses are well below doctoral -level writing expectations. They: · Use grammar and syntax that is that is unclear · Make many errors in spelling, grammar, and syntax; and –use incorrect APA format · Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints. |
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| Total Points: 30 | |||||
Name: NURS_8100_Week2_Discussion_Rubric
A Sample Of This Assignment Written By One Of Our Top-rated Writers
Discussion: NURS 8100 Week 2 Unintended Consequences of Health Care Reform
Discussion: Unintended Consequences of Health Care Reform
The selected topic for this discussion is Accountable Care Organizations (ACOs). ACOs refer to networks of healthcare professionals who collaborate to deliver enhanced and more cost-effective treatment interventions to patients (Lewis et al., 2018). ACOs were instituted under the Medicare Shared Savings Program, a segment of the Patient Protection and Affordable Care Act (PPACA) of 2010.
Positive results that could be achieved with ACOs include having cost-effective treatment services. The ACA incentive matrix was created to offset the trend of costs rising unreasonably under the traditional Medicare fee-for-service model. ACOs could reduce healthcare costs since ACO providers are ranked against a sequence of quantitative benchmarks that are modified to account for regional cost variations (Wilson et al., 2020). Besides, ACOs can realize substantial savings and maximize their Medicare incentives if they meet their agreements with the CMS. Nonetheless, individuals may face unintended consequences such as perceiving that they are stuck in an unfavorable network (Lewis et al., 2018). ACOs are created to lower this risk by getting rid of the structural barriers of the HMO system. However, some healthcare economists express concerns that consolidation may restrict options available to consumers.
My current organization should consider unintended issues such as facing losses with regard to ACOs. Financial losses may occur because ACOs have savings to share if they fail to reduce the cost of care. Consequently, the organization’s operating budget may be affected because of the costs of investments used to improve care (Wilson et al., 2020). Besides, the organization may pay penalties if it fails to meet quality and cost savings benchmarks. Furthermore, the nursing profession should consider the quality of patient care with respect to ACOs. Healthcare providers who participate in an ACO must meet particular quality benchmarks, focusing on prevention and adequately managing patients with chronic diseases (Colla & Fisher, 2017). Thus, nurses who participate in an ACO must consider providing high-quality preventive care and management of chronic illnesses
References
Colla, C. H., & Fisher, E. S. (2017). Moving forward with accountable care organizations: some answers, more questions. JAMA internal medicine, 177(4), 527-528. https://doi.org/10.1001/jamainternmed.2016.9122
Lewis, V. A., D’Aunno, T., Murray, G. F., Shortell, S. M., & Colla, C. H. (2018). The Hidden Roles That Management Partners Play In Accountable Care Organizations. Health affairs (Project Hope), 37(2), 292–298. https://doi.org/10.1377/hlthaff.2017.1025
Wilson, M., Guta, A., Waddell, K., Lavis, J., Reid, R., & Evans, C. (2020). The impacts of accountable care organizations on patient experience, health outcomes and costs: a rapid review. Journal of Health Services Research & Policy, 25(2), 130–138. https://doi.org/10.1177/1355819620913141
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