NRS 460 Topic 3 DQ 2 Discussion

Discussion: The management of complex disease states usually requires care coordination across multiple providers and settings over a long period of time.

NRS 460 Topic 3 DQ 2 Discussion Assessment Description

The management of complex disease states usually requires care coordination across multiple providers and settings over a long period of time. Describe how two financial and payment models in health care, such as capitation, value-based care, or fee-for-service, impact the delivery, access, and quality of care for patients requiring complex disease management. Students may use other financial and payment models of health care outside of those listed here.

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NRS 460 Topic 3 DQ 2 Discussion Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN Discussion Question Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

NRS 460 Topic 3 DQ 2 Discussion Sample

Topic 3 DQ 2

Complex diseases have been associated with higher healthcare costs. As a result, several healthcare models, such as capitation and value-based care, have been established to facilitate the cost of care is catered for. Capitation is a way of paying healthcare providers or organizations where they receive a fixed set amount of money to cover the cost of all or some of the healthcare services for a specific patient over a certain period. As a result, patients covered by the policy have increased access to various forms of healthcare services, including preventive, diagnostic, and treatment services, medications, and health education, resulting in improved health for the patients (Yan et al., 2023). NRS 460 Topic 3 DQ 2 Discussion In addition, capitation improves the quality and service delivery to the patients as different specialists can work together to ensure patient care is well coordinated to meet the continuous needs of the patients.

However, capitation has its challenges, the most common being under-financing, as patients with complex diseases require costly interventions and procedures. This results in healthcare providers and facilities declining to take up this model as it is associated with extra losses in cases where additional costs are required, limiting patient access (Matchar et al., 2023). Lastly, healthcare providers may overcharge, over-treat, or under-treat patients, where they may order unnecessary tests or limit the number of tests done to maximize profits. NRS 460 Topic 3 DQ 2 Discussion

Value-based care is an example of a healthcare delivery model where healthcare providers are paid based on patient health outcomes such as improved patient health and reduction of complications and readmissions. Value-based care aims at reducing the number of preventable healthcare conditions such as diabetes and hypertension by encouraging physicians to identify certain conditions early, initiate treatment, and provide health education to the patients (Leao et al., 2023). NRS 460 Topic 3 DQ 2 Discussion As a result, there is a reduction in overall healthcare spending through less hospitalization and medical emergencies. In addition, patients receive patient-centered care as physicians spend more time with them. The patients also receive quality healthcare services, which may include specialist coordination and remote monitoring that improve their health outcomes. However, inadequate finances may limit the efficacy of value-based care.

NRS 460 Topic 3 DQ 2 Discussion References

Leao, D. L. L., Cremers, H.-P., van Veghel, D., Pavlova, M., & Groot, W. (2023). The Impact of Value-Based Payment Models for Networks of Care and Transmural Care: A Systematic Literature Review. Applied Health Economics and Health Policy, 21(3). https://doi.org/10.1007/s40258-023-00790-z

Matchar, D. B., Lai, W. X., Kumar, A., Ansah, J. P., & Ng, Y. F. (2023). A Causal View of the Role and Potential Limitations of Capitation in Promoting Whole Health System Performance. International Journal of Environmental Research and Public Health, 20(5), 4581. https://doi.org/10.3390/ijerph20054581

Yan, J., Shi, Y., Zhang, J., Chen, S., Huo, X., Shen, Y., & Zhang, N. (2023). Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-17161-x