NR 506 Week 3 Discussion:

NURS 8100 Unintended Consequences of Health Care Reform

Sample Answer for NURS 8100 Unintended Consequences of Health Care Reform Included After Question

NURS 8100 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 

NURS 8100 Unintended Consequences of Health Care Reform

Discussion – Week 2 

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 several 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. 

NURS 8100 Unintended Consequences of Health Care Reform
NURS 8100 Unintended Consequences of Health Care Reform

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. 

A Sample Answer For the Assignment: NURS 8100 Unintended Consequences of Health Care Reform

Title: NURS 8100 Unintended Consequences of Health Care Reform

NURS 8100 Unintended Consequences of Health Care Reform

Since the Patient Protection and Affordable Care Act (PPACA) was signed into law, health care delivery has evolved from traditional fee-for-service-based care to value-based care in an effort to deliver high-quality, coordinated care to patients (Patient Protection and Affordable Care Act, 2010). One approach to achieve this goal has been the creation of accountable care organizations (ACOs), defined as a group of providers who are jointly held accountable for achieving measured quality improvements and reductions in the rate of spending growth (McClellan, McKethan, Lewis, Roski, & Fisher, 2010).

Accountable care organizations emphasize team-based care and shared responsibility for patient outcomes. The Centers for Medicare and Medicaid Services (CMS) is promoting the formation of accountable care organizations (ACOs). In these population-based models, CMS aligns a Medicare beneficiary population to an ACO with associated expenditure and quality targets, transitioning away from purely volume-based revenue of fee-for-service Medicare. Patients with mental illness are among high-cost Medicare beneficiaries, but this population has received little attention in ACO implementation. Although the ACO goals of providing chronic and preventive care in a coordinated, patient-centered manner are consistent with what some mental health providers have long advocated, the population-based orientation may be unfamiliar.

Accountable care organizations (ACOs), by focusing on coordinating care for Medicare patients across providers and multiple care settings, are a key element of the “better health care, better health, and improved quality” CMS triple aim. However, as has been the case for other quality improvement initiatives across the lifespan (Zima & Mangione-Smith, 2011), attention to patients with mental illness has been virtually absent in ACO implementation. Mental health conditions are among the most expensive as primary disorders and, when comorbid with general medical disorders, are associated with increased costs for the primary general medical disorder (Maust, Oslin & Marcus, 2013).NURS 8100 Unintended Consequences of Health Care Reform

The cohort of older adults with mental illness is expected to increase from under eight million in 2010 to 15 million in 2030 for several reasons, including the aging of baby boomers, their higher rates of depression and anxiety, and the onset of late-life psychiatric disorders in the expanding aged population (Maust, Oslin & Marcus, 2013). Despite this growing burden of mental illness and its cost implications, current ACO disease-specific quality and cost efforts are focused almost entirely on chronic general medical conditions. The one exception—depression screening with a documented follow-up plan—may have minimal impact on actual care (Maust, Oslin & Marcus, 2013).

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In addressing the needs of high-cost, high-risk patients to meet quality and expenditure targets, an ACO should examine the quality of mental health care it provides as well as medical quality for patients with mental illness. In addition, federal agencies should invest to ensure understanding of the impact of population-based initiatives on patients with mental illness.

Mental health conditions need to be examined for their impact not only as primary disorders but also for their impact on quality of care for comorbid general medical conditions. High-quality diabetes care, for example, is an explicit goal that has quality measures included for ACO beneficiaries; if the overall quality of diabetes care improves in an ACO, the improvements should include those with comorbid mental illness. Although improving mental health care is not an explicit ACO goal, part of the overall evaluation of medical care should focus on vulnerable populations, such as persons with mental illness (Maust, Oslin & Marcus, 2013).

References

Maust DT, Oslin DW & Marcus SC. (2013). Mental Health Care in the Accountable Care Organization. https://doi.org/10.1176/appi.ps.201200330

McClellan M, McKethan AN, Lewis JL, Roski J, & Fisher ES. (2010). A national strategy to put accountable care into practice. Health Affair, 29 (5), pp. 982-990

The Patient Protection and Affordable Care Act. (2010). US Centers for Medicare & Medicaid Services https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/.

Zima BT & Mangione-Smith R. (2011). Gaps in quality measures for child mental health care: an opportunity for a collaborative agenda. Journal of the American Academy of Child and Adolescent Psychiatry 50:735–737

Policymakers and healthcare leaders developed financial incentives to care quality, patient outcomes, and care coordination through ACOs is a key solution for fixing the inefficient fee-for-service system. Providers using ACOs who agree to coordinate care for patients and deliver the right care at the right time will avoid unnecessary utilization of services and medical errors. Organizations that meet quality goals and patient safeguards can generate financial gains from improved clinical and economic performance (Piper, 2010). A successful ACO will need a group of willing providers to take responsibility for their patients in reforming care so that costs are lower, and results are better.

An unintended that consequence(s) that organizations ACOs and other value-based care programs are reducing competition in the healthcare industry, resulting in higher prices for consumers (RevCycleIntelligence, 2019). For individuals, require adjustment in culture and expectations. For example, providing strong leadership to start saying ‘no’ to some equipment request or mandating physician to abide to protocols. Government-sponsored pilots are an option to help providers choose a targeted market and reimbursement methodology.

Houston Methodist Hospital functions as an ACOs. The Performance Year of 2020 was estimated $19,439,369 (Coordinated Care Organization: Houston Methodist, n.d.). In order to cultivate a culture, the hospital employs ACO professionals and practice group arrangement.

Reference

Coordinated Care Organization: Houston methodist. Organization | Houston Methodist. (n.d.). Retrieved March 6, 2022, from https://www.houstonmethodist.org/about-us/coordinated-care/

Moore, K. D., & Coddington, D. C. (2010). accountable care the journey begins. Healthcare Financial Management, 64(8), 57-63. https://www.proquest.com/trade-journals/accountable-care-journey-begins/docview/746684537/se-2?accountid=14872

Piper K. (2010). Accountable Care Organizations in the Era of Healthcare Reform… Mark B. McClellan, MD, PhD. American Health & Drug Benefits, 3(4), 242–244.

RevCycleIntelligence. (2019, December 18). Understanding the fundamentals of accountable care organizations. RevCycleIntelligence. Retrieved March 5, 2022, from https://revcycleintelligence.com/features/understanding-the-fundamentals-of-accountable-care-organizations

RESPOND HERE

Hello

I agree with you that policymakers and other stakeholders in the healthcare sector are concerned with improving patient outcomes and healthcare quality. Therefore, developing financial incentives such as Accountable care organizations and Medicaid is part of the assignment of these people and institutions (Bustamante et al., 2019). Arguably, the policymakers assume that their inclusion will sigh of relief to patients struggling to access quality healthcare.  ACOs is a policy that targeted all Americans struggling to access quality healthcare services. Unfortunately, the majority of the uninsured American population was battling to have quality healthcare services (Nikpay et al., 2018).  The idea of creating a group of providers has succeeded in avoiding unnecessary wastage of services and medical resources. Furthermore, the policy has reduced the chances of medical errors. The American healthcare sector has continued to indicate a commitment to improving healthcare quality. Therefore, stakeholders have been continued to develop mechanisms that will protect Americans from hiked medical bills.

References

Bustamante, A. V., Chen, J., McKenna, R. M., & Ortega, A. N. (2019). Health care access and utilization among US immigrants before and after the Affordable Care Act. Journal of immigrant and minority health21(2), 211-218.

Nikpay, S. S., Tebbs, M. G., & Castellanos, E. H. (2018). Patient Protection and Affordable Care Act Medicaid expansion and gains in health insurance coverage and access among cancer survivors. Cancer124(12), 2645-2652. https://doi.org/10.1002/cncr.31288