NURS 8100 Wk 1 Discussion: Health Care Reform

A Sample Answer For the Assignment: NURS 8100 Wk 1 Discussion Health Care Reform

This is an exceptional work on health care reform. I concur with you that cost of care is an important feature of health care system that has great influence on the health policy and reforms.  Other than the cost, the other important feature of the US health care system is politics. Politics play a crucial role in the health care affairs, particularly health policy and reforms (Tuohy, 2018). The health care reform discussion in the US has been a political issue centered on reduction of cost, funding, increasing medical coverage, insurance reform, government involvement, and philosophy of its provision. 

Health care reforms have been highly contentious among law makers (Haeder, 2020). For instance, President Obama enacted the Patient Protection and Affordable Care Act (PPACA) to increase health coverage to all Americans.  However, the Trump administration consistently made efforts to repeal the ACA and adopt alternative policy called repeal and replace approach.  This effort to repeal the ACA has been a controversial political topic among the Democrats and Republicans in the Congress (Michener, 2020).

References

Haeder, S. F. (2020). Political science and US health policy in the era of the affordable care act. Policy Studies Journal, 48, S14-S32. https://doi.org/10.1111/psj.12385

Michener, J. (2020). Race, politics, and the affordable care act. Journal of Health Politics, Policy and Law, 45(4), 547-566. https://doi.org/10.1215/03616878-8255481

Tuohy, C. H. (2018). Remaking policy: scale, pace, and political strategy in Health care reform (Vol. 54). University of Toronto Press.

The enactment of the Affordable Care Act in 2010 heralded reforms in health care that led to more Americans, about 25 million, who did not have health insurance coverage, getting insured. While the reforms from the passage of ACA 2010 led to increased access and quality of affordable care, they did not create universal health coverage to guarantee all Americans, irrespective of their socioeconomic status, access to quality care (Wilensky et al., 2020).

The recent COVID-19 pandemic has illustrated the need for in-depth reforms in the healthcare sector to be spearheaded by state and federal governments. The pandemic demonstrated the importance of having universal healthcare coverage to enhance access to all Americans. The U.S. recorded the highest caseload and fatalities from the COVID-19 pandemic because of the current health system despite being a developed country and spending over $4 trillion or about 12% of its gross domestic product (GDP) on healthcare (Auener et al., 2021).

Several studies have demonstrated that having universal health coverage would have enabled the U.S. to handle the pandemic better than it did (King, 2020). The purpose of this paper is to present a health reform plan that focuses on the implementation of universal health coverage with a single-payer model.

Conflict Between Federal and State Policies on Healthcare

Federal and state governments have different roles and responsibilities in healthcare provision. As such, there is no uniformity concerning policies between the federal and state governments. The existence of policy variations between these governments can lead to conflicts that require solutions to improve accessibility, reduce costs, and enhance the quality of care.

State and federal governments jointly fund health care provision based on existing policies like Medicaid under the ACA 2010 (Wilensky et al., 2022). Under this policy, states are free to take Medicaid and increase resources by developing their provisions. Such provisions may conflict with the federal mandates on Medicaid since the federal government hopes to offer access to care through the program (McClellan et al., 2021).

However, due to differences in state laws and rules based on their legislations, some states do not have Medicaid programs implying that in such states, Americans cannot access healthcare services under the policy.

According to the Kaiser Family Foundation (KFF), ten states have not expanded Medicaid, implying that over 2.1 million people belong to the “coverage gap” or income level that makes them eligible for the program yet cannot access it due to their state policies (Tolbert et al., 2022). Such a conflict in policies implies that Americans in the ten states have limited options to access healthcare services. Again, it means that state and federal governments cannot implement a universal healthcare model that will address the coverage and access gaps.

Currently, the federal government funds fully the Medicare program that caters to older Americans, those 65 years and above as well as Americans living with disabilities. Under the program, all state policies align with the provision since they do not fund costs, including prescription drugs. As such, these conflicts can only be solved through one healthcare plan as demonstrated by the Medicare program or the Veterans Administration (VA) healthcare plan.

Conflicting policies as demonstrated by the Medicaid program lead to limited access to health care and reduced resources to fight pandemics when they occur like the recent COVID-19 pandemic and other health emergencies (Hiam et al., 2021). Therefore, both state and federal governments should embrace a universal model like other developed countries with a single public-payer system where the federal government provides resources based on the state population’s healthcare needs.

Health Preparedness

The proposed health reform plan of having a universal health coverage plan that emphasizes primary care implies that more resources are allocated to the local health facilities within states and counties. Under this proposed plan, states will work with the federal government on the current model of both Medicaid and Medicare services based on the targeted population (Galvani et al., 2022).

The plan will entail having Medicaid-like coverage where all people get insured based on the resources that the federal government offers, and the state matches the same amount. For instance, based on the population levels, states will have different allocations and match half of that by evaluating their demand. The plan will expand access and ensure that populations and individuals previously not eligible become eligible in all states. The policy will ensure that states align their healthcare mandates with the federal government’s direction to improve access and quality of care.

The policy will entail allocating more resources to preventive and primary care interventions in the communities. These resources include investing in healthy food options, physical activities and exercising, giving nutritional information, expanding maternal care, and ensuring that all consultation services and physician visits are free (Wilensky et al., 2022).

Imperatively, the plan is to ensure that Americans can access not just emergency care as provided under the EMTALA provisions but also physician visits and annual routine reviews. The plan will seek to reimburse physicians for value provided and not quantity.

Through these provisions, the proposed plan will enhance health preparedness, especially during public health emergencies as witnessed recently due to the COVID-19 pandemic. Since the plan will focus on primary care, it enhances the level of preparedness as it means that the entire public can access information and emergency services (McClellan et al., 2021).

States would increase their allocation and build more facilities that prepare adequately for any health emergencies. The new plan will ensure seamless sharing of health information, effective coordination, and teamwork based on the expertise and number of healthcare workers who will be deployed in communities.

According to the American Public Health Association (2022), nations that had a universal healthcare system leveraged their models to mobilize resources and ensure the testing and care of their citizens and residents during the COVID pandemic. Universal health coverage would reduce disparities and support vulnerable populations’ access to care. These two factors can help reduce the impacts of pandemics as demonstrated in the country since a majority of those who succumbed to the disease were vulnerable and experienced health disparities.

Percentage of GDP for Health Care

Investing in and rolling out a universal healthcare system would be a critical part of attaining accessibility, reducing overall costs, and improving the quality of care. Currently, models like value-based purchase (VBP) emphasize quality as opposed to quantity implying that the plan does not have to spend more on the GDP but will deploy international best practice standards. For instance, Canada spends about $9,000 per person on universal healthcare (Geyman, 2021).

With a higher GDP than Canada’s, the U.S. can spend about $10,000 per person using this model implying that it will only be about 10% of the nation’s GDP. This figure will allow the federal and state governments to provide comprehensive care to all people who require care throughout the year. States will match the funding by half to close any gaps and reduce bureaucratic aspects that affect the implementation of the program.

Conclusion

Reforming the health system entails developing models that will leverage the limited resources but guarantee high-quality care to Americans and residents. Evidence demonstrates that embracing a universal healthcare model will allow more Americans to access quality care and reduce wastage and additional spending that make it difficult for many to get services.

The proposed plan will ensure that more Americans, especially those experiencing disparities and vulnerability, access care and prepare adequately for public health emergencies like the COVID-19 pandemic and other epidemics like the current opioid crisis.   

References

Auener, S., Kroon, D., Wackers, E., Van Dulmen, S., & Jeurissen, P. (2020). COVID-19: a

a window of opportunity for positive healthcare reforms. International Journal of Health Policy and Management, 9(10), 419-422. DOI: 10.34172/ijhpm.2020.66

American Public Health Association (APHA) (2022). Lessons from the COVID-19 Pandemic:

The Importance of Universal Health Care in Addressing Health Care Inequities. https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2022/01/07/Lessons

Galvani, A. P., Parpia, A. S., Pandey, A., Sah, P., Colón, K., Friedman, G., … & Fitzpatrick, M.

C. (2022). Universal healthcare as pandemic preparedness: the lives and costs that could have been saved during the COVID-19 pandemic. Proceedings of the National Academy of Sciences, 119(25), e2200536119. https://doi.org/10.1073/pnas.2200536119

Geyman, J. (2021). COVID-19 has revealed America’s broken healthcare system: What can we

learn? International Journal of Health Services, 51(2), 188-194. https://doi.org/10.1177/0020731420985640

Hiam, L., & Yates, R. (2021). Will the COVID-19 crisis catalyze universal health reforms? The

            Lancet, 398(10301), 646-648. DOI:https://doi.org/10.1016/S0140-6736(21)01650-0

King, J. S. (2020). Covid-19 and the need for health care reform. New England Journal of

            Medicine, 382(26), e104. DOI: 10.1056/NEJMp2000821

McClellan, M., Rajkumar, R., Couch, M., Holder, D., Pham, M., Long, P., … & Smith, M.

(2021). Health care payers COVID-19 impact assessment: Lessons learned and compelling needs. NAM Perspectives, 2021. https://nam.edu/health-care-payers-covid-19-impact-assessment-lessons-learned-and-compelling-needs/

Tolbert, J. & Drake, P. (2022). Key Facts about the Uninsured Population.

Key Facts about the Uninsured Population

Wilensky, S. E., & Tietelbaum, J. B., (2020). Essentials of health policy and law (4th ed.).

            Burlington, MA: Jones & Bartlett Learning.

Wilensky, G. R. (2022, January). The COVID-19 pandemic and the US healthcare workforce.

JAMA Health Forum, 3(1) pp. e220001-e220001. DOI:10.1001/jamahealthforum.2022.0001

This paper looks into an accountable care organization (ACO) in California and ways that it impacts population health. Accountable health care organizations play vital roles in promoting coordinated efforts between clinicians and medical practitioners while at the same time reducing costs and unnecessary treatments (McWilliams, 2016).

Accountable care organizations are a representation of changing health dynamics in the American care system. Accountable care organizations are formed when medical providers, for instance, doctors, nurses, health organizations and non-physician providers collectively agree to be responsible for financial and quality of care in a defined population.

Accountable Care Organization

In California, one of the common ACOs is the Shared Savings Programs (SSP) which is a voluntary program that is formed to encourage hospitals, doctors and other health providers in the country to come together as accountable care organizations. The organization gives coordinated and high-quality care to members who are beneficiaries of Medicare.

The SSP was formed wit the intention of moving the payment system of Medicare from a volume perspective to outcome and value-based (Lipa, 2020).  SSP has significantly impacted population health in California. By coming together, SSP has improved the quality of care to patients who could not have afforded such care.

The SSP ensures that patients from different areas in the state get the correct care at the right time. Quality care also means that patients do not go for unnecessary tests. Another way that SSP has impacted population health in California is by focusing on preventative care through coordination of services across the different levels of care (Milwee, 2020).

The concept of bundled care.

Bundled care is a concept that entails Medicare implementing voluntary episode of payment models.  Medicare used to make individual payments to individual services offered to patients. In Bundled care, all payments are combined in a single payment for physicians and hospital facilities. Bundled care increases the incentives for providers to work together to deliver patient care. Bundled care exposes healthcare facilities to certain risks and challenges.

Some of the risks of bundled care include the fact that patients may have comorbidities (Agrwal, 2020). This is where some patients might require expensive treatment procedures that are uncontrollable by the provider. Another risk of bundled care in handling cases of uncompliant patients. When patients fail to comply with their care plan such as the medication regimen, health care providers will have difficulties in managing the costs.

Benefits of showing pricing for care.

One benefit of showing pricing of care is that it promotes price transparency. When there is access to price transparency, it helps them to choose accountable payment models that are implemented by different organizations to improve healthcare quality. Another benefit of showing care pricing is that it empowers patients to make informed decisions and get more involved in their care.

Care pricing also ensures equitable prices for both insured and uninsured patients since in most cases the uninsured patients are often charged more (Mummadi & Mishra, 2020). Finally, showing care prices helps the patient to make decisions on which provider will be most effective at a low cost. Showing care prices increase competition in healthcare facilities thereby improving the quality of care provided.

In conclusion, the Shared Saving Program (SSP) is an accountable care organization (ACO) that is designed to improve population health as well as the quality of care to patients. Showing care pricing benefits healthcare in various ways. By showing care prices, patients can make an informed decision based on the pricing and quality of services offered.

References.

Agarwal, R., Liao, J. M., Gupta, A., & Navathe, A. S. (2020). The Impact of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review: A systematic review of the impact on spending, utilization, and quality outcomes from three Centers for Medicare and Medicaid Services bundled payment programs. Health Affairs, 39(1), 50-57.

Lipa, S. A., Sturgeon, D. J., Blucher, J. A., Harris, M. B., & Schoenfeld, A. J. (2020). Do Medicare Accountable Care Organizations Reduce Disparities After Spinal Fracture?. Journal of Surgical Research, 246, 123-130.

McWilliams, J., Hatfield, L., Chernew, M., Landon, B., & Schwartz, A. (2016). Early Performance of Accountable Care Organizations in Medicare.

Millwee, B. (2020). Accountable Care Organizations in Medicaid. The Journal of ambulatory care management, 43(1), 11-14.

Mummadi, S. R., Mishra, R., & Mummadi, R. R. (2020). Price Transparency in the Electronic Health Record. Jama, 323(3), 281-281.

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In an online educational program, there are many strategies one must develop to be successful. Time management is one of the most important strategies for me. Distractions can derail ones focus and lead to failure. Time management is complex with all the competing factors in the busyness of life. In a traditional setting, class time is offered on campus at a specific time there is a clearly defined classroom and base to start the learning process.

In the online classroom, the flexibility requires one to engage with increased frequency (Alvarez Sainz et al., 2019). While the flexibility can be helpful, it also requires dedication to manage successfully. One strategy I have used in the past is to write out my schedule and plan my class time in a way like my undergraduate studies where I have a schedule that required me to be in specific rooms on campus.

Time blocking is what I currently use and have found helpful. To time block, one simply creates immovable blocks within their schedule. As work arrival times are fixed for many, the same dedication is needed for success in an advanced degree setting. Making a list of the items I need to accomplish and establishing a time to complete each component has been helpful.

Anticipated Success

A new strategy that I am excited to try is the effective use of technology. I’ve discovered that my phone frequently draws my attention and tempts me to look at it whenever it makes a noise. To reduce the distraction of my phone I intend to silence my phone during my designated time blocks to avoid distractions.

Using the “do not disturb” setting will help keep my gaze away from my phone. Technology overload is common in today’s world (Orhan et al., 2021). While I expect this to help, I also know myself and will need to put the phone in another room to avoid picking it up carelessly and wandering out.

NURS 8100 Wk 1 Discussion: Health Care Reform

Conclusion

Success in any educational endeavor is difficult to achieve. Current world events, such as lockdowns, restrictions on group meetings, and life changes, necessitate agile mindsets for many.

The flexibility of online education is beneficial for social distancing and ensures that educational endeavors can continue uninterrupted. With this flexibility comes responsibility, and developing a solid plan will increase the likelihood of success. Time management allows for life balance and a positive outcome.

One feature of the US health care system is that it is the most expensive healthcare in the world with results that would not agree with the cost. It is interesting to see that the US healthcare system has tried to evolve over the years and in that evolving has actually increased the cost of healthcare (Bodenheimer & Grumbach, 2020).

Competition has fueled the improvement of healthcare, but at the cost of raising healthcare costs for the individual. There are other countries that have better health care systems in place, for a fraction of the cost. It would be interesting to investigate the actual cost of care and how much insurance companies gain compared to their actual payout. There is much that could be improved in the US health care system.

It could be possible that the monetary issues prevent there from being major reform to the system because companies make such a large sum of money that they do not want things to change. As the US health care system has tried to change and become seemingly more affordable through the use of policy changes there has been an increase in the amount of money that they government pays, which is actually paid by US citizens through taxes (Bodenheimer & Grumbach, 2020). It seems that whenever the US health care system is taking one step forward it is also taking two steps back.

Challenges

The Affordable Care Act (ACA) did provide more individuals with health care coverage. This has improved the health of many individuals. One condition of the ACA is that it protects individuals with preexisting conditions from insurance companies denying care based on their condition (Healthcare.gov, n.d.). This is a great benefit for many individuals, but it comes at a cost for the insurance companies.

This mandatory coverage causes insurance companies to then have to try to balance out coverage for those individuals that are ill versus those individuals who are healthy which can end up costing those individuals that are healthy to pay for others in their groups (Bodenheimer & Grumbach, 2020).

This causes insurances to have to base their premiums on an experience rating versus a community rating which potentially provides unfair coverage to individuals (Bodenhemier & Grumbach, 2020). This seemingly minor change from the ACA has a ripple effect in the way that insurance companies need to charge for care and how they will determine premiums for individuals.

The ACA in general is an example of how the policy making process is in the United States. Making or changing policy in the United States is a very slow, very incremental process which makes it hard to change or add policies (Walden University, LLC, 2011). The ACA was a worked on for a long time and because of the changes that were made many companies had to adjust accordingly.

Health reform in the United States is difficult because there are so many entities that want to make sure that they are not being left out or hurt in decisions or policies that are being made and so they will stall or stonewall different policies if they feel that it does not benefit them.

When there are policy changes then there are adjustments that need to be made and sometimes that effects so many different things that the changes end up being a negative instead of a positive, such as individuals who have to pay too much for the ACA healthcare and therefore opt out and are fined for that decision (Bodenheim & Grumbach, 2020).

References

Bodenheimer, T., & Grumbach, K. (2020).  Understanding health policy: A clinical approach (8th ed.). McGraw-Hill.

HealthCare.gov. (n.d.) Understanding the Affordable Care Act. Retrieved from https://www.hhs.gov/healthcare/about-the-aca/index.html

Walden University, LLC. (Executive Producer). (2011). Healthcare policy and advocacy: The policy process. Baltimore: Author.