NUR 514 Discuss how the shift to value-based health care has impacted delivery of care

To note, the United States healthcare system “does not function as a rational and integrated network of components designed to work together” (DeNisco, 2024, p. 175). Instead, several private entities offer a variety of services and are largely driven by the capitalistic economy (DeNisco, 2024). This includes private insurance companies, public insurance funded by the government, varied agreements to pay for services, different settings for healthcare delivery, and private consulting firms to assist with planning, cost containment, etc. (DeNisco, 2024). As a result of this melting pot of entrepreneurship, the US healthcare system lacks consistency and control, allowing decisions to be made by these private and corporate entities to drive profits and increase costs for consumers, further negatively impacting the healthcare system as a whole (DeNisco, 2024).

Understanding the intricacies of the US healthcare system is incredibly important for the advanced registered nurse. As an advanced registered nurse, this “can help them understand changes and the impact of those changes on their own practice” which may include “adaptation and relearning” (DeNisco, 2024, p. 189). For example, nurse managers and leaders must be savvy when it comes to the economic market and understand the impact of emerging technology and health services, healthcare regulations and policy, cost of services and insurance, etc. on their organization and its services (DeNisco, 2024). The advanced registered nurse can continue to influence the healthcare system by advocating for legislation that may affect healthcare policy and finances, such as cost of treatments and insurance coverage (American Organization for Nursing Leadership, 2023). Moreover, the advanced registered nurse may utilize evidence based practice to advocate for the use of emerging technology and treatments. With a healthcare system that is driven by private companies’ profits, these are incredible steps that the advanced registered nurse may do to improve healthcare deliver within their organization and clinical setting. 

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American Organization for Nursing Leadership. (2023). American Organization for Nursing Leadership. https://www.aonl.org/about/overview

DeNisco, S. M. (2024). Advanced practice nursing: Essential knowledge for the profession (5th ed.). Jones & Bartlett Learning.

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NUR 514 Discuss how the shift to value-based health care has impacted delivery of care

NUR 514 Discuss how the shift to value-based health care has impacted delivery of care

Consider the evolution of the U.S. health care system. Discuss how the shift to value-based health care has impacted delivery of care and the role and responsibilities of the advanced registered nurse. Project what major evolving trends in the health care delivery system will affect nursing practice and how advanced registered nurses will influence the direction of health care.NUR 514 Discuss how the shift to value-based health care has impacted delivery of care

Health care delivery is an evolving practice that must respond to the ever-evolving needs regarding patient experience, care quality, cost-effectiveness, and safety. Health statistics reveal that health care spending increased from 5% to 17.7% of the U.S Gross Domestic Product between 1960 and 2019 without a proportional increase in health care quality (Harrill & Melon, 2021). Such gaps have necessitated value-based health care to enhance patient experience and ensure patients receive health care services that match their needs.

Characteristically, value-based health care is a payment reform to improve the quality of care. Achieved primarily through the pay-for-performance (P4P) model, value-based health care entails incentivizing health care providers depending on the quality of services (Harrill & Melon, 2021; Teisberg et al., 2020). The model characterizes a shift from the fee-for-service model, where health care providers are reimbursed based on the quantity of services rendered to patients. The shift to value-based health care has impacted the role and responsibilities of the advanced registered nurse by increasing focus on care quality. Accordingly, the advanced registered nurse must be innovative and integrate approaches that reduce medical errors and optimize safety to achieve the desired care quality.

Besides value-based health care, other evolving trends will profoundly influence the nursing practice. For instance, Snoswell et al. (2020) projected increased use of telehealth and technology-driven practices to reduce health care spending, increase access to care, and enhance efficiency. These technologies will support remote patient monitoring and facilitate the absorption of self-help kiosks to reduce staffing. Amid these evolutions, advanced registered nurses will influence the direction of health care by promoting technology use in health care delivery and leading change. The implication is that advanced registered nurses will use their knowledge and skills to ensure health care organizations embrace evolution and invest in appropriate resources to accommodate practice changes.

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NUR 514 Discuss how the shift to value-based health care has impacted delivery of care References

Harrill, W. C., & Melon, D. E. (2021). A field guide to US healthcare reform: The evolution to value‐based healthcare. Laryngoscope Investigative Otolaryngology6(3), 590-599. https://doi.org/10.1002/lio2.575

Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if telehealth can reduce health system costs: Scoping review. Journal of Medical Internet Research22(10), e17298. https://doi.org/10.2196/17298

Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based health care: a strategic framework. Academic Medicine: Journal of the Association of American Medical Colleges95(5), 682–685. https://doi.org/10.1097/ACM.0000000000003122

Value-based healthcare is meant to be personalized medicine. VBH has the motto to “treat the right patient at the right time with the right treatment”. Treatments can be much more personalized, increase efficacy, reduced adverse events, improved quality of life and efficient use of healthcare expenditure (Steffen, J.A. & Lenz, C. 2013). Diagnostic testing for cancer care has drastically improved for cancer patients with use of single testing, parallel testing, and whole-genome sequencing which has led to wide range of diagnostic technologies that are available for use, the drawback is local and state regulations as well as reimbursement specifically if it is seen as value added (Steffen, J.A. & Lenz, C. 2013). This is a drastic change from value-based healthcare as care was delivered by a physician and was seen as the only truth to care and one-size fits all approach.

Introduction of value-based healthcare has allowed advanced practice registered nurses to expand responsibilities and there has been an increase in service and specialties. Examples of this is nurse practitioners moving into a variety of settings such as acute care and partnering with specialty providers, ability to perform initial hospital assessment and consultation, continued oversight of patients, development of treatment plans, discharge planning and follow up at clinics. Kocakulah, M.C. et al. (2021) states discharge clinics are being staffed more by nurse practitioners with access to other team members. Nurse practitioners are more cost effective, and use of NP’s has allowed providers to meet Medicare guidelines of a 7 day post-discharge follow-up. This can help patients and the primary providers meet this guideline when obtaining an appointment to see their primary is difficult to impossible. In my prior role nurse practitioners worked in various specialties including cardiology, orthopedic, oncology and palliative are. Each NP worked hand in hand with their physician(s) from admission to discharge and into the specialty clinics. 

A healthcare setting that will likely see a change in home healthcare and home hospice. It is likely more NP’s will be allowed to prescribe for home health care and hospice services as well as NP’s work in these environments with the ability to provide necessary care for home bound patients. During the pandemic lifts on these regulations provided much needed relief for agencies, providers, patients and family members.

NUR 514 Discuss how the shift to value-based health care has impacted delivery of care References:

Steffen, J.A, & Lenz, C. (2013). Technological evolution of diagnostic testing in oncology. Personalized Medicine, 10(3), 275-283. Doi:http://dx.doi.org/10.2217/pme.13.19

Kocakulah, M. C., Austill, D., & Henderson, E. (2021). Medicare cost reduction in the US: A case study of hospital readmissions and value-based purchasing. International Journal of Healthcare Management14(1), 203–218. https://doi.org/10.1080/20479700.2019.1637068 

Consider the evolution of the U.S. health care system. Discuss how the shift to value-based health care has impacted delivery of care and the role and responsibilities of the advanced registered nurse. Project what major evolving trends in the health care delivery system will affect nursing practice and how advanced registered nurses will influence the direction of health care. 

According to Encyclopedia.com, healthcare in the United States developed from a simple system of home remedies and itinerant doctors who had little training to a multifaceted, scientific, high-tech, and bureaucratic system between 1750 and 2000. The system has been developed on medical science and technology and the influence of medical professionals. The evolution of this system comprises the recognition of the “germ theory” as the root of disease, professionalization of doctors, evolution of technology in treating disease, the increase of great institutes of medical training and healing, and the introduction of medical insurance. There has also been the advent of governmental organizations, regulations, health care programs, drug laws, and medical insurance throughout this period. Recent developments have ushered in the evolution of corporations whose business is profit generation from healthcare (Encyclopedia.com, 2019). 

The United States healthcare system keeps evolving over decades. It has gone through many transformative processes in attempts to improve care quality, patient outcomes, and quality of life. Salmond and Echevarria argued that the driving forces of healthcare transformation include fragmentation, accessibility challenges, unsustainable costs, suboptimal outcomes, and inequalities (Salmond &Echevarria, 2017). 

Challenges with cost and quality as well as changing social and disease-type demographics have led to the urgency for the need for change. Patients with chronic health conditions are significantly burdened with cost of care. The Centers for Medicare and Medicaid Services under the Affordable Care Act have some programs aimed at improving quality and control cost. This has brought to bear the need for a greater coordination of care across providers and settings to improve quality care, outcomes, and decrease expenditure, particularly ascribed to needless hospitalization, needless emergency department visits, repetitive diagnostic testing, duplicate medical histories, multiple prescriptions, and adverse drug interactions (Salmond &Echevarria, 2017). 

As the United States continues to take incremental steps toward achieving better quality and lower costs, nurses are positioned to contribute to and lead the transformative changes that are happening in healthcare by participating fully at the interprofessional team as a paradigm shift is made from episodic, provider-centered, fee-for-service care to team-focused, patient-centered care across the continuum that delivers seamless, affordable, and quality care. These shifts demand a new or an improved set of knowledge, skills, and attitudes about wellness and population care with a changed focus on patient-centered care, care coordination, data analytics, and quality improvement (Salmond &Echevarria, 2017). Nurses by virtue of our close relationship with patients and their families due to the nature of our work and better positioned to lead this change to bring the much-needed results. Therefore, with the focus being shifted to patient-centered care, nurses are better positioned than any other healthcare professionals to be in the lead role. 

References 

Encyclopedia.com. (2019). www.encyclopedia.com. Retrieved from https://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/evolution-us-healthcare-system#:~:text=The%20Evolution%20of%20the%20U.S.%20Healthcare%20System%20Overview,bureaucratic%20system%20often%20called%20the%20%22medical%20industri 

Salmond, S. W., &Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1), 12. 

Response 

Hello Isaac! This is an exceptional discussion about evolution of US health care system. I agree with you that the healthcare in the United States developed from a simple system of home remedies and itinerant doctors who had little training to a multifaceted, scientific, high-tech, and bureaucratic system between 1750 and 2000. Indeed, science and technology has played instrumental roles in influencing and advancing the evolution of the US health care system. After the introduction of the Patient Protection and the Affordable Care Act policies in 2010, the US health care system shifted focus to value. The new policies changed the health care system and roles of registered nurses. Value-based health care emphasized quality of care instead of quantity of care (Muhlestein et al., 2021). The practice of registered nurses changed fundamentally and they proactively participated in patient care, with more practical roles being created for nursing practitioners (Zanotto et al., 2021). The health care focus also changed from disease treatment to prevention, which requires significant involvement of nurses and their roles in health education.  

References 

Muhlestein, D., Bleser, W. K., Saunders, R. S., & McClellan, M. (2021). All‐payer spread of ACOs and value‐based payment models in 2021: the crossroads and future of value‐based care. Health Affairs. https://www.healthaffairs.org/do/10.1377/forefront.20210609.824799/full/ 

Zanotto, B. S., da Silva Etges, A. P. B., Marcolino, M. A. Z., & Polanczyk, C. A. (2021). Value-based healthcare initiatives in practice: a systematic review. Journal of Healthcare Management, 66(5), 340. doi: 10.1097/JHM-D-20-00283 

Traditionally, U.S. healthcare was paid per service. This system has encouraged excessive testing and treatments, resulting in unnecessary spending (Aroh, et al., 2015). Value-based purchasing should encourage efficiency and caps spending (Aroh, et al., 2015). To define value, CMS has outlined specific standards that must be met by healthcare facilities. Hospitals that can perform at a high level will be better reimbursed than those who do not. Advanced registered nurses need to understand the concepts of value-based purchasing, reimbursement, and functions of the healthcare systems to fully meet their potential to affect value-based care (DeNisco, 2021). Advanced registered nurses are in a position to support their hospitals in creating evidence-based protocols that can greatly increase efficiency as well as improve outcomes (DeNisco, 2021).  Aroh, et al., explain the difficulties their hospital team overcame with collaboration to change practices to align with value-based care (2015). Advanced registered nurses were central to their care model by working in collaboration with the healthcare team to provide quality care with decreased costs and wastes (Aroh, et al., 2015).  Aroh’s team utilized evidence-based practices to ensure that they were providing the best possible care, highlighting the increasing importance of nurses’ understanding of research and evidence utilization (Aroh, et al., 2015). 

Aroh, D., Colella, J., Douglas, C., &Eddings, A. (2015). An example of translating value-based purchasing into value-based care. Urologic Nursing, 35(2), 61–74. https://doi-org.lopes.idm.oclc.org/10.7257/1053-816X.2015.35.2.61 

https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103795581&site=ehost-live&scope=site 

DeNisco, S. (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. 

Response 

Hello Corina! This is an outstanding post about the evolution of US health care system. Your focus on value-based health care is compelling. Following the introduction of the value-based care, patients no longer stay in hospitals more periods to under numerous unnecessary tests. One of the primary achievements of value-based care is enabling nurses to help patients stay healthy, which is the major priority of nursing practice. Value-based care model advocates for health maintenance and disease prevention, which eventually reduces the incidences of serious diseases and hospital readmissions (Teisberg et al., 2020). Value-based health care programs are also critical because they help in advancing payment of providers based on the quality and not the quantity of care they provide. Instead of letting patients undergo various costly procedures and tests that may be unwarranted, value-based care model gauge clinicians against established best practices in different health scenarios (Zipfel et al., 2019). These initiatives minimize cost of care and enhance care quality. Value-based model also focus on care coordination and providers are rewarded for working with other providers from different specializations to provide sophisticated care to patients.  

References 

Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based health care: a strategic framework. Academic Medicine, 95(5), 682. Doi: 10.1097/ACM.0000000000003122 

Zipfel, N., van der Nat, P. B., Rensing, B. J., Daeter, E. J., Westert, G. P., & Groenewoud, A. S. (2019). The implementation of change model adds value to value-based healthcare: a qualitative study. BMC health services research, 19(1), 1-12. https://doi.org/10.1186/s12913-019-4498-y 

The U.S. health care system has evolved throughout this last century and arguably not for the better. Shi and Singh (2021) define the U.S. health care system as an imperfect fragmented process which doesn’t fully meet the requirements to properly be called a system. In the 1990s, the U.S. health care system was dictated by the transaction between the provider and the patient which allowed the concept of supply and demand to determine cost and resource availability (Shi & Singh, 2021). Unfortunately, the determination of cost and accessibility of health care is determined by private insurance companies making the process complex and confusing for both provider and patient.

There are global trends which affect the U.S. which are negatively impacting the health care system (e.g., increase in cost, chronic illness, aging population, and infectious diseases) leading to a greater number of citizens seeking health care resources (Walsh et al., 2020). There has been a considerable push for health care reform to encourage affordable premiums and higher quality of care (Shi & Singh, 2021). This shift also encourages value-based care which affects nursing by providing opportunities for nurse executives and advanced practice registered nurses (APRN) to build on competencies (i.e., communication, knowledge, leadership, professionalism, and business skills) as well as ethical critical thinking in order to provide higher valued patient care (Walsh et al, 2020). 

Resources 

Shi, L. & Singh, D. A. (2021). An overview of U.S. healthcare delivery. In DeNisco, S. M. (Ed.), Advanced practice nursing: Essential knowledge for the profession (4th ed.). (pp. 177-210). Jones & Bartlett Learning. ISBN-13: 9781284176124 

Walsh, A. P., Harrington, D., & Hines, P. (2020). Are hospital managers ready for value-based healthcare? A review of the management competence literature. International Journal of Organizational Analysis. 28(1), 49-65. https://www.doi.org./10.1108/IJOA-01-2019-1639 

Response 

Hello Samantha! Your discussion post about the evolution of US health care system is interesting and compelling. Indeed, the US health care system has evolved throughout the last century and it has not achieved perfection. As such, the evolution is still expected. Historically, the reimbursement of US health care professionals is based on a fee-for-service model. However, after the passage of the Patient Protection and the Affordable Care Act policies in 2010, the payment system has significantly evolved. This legislation has integrated various programs advancing value-based care after acknowledging that the traditional fee-for-service model is ineffective because it required providers to be paid anytime they provide a service (Zanotto et al., 2021). There are various types of value-based payment models including Capitation, Pay-for-Performance, Accountable Care Organizations, Bundled Payment, and Patient-Centered Medical Homes. The objective of these health care reforms towards value-based care is to enable providers to provide quality health care services at affordable costs (Muhlestein et al., 2021).  

References 

Muhlestein, D., Bleser, W. K., Saunders, R. S., & McClellan, M. (2021). All‐payer spread of ACOs and value‐based payment models in 2021: the crossroads and future of value‐based care. Health Affairs. https://www.healthaffairs.org/do/10.1377/forefront.20210609.824799/full/ 

Zanotto, B. S., da Silva Etges, A. P. B., Marcolino, M. A. Z., & Polanczyk, C. A. (2021). Value-based healthcare initiatives in practice: a systematic review. Journal of Healthcare Management, 66(5), 340. doi: 10.1097/JHM-D-20-00283 

The U.S. healthcare delivery system lacks a rational and integrated network of components designed to function coherently together. On the contrary, it is a diverse array of finance, insurance, distribution, and payment processes that need to be more coordinated. Each of these fundamental functional components embodies a combination of public (government) and private sources. The market-oriented economy of the United States entices a diverse range of private enterprises that seek to generate profits by facilitating the essential activities of healthcare delivery. Employers get health insurance for their employees from private entities, and employees avail of healthcare services provided by the private sector. The government funds public insurance for a substantial proportion of the nation’s low-income, elderly, disabled, and pediatric populations through Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). However, private businesses like health maintenance organizations (HMOs) facilitate insurance arrangements for many people with public insurance, and private physicians and hospitals offer healthcare services (DeNisco, 2024).  This has an impact on how the insurance company decides to reimburse providers for particular services.  However, if a patient is using government funds such as Medicare or Medicaid, there are certain items, such as DME, that are only covered once every 5–7 years.  Knowing what is covered helps providers properly care for their patients and assist them in obtaining resources to help.  For example, when I worked in home care, patients on Medicare or Medicaid could only obtain a walker or cane every 7 years.  This meant that if they were prescribed a walker on discharge from the hospital and recently obtained a cane, they would have to pay out of pocket or get one from another source.

DeNisco, S. M. (Ed.). (2024). Advanced practice nursing: Essential knowledge for the profession (5th ed.) Jones & Bartlett Learning. ISBN-13: 9781284264661

The United States health system has undergone different changes influenced by evolution. This is a form of remodeling from a tertiary to primary care system, and an example relates to the shift to a value-based health system. This shift has impacted the delivery, roles, and responsibilities of advanced registered nurses. This is based on some of the roles and responsibilities that the leaders conduct. Value-based Healthcare system model has eradicated fees for services within the health service that require payment for services provided to the patients and meeting of outcomes (Francavilla, 2019). Advanced registered nurses have been regularly influenced to provide sufficient care through working on responsibility and offering quality care while associating with the value-based health system. The impact has been evident due to the increased need for education and appropriate health management to support promotion.

Different trends in the healthcare delivery system will affect nursing practice and how advanced the registered nurses take part in addressing and influencing the direction of health. Examples of trends are the development of policies that impact the nursing practice and influence measures that advanced registered nurses influence the direction of health. It can be related to introducing policies supporting activities such as advocacy and providing quality care. The policies influence how registered nurses may support by providing direction in practice to meet the needs and make effective decisions. Direction on health care may be influenced when addressing specific patient issues. In this case, it is vital to introduce new changes related to healthcare delivery. Contributions within the practice can be achieved by handling the issues of patients directly, while the registered nurses have to understand the direction followed through the provision of services (Stalter & Mota, 2018). Another major trend in current healthcare delivery is information technology, which emphasizes benefiting members through providing care.

References

Francavilla, C. (2019). Understanding the Impact of Care Delivery Models in Value-Based Payment. MEDSURG Nursing, 28(5), 331-338.

Stalter, A., and Mota, A., (2018). Using systems thinking to envision quality and safety in healthcare. Nursing Managemen

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