NURS 8100 Discussion: Health Care Reform SOLUTION

• Analyze at least one important feature of the U.S. health care system that is of particular interest to you. Explain why you think this feature is significant in terms of health policy and reform.
• Describe one or more conditions or challenges specifically related to the passing of the PPACA. Explain how this exemplifies the nature of the policy-making process, and evaluate how it could relate to the question of why health reform in the United States has been so difficult.

Read a selection of your colleagues’ postings.

Sample Answer for NURS 8100 Discussion: Health Care Reform SOLUTION

One important feature of the U.S. health care system that is of interest of the writer is the PPACA Subtitle F – Medicaid Prescription Drug Coverage.  This feature is significant in terms of health policy and reform so more patients have affordable drugs for treatment.  “The Secretary shall calculate the Federal upper reimbursement limit established under paragraph (4) as no less than 175 percent of the weighted average (determined on the basis of utilization) of the most recently reported monthly average manufacturer prices for pharmaceutically and therapeutically equivalent multiple source drug products that are available for purchase by retail community pharmacies on a nationwide basis. The Secretary shall implement a smoothing process for average manufacturer prices. Such process shall be similar to the smoothing process used in determining the average sales price of a drug or biological under section 1847A’’(“Understanding the Affordable Care Act: About the Law,” n.d.).  This is important to the writer because patients on fixed incomes should not have to worry about how they will pay for there life sustaining medications.

In March 2010, the Patient Protection and Affordable Care Act was signed and initiated.  Reflecting on the evolution of health care in the United States and the overall response to the health care reform efforts was interesting.  The principle feature of the U.S. health care system helped the enactment of federal health reform.  There were some challenges along the way in this country.  “Health policy is an important area for study

, and it’s really relevant to the day-to-day operations of health care organizations because it is what shapes, sort of, the rules of the game”(Kominski & Zelman, 2011).  When thinking about how policy is developed and rolled out it isn’t always made at an organizational level, there is usually more people involved.  Often times these policies are made at a political level.  The overall influence on policy is by setting at a national, state, and local level.  Additionally, “It’s hard to change any policy in the United States [not to mention healthcare policy].  The president has some powers, Congress has some, judiciary has some, and then we have state and local government. And they’re also divided up in the same kinds of ways” (Kominski & Zelman, 2011).  When discussing the United States Senate it takes a certain amount of votes to move anything to Congress so that Congress can pass it, then the President has to also agree to it and the court does as well.  So overall it’s pretty complicated process.  Overall our system is doesn’t seem to like change much because it seems very challenging to implement change.  I also think it’s challenging because health care is such a personal topic for so many people.  So many people have so many different opinions.

References:

Kominski, G., & Zelman, W. (2011). Healthcare policy and advocacy: The policy process. Walden University, LLC.

Understanding the Affordable Care Act: About the law. (n.d.). HealthCare.Gov. http://www.hhs.gov/healthcare/rights/law/index.html

Sample Answer 2 for NURS 8100 Discussion: Health Care Reform SOLUTION

The Affordable Care Act (ACA) was signed into law over 10 years ago and it has remained highly controversial by many law makers since its inception on March 23, 2010. Many law makers have tried to get rid of the ACA but have yet to find a health care system to replace the ACA that works with law makers and the public. Even though people may not like the ACA it has improved the health care system, provided health insurance to the uninsured, provided more prevention program to help improve the overall health of the American people. There was so much resistance to passing the ACA since the President at that time was African American and a Democratic (Silberman, 2020). The Patient Protection and Affordable Care Act (ACA) was passed by a Democratic Congress and signed into law by a Democratic president in 2010. Republican congresspeople, governors, and Republican candidates have consistently opposed the ACA and have vowed to repeal it during every election, but more than 50% of Americans support ACA. In the first year of ACA 10 million Americans gained accessed to health insurance. The ACA also eliminated the no coverage for prior conditions, it also decreased prescription drug cost and eliminated co-pay for preventive services. When people are asked why they oppose the ACA they mention they do not like the government involved in their healthcare, but they pay into Medicare which is a mandatory federal government insurance. Despite positive changes the ACA has brought to many Americans many politicians and people oppose ACA and want to get rid of ACA(Silberman,2020). While ACA has made great strides in improving health care, health disparity remains a major problem among people of color. The recent pandemic has shown the world once again that the health care system is even though Black Americans make up 13 percent of the US population over 23 percent of COVID deaths were Black Americans (USA, 2021).

 In spite of significant advances in the diagnosis and treatment of most chronic diseases, there is evidence that racial and ethnic minorities tend to receive lower quality of care than non-minorities and that, patients of minority ethnicity experience greater morbidity and mortality from various chronic diseases than non-minorities. The Institute of Medicine (IOM) report from 2006 showed unequal treatment “racial and ethnic disparities in healthcare exist and, because that lead to worse outcomes in many cases. Minorities were provided less access to health care intervention, sources, and funding (Egede, 2006).

References

Egede, L. (2006). Race, Ethnicity, Culture, and Disparities in Health care

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924616/

 Silberman, P. (2020). The Affordable Care Act: Against the Odds, It’s Working. North Carolina Medical Journal, 81(6), 364–369. https://doi-org.ezp.waldenulibrary.org/10.18043/ncm.81.6.364 

USA FACTS. (2021).US COVID-19 cases and deaths by state

https://usafacts.org/visualizations/coronavirus-covid-19-spread-map/

Sample Answer 3 for NURS 8100 Discussion: Health Care Reform SOLUTION

Significant transformations in healthcare have been witnessed in the US over the past one decade. The transformations mainly target at improving the health and wellbeing of the America citizens irrespective of their backgrounds. The reforms aim to achieve this by increasing the populations covered by different health insurance schemes, which will improve access and utilization of healthcare services by the diverse populations (Jones, 2017). Despite these benefits, significant challenges surround the transformations. For instance, concerns have been raised on whether the reforms will be of importance in the long-term. Therefore, this paper expounds on these issues based on the interview I conducted with the director of health in our state.

Summary and Analysis of the Interview

The interview was conducted on 5 January 2020 at the director’s office. In my view, the interview was a success since the director explored a wide range of issues on healthcare reforms. The director was keen on ensuring that all the questions asked were tactfully addressed. The main areas of focus in the interview included achievements of healthcare reforms, opportunities for healthcare institutions, challenges with the reforms and ways of addressing them. According to the director, significant successes have been reported with the adoption of healthcare reforms in the US. The success can be seen in the percentage of American citizens who have access to their needed care in the modern world. As reported by her, the healthcare reforms have not only increased healthcare access for the ethnic minorities but also individuals from non-minority communities that are unemployed. The consequences of these improvements are a significant rise in the utilization of healthcare services and healthier populations.

The director also reported that the adoption of healthcare reforms has led to a significant improvement in the quality of care offered to the American citizens. Accordingly, it has shifted the payment system for healthcare services where hospitals that meet the goals of value-based purchasing system receive higher numeration than those that does not. There has also a significant improvement in the protection of data of the patients since institutions have to abide by regulations guiding its use. Health organizations have also embraced new technologies that have enhanced the safety, efficiency, and quality of care (Thompson, 2015). Therefore, she was optimistic that the achievements reported with the adoption of healthcare reforms are expected to transform the healthcare system of the US in the future.

Moreover, the director was keen to note that there exist opportunities that can be explored to enhance the efficiency of the healthcare reforms. She expressed the increased need for healthcare stakeholders to focus on upholding the principle of doing no harm to others. In this case, she expressed that while most people have criticized the use of single-payer system to be unsustainable; it should not be disbanded but be fixed. The imperfections in the Affordable Care Act need to be fixed with the aim of increasing insurance coverage to the Americans who are not insured. The director gave four ways in which this can be achieved. Firstly, the legislators should consider expanding the eligibility for tax credit offsets. This will raise the number of poor individuals who can afford the premiums. Secondly, there is a need for the states to provide citizens with enhanced tax credit offsets. This will specifically benefit the young adults with low income (Shaw, 2017). Lastly, the Medicaid eligibility should be expanded to a level that ensures that a majority of the poor can afford the cost of premiums in the state insurance cover. Through these interventions, the goals of healthcare reforms can be achieved.

The director expressed concerns that despite the success in healthcare reforms, the implementation process has experienced significant challenges. Firstly, there has been considerable resistance from healthcare institutions in the implementation of some provisions. Successful implementation of the healthcare reforms demands the restructuring of most processes of health care organizations. The restructuring require the use of financial resources to acquire new technologies and train staffs on its use (Shaw, 2017). As a result, the adoption process must consider the needs and concerns of healthcare institutions, hence, the challenge.

In addition, the director also expressed that the implementation process could be affected adversely by the rising costs of healthcare in the US. According to evidence, the cost of healthcare in the US is higher than any other developed state in Europe and the rest of the world. The high cost is expected to rise further with the adoption of the reforms. The rise is attributed to a decline in the population covered by the employers in the state (Jones, 2017). The consequence of such change will be an increase in consumer spending on healthcare, hence, the rise in healthcare cost and unaffordability of care to a majority of the citizens.

The last part of the interview was on the ways in which the above challenges can be addressed. According to the director, there is a need for the expansion of federal coverage to solve the cost-related issues affecting the reforms. The coverage should be nationwide with states having complete responsibility for the vulnerable in the society. The second recommendation is retaining the Medicaid expansion for individuals with income level below 138% of the poverty levels to increase affordability and coverage (Thompson, 2015). Lastly, coverage should be comprehensive to cover all the healthcare needs of the diverse populations.

Conclusion

In summary, the interview revealed that the adoption of healthcare reforms in the US have achieved significant milestones in promoting the health of the American citizens. There has been an increase in healthcare access, affordability, and utilization among the population. Despite these achievements, the adoption process has faced challenges related to financial implications it has on health care organizations. Therefore, it is important that a focus be placed on ensuring that the challenges are addressed to realize the full benefits of the reforms.

References

Jones, D. K. (2017). Exchange politics: Opposing Obamacare in battleground states. New York, NY: Oxford University Press.

Shaw, G. M. (2017). The dysfunctional politics of the Affordable Care Act.  Santa Barbara, CA: California Praeger.

Thompson, T. (2015). The Affordable Care Act. Farmington Hills, MI: Greenhaven Press.

Sample Answer 4 for NURS 8100 Discussion: Health Care Reform SOLUTION

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). 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).

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