NURS 8100 Discussion: Unintended Consequences of Health Care Reform

Walden University NURS 8100 Discussion: Unintended Consequences of Health Care Reform-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 8100 Discussion: Unintended Consequences of Health Care Reform assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 8100 Discussion: Unintended Consequences of Health Care Reform

Whether one passes or fails an academic assignment such as the Walden University NURS 8100 Discussion: Unintended Consequences of Health Care Reform depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 8100 Discussion: Unintended Consequences of Health Care Reform

The introduction for the Walden University NURS 8100 Discussion: Unintended Consequences of Health Care Reform is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 8100 Discussion: Unintended Consequences of Health Care Reform

After the introduction, move into the main part of the NURS 8100 Discussion: Unintended Consequences of Health Care Reform assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 8100 Discussion: Unintended Consequences of Health Care Reform

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 8100 Discussion: Unintended Consequences of Health Care Reform

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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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.

Sample Answer for NURS 8100 Discussion: Unintended Consequences of Health Care Reform

Accountable Care Organizations (ACOs)

Today’s rapidly evolving health care landscape requires hospital systems and providers to make significant efforts to adopt a culture of quality improvement and accountability. An Accountable Care Organization (ACA) consists of a voluntary group of providers responsible for the quality and cost of care for a defined group of patients throughout the continuum (Moore & Coddington, 2010). In 2012, Medicare introduced the Accountable Care Organization Program after the passage of the 2010 Patient Protention and Affordable Care Act (ACA) (Gold, 2015). The central concept of an ACO is shifting to a new payment model that supports value-based care. In addition, an ACO urges health systems and providers towards an integrated care model with shared financial risks ( Boddenheimer & Grumbach, 2020).

Benefits of Accountable Care Organizations (ACOs)

Under this reimbursement model, hospital organizations, physicians, and other care providers receive incentives for eliminating barriers to care coordination and managing costs (Boddenheimer & Grumbach, 2020). Additionally, they qualify to share in any savings generated from meeting quality and performance goals, including cost containment (Boddenheimer & Grumbach, 2020). Another benefit is that an ACO may elect to retain the majority of the shared savings when the actual cost of care is less than the projected budget. In contrast, they must refund Medicare should the actual care costs exceed the financial benchmarks (Boddenheimer & Grumbach, 2020).

NURS 8100 Discussion Unintended Consequences of Health Care Reform

A Disadvantage of Accountable Care Organizations (ACOs)

Although the concept of ACOs stems from integrating value-based care to address numerous silos in the healthcare delivery system, one disadvantage is the potential for restricting necessary care due to the economic implications imposed on health care systems and providers under an ACO ( Boddenheimer & Grumbach, 2020).

Challenges in Implementing Accountable Care Organizations (ACOs)

A critical component of implementing the ACO framework is obtaining provider buy-in to work together in creating meaningful change in care delivery (McClellan et al., 2010). Additionally, it is essential to establish the required number of eligible patients to sustain an ACO model (McClellan et al., 2010). Another challenge is the organizational readiness for change in fully implementing an ACO (McClellan et al., 2010).

In my practice, which is part of an extensive academic health system, the success of adopting the ACO model is due to the shared goals of everyone to provide high-quality patient-centered care, especially from the leadership of the organization. The presence of primary physicians, specialists, nurses, health IT, and other resources facilitates care coordination and eliminates waste. In addition, the active participation of physician leaders in collaboration with nurse leaders and other disciplines underpin the collective efforts of everyone to provide quality care throughout the continuum.

References

Boddenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach

(8th ed.). McGraw-Hill.

Gold, J. (2015). Affordable Care Organizations: explained. Kaiser Health News.

http://kaiserhealthnews.org/news/aco-accountable-care-organization-faq/.

McClellan, M., McKethan, A.N., Lewis, J.L. & Fisher, E.S. (2010).A national strategy to put

accountable care into practice. Health Affairs, 29(5), 982-990.

Moore, K.D. & Coddington, D.C. (2010). Accountable care: The Journey begins. Health Care

Financial Management. 64(8), 57-63.

Sample Answer 2 for NURS 8100 Discussion: Unintended Consequences of Health Care Reform

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. The healthcare payment process is undergoing a dramatic transformation as payers and providers shift from volume to value. While stakeholders are currently piloting many different value-based care models, accountable care organizations are among the most popular and successful strategies to date. Accountable care organizations, or ACOs, are groups of hospitals, physicians, and other providers who agree to coordinate care for patients and deliver the right care at the right time, while avoiding unnecessary utilization of services and medical errors. ACO participants also agree to take on responsibility for the total costs of care for their patients. ACOs that reduce the total costs of care for their patient populations can share in the savings with the payer. In certain models, they may also be liable to pay back losses if their costs exceed their spending benchmarks (Moore et al., 2017). Policymakers and healthcare leaders believe tying financial incentives to care quality, patient outcomes, and care coordination through ACOs is a key solution for fixing the inefficient fee-for-service system. The programs encourage providers to partner with others across the care continuum. Some providers are formally acquiring to gain control over a wide range of services, achieve economies of scale, and access the technology, data, and clinical capabilities of their peers. In fact, ACOs are and are likely to continue to be a major player in the value-based care and payment transformation. When all the parts work together, providers in an ACO can bring down costs and improve care quality while earning incentive payments. HMOs, on the other hand, seek to cut costs by setting fixed prices for services, which may encourage providers to reduce utilization or skimp on care in an effort to stay under the cap(Colla et al., 2018).

References

Colla, H., & Fisher, E. S. (2018). 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

Moore, K. D., & Coddington, D. C. (2017). Accountable care the journey begins. Healthcare Financial Management, 64(8), 57-63. Retrieved from https://www.proquest.com/trade-journals/accountable-care-journey-begins/docview/746684537/se-2?accountid=14872

Sample Answer 3 for NURS 8100 Discussion: Unintended Consequences of Health Care Reform

This is insightful Edwige, Bottom of FormAccountable Care Organizations (ACOs) are groups of doctors, hospitals, and other healthcare providers who come together to provide coordinated care to their patients (Colla & Fisher, 2018). The goal of ACOs is to improve the quality of care while also reducing costs. One way that ACOs achieve this goal is by sharing information about their patients (Meyer et al., 2017). This allows the providers in the ACO to work together to come up with a plan for each patient that meets their individual needs. ACOs can also use this information to track how well they are meeting quality and cost goals (Lewis et al., 2019). ACOs are funded in part by Medicare and Medicaid. However, they are also open to patients who have private insurance. ACOs have been shown to improve the quality of care while reducing costs. For example, a study published in Health Affairs found that ACOs were associated with improvements in quality of care and reductions in spending on Medicare patients.

References

Colla, H., & Fisher, E. S. (2018). 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., Schoenherr, K., Fraze, T., & Cunningham, A. (2019). Clinical coordination in accountable care organizations: A qualitative study. Health care management review, 44(2), 127. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461217/

Meyer, C. P., Krasnova, A., Sammon, J. D., Lipsitz, S. R., Weissman, J. S., Sun, M., & Trinh, Q. D. (2017). Accountable care organizations and the use of cancer screening. Preventive medicine, 101, 15-17. https://doi.org/10.1016/j.ypmed.2017.05.017

Sample Answer 4 for NURS 8100 Discussion: 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). 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

Sample Answer 5 for NURS 8100 Discussion: Unintended Consequences of Health Care Reform

This is insightful . Value-based care has developed from conventional fee-for-service-based care to high-quality, coordinated care since the PPACA was enacted into law (Kaufman et al., 2019). The creation of accountable care organizations (ACOs) significantly led to the improvement of quality of healthcare service delivered to different patients. There is a lot of excitement around accountable care organizations (ACOs) as a way to improve the quality and value of healthcare (Lewis et al., 2019). But while there are many potential benefits to ACOs, addressing the needs of high-cost, high-risk patients is critical to their success. One challenge for ACOs is that they are often rewarded for keeping patients healthy and out of the hospital (Resnick et al., 2018). But many high-cost, high-risk patients require expensive interventions and care coordination in order to stay healthy. Without focused attention on this population, ACOs may not be able to achieve the cost savings and quality improvements they are hoping for.

Question: what are some of the contribution of accountable care organizations (ACOs) in the management of ethical issues in the healthcare system?

References

Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2019). Impact of accountable care organizations on utilization, care, and outcomes: a systematic review. Medical Care Research and Review, 76(3), 255-290. https://doi.org/10.1177/1077558717745916

Lewis, V. A., Tierney, K. I., Fraze, T., & Murray, G. F. (2019). Care transformation strategies and approaches of accountable care organizations. Medical Care Research and Review, 76(3), 291-314. https://doi.org/10.1177/1077558717737841

Resnick, M. J., Graves, A. J., Buntin, M. B., Richards, M. R., & Penson, D. F. (2018). Surgeon participation in early accountable care organizations. Annals of Surgery, 267(3), 401-407. https://journals.lww.com/annalsofsurgery/Abstract/2018/03000/Surgeon_Participation_in_Early_Accountable_Care.1.aspx

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Important information for writing discussion questions and participation

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I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

Your response needs to be a minimum of 150 words (not including your list of references)
There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
Include in-text citations in your response
Do not include quotes—instead summarize and paraphrase the information
Follow APA-7th edition
Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

A minimum of 6 responses per week, on at least 3 days of the week.
Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
Each response needs to be at least 75 words in length (does not include your list of references)
Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
Follow APA 7th edition
Points will be deducted if the above is not followed
Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
Here are some helpful links
Student paper example
Citing Sources
The Writing Center is a great resource