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Jun 05, 2023
Discussion Question:
Discuss managed care,
the initiatives implemented by private insurers to transform healthcare, and
the various roles nurses play to improve quality patient outcomes tied to healthcare
reimbursement. What are some strategies nurses can use to advocate for
healthcare consumers and reduce the increasing cost of healthcare?

 

OVERVIEW:
Consumers of healthcare are expected to pay for goods and services
at the time of service (Nickitas et al., 2019). Today, mostly due to the
Affordable Care Act, private insurers are aimed more at managing populations
than underwriting risks (Nickitas et al., 2019). Nurses are in the
forefront and directly tied to patient outcomes that impact healthcare
reimbursement. This week’s module examines healthcare costs and financing and
how they impact healthcare providers and consumers. The history of how private
health insurance and managed care evolved will be discussed. The impact of
consumer-driven healthcare and the role nurses play in empowering healthcare
consumers will be a primary focus.
Nickitas, D. M., Middaugh, D. J., & Feeg, M. D.
(2019). Policy and
politics for nurses and other health professionals: Advocacy and action. (3rd
ed.). Sudbury, MA: Jones and Bartlett Publishers
GOALS:
Explain how private health
insurance and manage care involved into a large healthcare industry.
Analyze the cost of care across
hospitals, pharmaceuticals, and healthcare providers and how it is
impacted by the Affordable Care Act.
Describe the fundamental
processes of managed care accountability efforts.
Identify the key federal laws
that protect individuals who are enrolled in private insurance.
Articulate consumer-driven
healthcare and empowerment of the healthcare consumer.
Discuss the emerging nursing
practice changes in a market-driven healthcare system.
Learning Materials
Required Resources:
Nickitas, D. M., Middaugh, D. J.,
& Feeg, M. D. (2019). Policy and politics for nurses and other
health professionals: Advocacy and action. (3rd ed.). Jones and
Bartlett Publishers. Read chapters 9 & 10.
Additional Resources:
Bird, K., Reney, M., & Ross,
R. (2015). Funds flow in the
era of healthcare transformation. Healthcare Financial Management, 69(12), 42–47.
CMS.gov (2019). What’s the quality
payment program? (Explore the various links found on the Quality Payment Program
website to learn more about the new way healthcare providers are being
paid. Also, you will find resources on evidence-based measures that
encourage improvement in clinical practice and the utilization of advanced
technology that allows providers of care to easily exchange patient
information)
Mulder, J. (2017). The value of “smart
growth” in the era of value-driven care. Health Management Technology, 38(9),
6–7.
Wright, B., Potter, A. J., &
Nattinger, M. C. (2016). Iowa Wavering on
Medicaid: From Expansion to Modernization. Journal of Health Politics, Policy &
Law, 41(2), 287–300.

 

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