The Patient Protection and Affordable Care Act of 2010 (PPACA)

Posted: February 15th, 2023

Health Care Delivery Models And Nursing Practice.
DQ 2
The Patient Protection and Affordable Care Act of 2010 (PPACA) contains many provisions that seek to intertwine the quality of care with the cost of care. Nurses’ education, skills and professional scope make them indispensable contributors to the successful implementation of evolving patient–centred care delivery models. One of the innovative healthcare delivery models is Accountable Care Organizations (ACOs). It is a collaboration among primary care clinicians, a hospital, specialists and other health professionals who accept joint responsibility for the quality and cost of care provided to its patients (HPI, n.d.). It is a group of providers that promotes accountability patient population and coordinates items and services under Medicare and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery.

The largest benefit that accountable care could bring for the healthcare industry is to garner cost savings or reduce spending. Another major benefit of ACOs is their ability to improve population health management and patient outcomes. A brief from the Center for Health Care Strategies and the Urban Health Research and Practice at Northeastern University shows that new healthcare delivery models like ACOs offer innovative methods for payers and providers to achieve better population health outcomes. Medicaid ACOs, for instance, have shown a greater focus on preventing disease and promoting wellness, which leads to stronger population health improvements. This reduces the likelihood that a disease would progress and lead to more costly hospital stays. The community gains a wide number of advantages including, improved patient outcomes, the better quality of care, greater engagement with providers, and an overall reduction in out-of-pocket costs.

Describe one innovative health care delivery model that incorporates an interdisciplinary care delivery team. Explain how this model is advantageous to patient outcomes.

Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years.

Health Care Delivery Models And Nursing Practice
Introduction
The Patient Protection and Affordable Care Act (PPACA) of 2010 sought to link the quality of healthcare with its cost through various provisions. Nurses play an indispensable role in successfully implementing evolving patient-centered care models through their education, skills, and professional scope. One such innovative model is the Accountable Care Organization (ACO). ACOs promote accountability for a patient population’s quality and cost of care through collaboration between primary care clinicians, hospitals, specialists, and other health professionals (Healthcare Performance Improvement, n.d.). They encourage investment in infrastructure and redesigned care processes to deliver efficient, high-quality services.
Benefits of Accountable Care Organizations
The largest benefit ACOs can bring to healthcare is cost savings or reduced spending. By focusing on preventive care, chronic disease management, and care coordination, ACOs aim to improve health outcomes and lower the overall cost of care over time (Center for Health Care Strategies & Urban Health Research and Practice, n.d.). Another major ACO benefit is their ability to enhance population health management and patient outcomes. For example, Medicaid ACOs have shown greater emphasis on disease prevention and wellness promotion, reducing the likelihood conditions will progress to more costly hospital stays (Center for Health Care Strategies & Urban Health Research and Practice, n.d.). Communities also gain from improved patient outcomes, higher quality care, increased provider engagement, and lower out-of-pocket costs with ACO implementation.
Patient-Centered Medical Home Model
One innovative model incorporating an interdisciplinary care team is the patient-centered medical home (PCMH). The PCMH aims to replace episodic, reactive sick care with coordinated, comprehensive preventive care led by a primary care physician and care team (Agency for Healthcare Research and Quality, 2018). This team may include nurses, pharmacists, nutritionists, social workers, and others working together to address a patient’s overall health rather than single diseases (American Academy of Family Physicians, 2020). Care is coordinated across all elements of the broader health system, including specialty, hospital, home health and community services.
Advantages of the PCMH Model for Patient Outcomes
The PCMH model has demonstrated several advantages for patient outcomes. First, its team-based approach allows comprehensive management of all a patient’s health issues and preventive needs, reducing duplication and gaps in care (Agency for Healthcare Research and Quality, 2018). Second, care coordination in the PCMH helps ensure patients receive the right care at the right time in the right setting, improving adherence to treatment plans and chronic disease management (Agency for Healthcare Research and Quality, 2018). Third, enhanced access to providers through telehealth, secure messaging, and other technologies improves patient-provider communication and convenience (Agency for Healthcare Research and Quality, 2018). Overall, studies link the PCMH to better care quality, fewer hospitalizations and emergency visits, and lower healthcare costs (Agency for Healthcare Research and Quality, 2018).
Role of Nursing in Care Delivery Models
Nurses are well-positioned to contribute significantly to innovative care models through their education and skills. In ACOs and the PCMH model, nurses play vital roles in care coordination, patient education, and chronic disease management. As members of interdisciplinary teams, nurses conduct health assessments, treatment planning, and ensure care transitions between settings run smoothly (Bodenheimer & Laing, 2007). Advanced practice registered nurses (APRNs) can provide primary care, chronic illness management, and behavioral healthcare within these models as well (Bodenheimer & Laing, 2007; Naylor & Kurtzman, 2010). With their focus on health promotion and disease prevention, nurses also help these models achieve their goals of improving population health and outcomes. Telehealth further expands nurses’ ability to monitor and support patients remotely as part of coordinated care teams.
Conclusion
Innovative care delivery models like ACOs and the PCMH incorporate interdisciplinary teams to provide high-quality, cost-effective, and coordinated care. Nurses are indispensable contributors to these models through roles in care coordination, chronic disease management, health education, and telehealth. Their skills and focus on prevention, wellness, and patient-centered care align well with the goals of these emerging models. As healthcare continues evolving to link quality with cost, nurses will remain vital partners in successful implementation and outcomes of innovative delivery systems.
References
Agency for Healthcare Research and Quality. (2018, March). What is the patient-centered medical home? https://www.ahrq.gov/patients-consumers/patient-involvement/advocate/patient-centered/whatispcmh.html
American Academy of Family Physicians. (2020, February 24). Joint principles of the patient-centered medical home. https://www.aafp.org/about/policies/all/joint-principles.html
Bodenheimer, T., & Laing, B. Y. (2007). The teamlet model of primary care. Annals of Family Medicine, 5(5), 457–461. https://doi.org/10.1370/afm.731
Center for Health Care Strategies & Urban Health Research and Practice. (n.d.). Medicaid accountable care organizations: State profiles and program reports. https://www.chcs.org/resource/medicaid-accountable-care-organizations-state-profiles-program-reports/
Healthcare Performance Improvement. (n.d.). What is an accountable care organization (ACO)? https://www.hpiresults.com/aco
Naylor, M. D., & Kurtzman, E. T. (2010). The role of nurse practitioners in reinventing primary care. Health Affairs, 29(5), 893–899. https://doi.org/10.1377/hlthaff.2010.0440