Discussion: Health Care Reform NURS 8100
Discussion Health Care Reform NURS 8100
Discussion: Health Care Reform
After much public and political debate, in March 2010, the Patient Protection and
Affordable Care Act (PPACA) was signed into law by President Barack Obama. The
PPACA is one of many health care reform efforts that have sought to correct key
features of the U.S. health care system such as financing, service delivery, and care
coordination. This week, you will examine the passage of PPACA as a milestone along
the historical continuum of health care reform in the United States.
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).
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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).
Discussion: Health Care Reform NURS 8100 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
To prepare:
 Review this week’s Learning Resources and media presentation, reflecting on the evolution of
health care in the United States and the public’s response to health care reform efforts
historically and currently.
ï‚· Consider: What principal features of the U.S. health care system helped or hindered the
enactment of federal health reform in March 2010? What challenges were encountered?
ï‚· How do these conditions and/or challenges reflect characteristics of the policy process and the
political environment?
By Day 3
Post a cohesive response that addresses the following:
ï‚· 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.
ï‚· 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.
By Day 6
Respond to at least two of your colleagues in one or more of the following ways:
ï‚· Ask a probing question, substantiated with additional background information, evidence or
research.
 Share an insight from having read your colleagues’ postings, synthesizing the information to
provide new perspectives.
ï‚· Offer and support an alternative perspective using readings from the classroom or from your
own research in the Walden Library.
ï‚· Validate an idea with your own experience and additional research.
ï‚· Make a suggestion based on additional evidence drawn from readings or after synthesizing
multiple postings.
 Expand on your colleagues’ postings by providing additional insights or contrasting perspectives
based on readings and evidence.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question
posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting.
Note what you learned and/or any insights you gained as a result of the comments
made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning
Resources and any additional sources.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 1 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 1 Discussion
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Learning Resources
Required Readings
Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical
approach (7th ed.). New York, NY: McGraw-Hill Medical.
ï‚· Chapter 1, “Introduction: The Paradox of Excess and Deprivationâ€
This chapter introduces the concept of “excess and deprivationâ€â€”p eople receiving either too
little or too much health care, which contributes to the weakness of the health care system.
ï‚· Chapter 2, “Paying for Health Careâ€
This chapter discusses the evolution of health care financing, including out-of–pocket payments,
individual private insurance, employment-based insurance, and government-financed insurance.
ï‚· Chapter 3, “Access to Health Careâ€
This chapter focuses on financial and nonfinancial barriers to health care and concludes with
influences to one’s health status unrelated to health care.
ï‚· Chapter 4,“Paying Health Care Providersâ€
This chapter provides information on how physicians and hospitals are paid.
HealthCare.gov. (n.d.). Understanding the Affordable Care Act. Retrieved
from http://www.hhs.gov/healthcare/rights/index.html
Posted by U.S. Department of Health & Human Services, this article provides an
introduction to the Patient Protection and Affordable Care Act of 2010 (PPACA).
HealthCare.gov. (n.d.). Understanding the Affordable Care Act: About the
law. Retrieved from http://www.hhs.gov/healthcare/rights/law/index.html
Also posted by U.S. Department of Health & Human Services, this article focuses on
specific provisions of the law and outlines how it will increase access to affordable
health coverage.
In Week 1 of this course, you are required to subscribe to one of the health information
services listed below. In preparation, review these different sites:
Agency for Healthcare Research and Quality. (2010). AHRQ PSNet Patient Safety
Network. Retrieved from http://psnet.ahrq.gov/
ModernHealthcare.com. (n.d.). Registration is free: The news is invaluable. Retrieved
from https://home.modernhealthcare.com/clickshare/addAccountFree.do
Robert Wood Johnson Foundation. (2011). Publications and research. Retrieved from
http://www.rwjf.org/?topicid=1318
The Commonwealth Fund. (2010). The Commonwealth Fund. Retrieved from
http://www.commonwealthfund.org/
The Henry J. Kaiser Family Foundation. (2011). New & noteworthy. Retrieved from
http://www.kff.org/
Required Media
Laureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy:
The policy process. Baltimore: Author.
Note: The approximate length of this media piece is 11 minutes.
In this media presentation, Dr. Kominski and Dr. Zelman discuss the policy process and
provide an overview of the influence of policy on health care practices. Dr. Zelman also
discusses the challenges of passing new policy and relates this to health care reform
efforts.
Accessible player
Optional Resources
Hammer, D., Phillips, B., & Schmidt, T. L. (2010). The intended and unintended
consequences of health care reform. Healthcare Financial Management, 64(10), 50–55.
Rettenmaier, A. J., & Saving, T. R. (2011, January 5). Reforming Medicare: The
Affordable Care Act versus the Rivlin/Ryan proposal. National Center for Policy
Analysis. Retrieved from http://www.ncpathinktank.org/pub/ba736
Stephens, J. H., & Ledlow, G. R. (2010). Real health care reform: focus on primary care
access. Hospital Topics, 88(4), 98–106.
Your work on health care reform is insightful and interesting. Indeed, politics is playing an important role in the US health care reforms and PPACA has remained controversial issue due to political differences. The other challenge related to the passing of the PPACA is healthcare inequalities, which has disproportionately impacted the minority groups such as African Americans and marginalized groups (Yue et al., 2018). While the PPACA coverage increased the progress towards universal coverage, the persistent high cost of various coverage options implies limited access to affordable health care among many Americans, especially the minority and marginalized groups (Gaffney & McCormick, 2017). These disparities lead to the gaps in health insurance coverage, poor health outcomes among minority and marginalized groups, and unequal access to services (Dickman et al., 2017). The issue of healthcare inequalities and other challenges portray why health care reforms in the US have been difficult. They characterize systematic health care challenges that indicate that the US health care reforms are not comprehensive and fail to capture the health care needs of all Americans.
Discussion: Health Care Reform NURS 8100 References
Dickman, S. L., Himmelstein, D. U., & Woolhandler, S. (2017). Inequality and the health-care system in the USA. The Lancet, 389(10077), 1431-1441. https://doi.org/10.1016/S0140-6736(17)30398-7
Gaffney, A., & McCormick, D. (2017). The Affordable Care Act: implications for health-care equity. The Lancet, 389(10077), 1442-1452. https://doi.org/10.1016/S0140-6736(17)30786-9
Yue, D., Rasmussen, P. W., & Ponce, N. A. (2018). Racial/ethnic differential effects of Medicaid expansion on health care access. Health services research, 53(5), 3640-3656. https://doi.org/10.1111/1475-6773.12834
Important information for writing discussion questions and participation
Welcome to class
Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires alot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message†icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to
I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.
Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.
If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.
Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.
Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
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
