Essay on Nursing

Published: 2022/01/11
Number of words: 1228

Evolving nurse practice and patient care delivery models

Medical care in the U.S. has been plagued with adverse high costs, a fragmented delivery system and provisions of poor quality services. In response to this, there has been the development of key concepts integrated with health care delivery. They include Accountable Care Organizations (ACOs), medical homes and managed health clinic, further reviewed and discussed in detail later in the assignment (Benner, 2010).

Patient Protection and Affordable Care (PPACA) contains provisions that intertwine with quality and cost of care. It is a response to demonstrate that only focusing on reducing care costs is not enough. Rather raises the question on how investments contribute toward raising health care standards for individuals and all citizens (Benner, 2010).

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With the current system extremely fragmented without any entity solely taking responsibility to oversee quality and coordination within patient care, has resulted in the creation of incentives that integrate with the care delivery modes. In health care, you get what you have paid for; however, this fee for service system directs resources largely towards tests, procedures and acute care. In addition, the law seeks to reorganize the systems resource allocation by rewarding value over volume of care (American Association of Colleges of Nursing, 2010).

Making comparisons with other developed countries, the U.S health care system is among the costliest in the world yet curbed with poor quality measures. Medical homes are increasingly becoming popular with continuous emphasis regarding the potential to lower cost and improve health care outcomes. These medical homes are at heart with ACOs in order to establish teamwork amongst doctors and hospitals toward healthcare delivery systems (Benner, 2010).

Accountable Care organizations and its contribution in-patient care

ACOs are collaborations among healthcare clinics, hospitals, specialists and nurse practitioners, in addition to other health professionals. All the above entities accept joint responsibility for reforms, quality and cost of care given to their patients. Interestingly when ACOs attain certain targets in quality and targets, entitled members receive a fair share of financial bonuses (Mahaffey, 2002).

The ACOs is a product of Medicare, shared savings allocated between the ACOs and Medicare institutions. ACO is a group of health care service providers and suppliers, who promote accountability, Coordinate of services, encourage investments in infrastructure and finally, redesign the health care process to suite patient populations through enhancing quality and efficiency in service delivery. In addition, if ACOs meet quality performance standards they qualify to receive payments for their shared savings as established by the HHS Secretary (Benner, 2010).

Through how ACOs organize themselves in terms of leadership, provide leeway by permitting nurse leadership and participation. The law defines ACO professionals as physicians or Nurse practitioners. However, the ‘and’ is arguably vague but necessary by the HHs secretary. Private projects are under way to expand ACOs beyond Medicare. Pilot projects begun at the Engelberg center for healthcare Reform and Dartmouth institute for health Policy and Clinical practice. The two leaders advocate for Physician centered ACOs. These projects models tested under different settings and different levels of integrations among healthcare entities and private payers. Amajor hurdle they may encounter is figuring out how to coordinate quality targets and cost sharing among private insurers implicated (Mahaffey 2002).

Medical patient centered homes

The medical home concept can be understood as a mechanism to give patients central primary care and coordination across patient care settings and providers. It is promoted via financial incentives or capitated payment incentives aimed at encouraging preventive and chronic care management while reducing reliance on specialist care.HHS is authorized by PPACA to give grants and contract directly with state designated entities in order to establish inter-professional teams to support the primary care practices such as gynecology or obstetrics. The mentioned teams must also agree to provide their services to individuals with chronic illnesses. The inter-professional providers comprising a health team includes nurses, social workers, specialists, nutritionists, substance use and prevention providers, doctors, dieticians, behavioral and mental care providers, lastly, alternately medical practitioners (Benner 2010).

Health homes organized similar to ACOs because they need meet statutory requirements. These requirements place emphasizes on care and services solely within the scope of nursing practice. Nurses then acknowledged as indispensable members of the health team. The health team among other obligations must support patient centered health homes. Defined as a mode of health care, which comprises of personal physicians and whole persons orientations.Entailed to expanded access to coordinate and integrate safe and high quality care. Hence, made possible to achieve through evidence informed medicine and continuous improvements in quality. Payments award through recognition of additional value and components in patient centered care (American Association of Colleges of Nursing 2010).

Health teams collaborate with local care, state and community based resources to coordinate prevention and management of chronic diseases. Careful transitions among health provider settings and case management of patients conducted. Within such collaborations, the healthcare teams develop and implement inter-professional health care plans that integrate with the community through clinical prevention and promotion services. Such planning portrays the basic element of skilled nursing. Through an authoritative voice and experience, nurses can guide such implementation and development (American Association of Colleges of Nursing, 2010).

Health teams must facilitate primary healthcare services that coordinate preventive and promotional services. They include; Access to an appropriate specialist, in patient services, cost effective, quality drove and culturally acceptable patient centered health care. In addition, they provide reconciliation and medication management services. These activities then rewarded financially or via incentives with the aim to encourage and facilitate healthcare delivery elements. These elements viewed as improved outcomes from reduced costs (Mahaffey, 2002).

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Nurse managed clinics

PPACA established a grant program to fund these clinics. The purpose essential was to provide primary and wellness health care services in order to the unwanted or rather vulnerable populations. Nurse managed Health clinics are crucial nurse practice arrangements led by advanced nurses in the medical fraternity. They must associate with college, university, school or department of nursing. The law authorized the appropriation of fifty million dollars from 2011 through to 2014, as deemed necessary for each fiscal year (Mahaffey 2002).

Nurse practitioners have the skills and ability to reframe primary care delivery. Wellness education, primary health care and the management of chronic diseases are building blocks to remold a care system that seeks to attain reduced costs while giving optimal patient outcomes. Studies have suggested that health care delivery via nurses is cost effective and friendly.In anticipation, data acquired from the requirements of HHs will demonstrate that, by allowing nurses to practice fully within their professional scopes, results of improved outcomes possible to achieve. Care settings encourage continued efforts to build quality and cost imperatives while doing away with the remaining barriers limiting effective primary healthcare practices from nursing practitioners. Therefore, barriers to expansion and relocation of healthcare resources involving the workforce have been met with new demands to be removed under the PPACA goals.


American Association of Colleges of Nursing. (2010). Doctor of Nursing Practice. Retrieved from

Benner, P. (2010). Educating Nurses: A Call for Radical Transformation. San Francisco, Jossey Bass

Mahaffey, E. (2002). The relevance of associate degree nursing education: past, present, and future. Online Journal in Nursing 7(2). Retrieved from

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