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Understanding Health Policy Essay


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Understanding Health Policy Essay

I prefer the individual mandate in this discussion instead of accountable care organizations. As a patient, because I have Kaiser Permanente as health care insurance, which is the largest of the nation’s prepaid group, it is vertical integration. It provides all levels of care, from primary to tertiary care (Bodenheimer & Grumbach 2020, page 49). However, in an inpatient hospital setting, accountable care organizations may be the best setting for the organization to manage and coordinate care and save resources. Understanding Health Policy Essay

During my clinical rotation for FNP, I shadowed many primary care physicians’ clinics and the cooperation of their networks, such as individual mandate, where the physician is the primary care provider. Per Bodenheimer & Grumbach 2020, “Primary care involves common health problems and preventive measures” (page 48). Many patients make an appointment for their illnesses such as sore throats, diabetes, arthritis, depression, or hypertension (Bodenheimer & Grumbach 2020, page 48). The primary care providers practice in small- to medium-sized groups and are responsible for ambulatory care (Bodenheimer & Grumbach 2020, page 49). The primary care provider also has the authority to refer the patient to a specialist because the patients may not directly refer themselves to a specialist (Bodenheimer & Grumbach 2020, page 49). Primary care has some advantages as knowing the patients and taking a comprehensive physical assessment and continuing care to the patient, and will be able to monitor the progressive care of the patient’s condition or disease. Per Bodenheimer & Grumbach 2020, “Primary care provides better patient experiences, better patient outcomes, and lower costs, more likely to receive recommended preventive services, are more likely to adhere to treatment and are more satisfied with their care “(page 53). Understanding Health Policy Essay


On the other hand, the accountable care organization is defined, as per Bodenheimer & Grumbach 2020, page 69 “a provider-led organization whose mission is to manage the entire continuum of care and be responsible for the overall costs and quality of care and be accountable for the overall costs and quality of care for a defined population. ” Moreover, in the accountable care organizations, the goal is to create outpatient teams of nurses and social workers to assist clinicians in managing the care of patients with costly illnesses to avoid unnecessary hospitalizations, requiring more excellent clinical and data integration than occurs under the dispersed organization model (Bodenheimer & Grumbach 2020, page 71). Understanding Health Policy Essay Such as multispecialty group practice, community health centers, prepaid group practice, and health maintenance organizations, Patients are more satisfied with integrated HMOs such as Kaiser than with network-model HMOs (page 72). The integrated medical groups perform better than IPAs in delivering up-to-date preventive care such as mammograms and pap tests (page 72).

Describe one or more positive results that could be achieved Understanding Health Policy Essay

Each of these types of providers has its benefits and positive results. According to Bodenheimer & Grumbach, 2020 “patient satisfaction is higher when care is received in small offices rather than larger clinic structures” Page 72. Understanding Health Policy Essay

More unintended consequence(s) that organizations or individuals may experience.

For the integrated care to work, it has to have good primary care and refers to the delivery of comprehensive health care services that are well coordinated with good communication among providers; include informed and involved patients; and lead to high-quality, cost-effective care (Bodenheimer & Grumbach 2020, page 71).

Briefly evaluate issues on the topic that may be a consideration for the organization you work in and the nursing profession. Understanding Health Policy Essay

In the organization I work in, which is secondary care, such as long-term acute care and mental institute hospital, the topic issue I may be a consideration for the organization I work in and the nursing profession is the continuing care for the patients and saving resources staffing. For example, some days may have overstaffing, and on other days, there is not enough staffing to maintain the quality care for the patients. One time, at one of my organizations, three nurses called out, and I had to get reports for eleven acute care patients at the beginning of my shift. I was blessed because the nursing coordinator came to assist, three other nurses volunteered to help, and I had six patients instead of eleven patients. I provided quality care to my patients, and I was pleased due to the teamwork. I couldn’t take care of eleven acute ill patients in a timely matter. In the study in Solidarity and Cost Management article by Schindler et al. 2018 “The management system’s effectiveness was considered essential. Participants recognized a high probability of increasing costs, considered some coverage to be an investment, prevented further expenses later on, and took great care to avoid duplication.” Primary care is critical in providing quality care to veteran affairs (VA). Per Silva et al. 2016 “In the VA, primary care is the entry point to continuous and coordinated care in the VA.” Understanding Health Policy Essay

The two types of managing care that we are challenging in the United States are the individual mandate and accountable care organizations. Both have their benefits and disadvantages, but the goal is to provide quality care for the patient, save resources, and avoid duplicating care. Everyone is responsible for saving resources, including the patients, families, and healthcare providers. Understanding Health Policy EssayUnderstanding Health Policy Essay

A comprehensive assessment is crucial in managing the healthcare industry, which can save resources, reimbursement by the healthcare insurances, cost-effectiveness, and saving a life. Dr. Kathleen White discusses the challenge of accountable care with bundled payment to prevent care to direct care. Discharge a person from a primary consideration after receiving responsible care in the hospital (Walden University.,2011). Primary care must be combined with other organizations involved in bundled payment, increasing access and providing continuing care, and monitoring and measuring the quality of care (Walden University.,2011). The role of the registered nurse or DNP will be to coordinate the team of care measuring their outcomes (Walden University.,2011) . Understanding Health Policy Essay


Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach (8th ed.). McGraw-Hill.

Schindler, M., Danis, M., Goold, S. D., & Hurst, S. A. (2018). Solidarity and cost management: Swiss citizens’ reasons for priorities regarding health insurance coverage. Health Expectations, 21(5), 858–869. https://doi.org/10.1111/hex.12680

Silva, A., Tarlov, E., French, D. D., Zhiping Huo, Martinez, R. N., Stroupe, K. T., & Huo, Z. (2016). Veterans Affairs Health System Enrollment and Health Care Utilization After the Affordable Care Act: Initial Insights. Military Medicine, 181(5), 469–475. https://doi.org/10.7205/MILMED-D-15-00094

Walden University, LLC. (Executive Producer). (2011). Healthcare policy and advocacy: Reforming health care delivery: Accountable care organizations. Baltimore Understanding Health Policy Essay

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