Health Care Delivery Models and Nursing Practice

Health Care Delivery Models and Nursing Practice
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Health Care Delivery Models and Nursing Practice
Introduction
The United States has made efforts to restructure health care delivery systems in a bid to reduce the cost of care and improve quality. While about a fifth of the U.S. budget is spent on health care, Americans are yet to experience the benefits of high-quality care services (Korenstein et al., 2016). The idea to improve the value of health care in the United States has emerged to formulate the needed reforms. Among the factors that have driven changes in health care include rising costs, access problems, fragmentation, disparities, and low patient outcomes (Salmond & Echevarria, 2017). The realization of poor return for excessive spending and lack of transparency has resulted in broad engagements to implement fundamental changes in the county's health care system to improve quality and lower costs. Value can be defined as the balance between expenditures and quality of care in terms of health outcomes and patient satisfaction (Korenstein et al., 2016). This paper examines the American Health Care Act (2017) introduced to restructure the U.S. health care delivery system, the actions taken for reform, and the role of nurses within this ever-changing health care environment.
Current Health Care Law to Reform Health Care Delivery System
The American Health Care Act (AHCA) was proposed in March 2017 in the House and enacted with changes in May 2017 (Kaiser Family Foundation, 2017). While AHCA is not technically a repeal of the Affordable Care Act (ACA), the law has sweeping reforms to the ACA. For instance, AHCA repeals employer and individual mandates change age-based rate banding to 5:1 from ACA's 3:1 and replace income-based with age-based subsidies in the market whose generosity tends to rise with age (Hirsch et al., 2017). AHCA also converts Medicaid funding to per-capita allotments and thus ending the current possibilities for states to expand Medicaid. From 2020 onwards, the law will offer new enrollees with similar per-capita allotment as eligible adults before 2014 (RAND Health Care, 2019). It is projected that major changes to the bill in May 2017 would permit states to implement waivers that would set age rating to over 5:1 and define their health benefits instead of applying the 10 sets as provided in the ACA. With this law, insurers would also be allowed to use health conditions to define premium prices to Americans allowing lapses in their coverage.
Quality Measures, Pay-for-Performance and Patient Outcomes
Quality measures and pay-for-performance in health care settings largely affect patient outcomes. In 2010, the Patient Protection and Affordable Care Act required that the U.S. Department of Health and Human Services (HHS) implement value-based purchasing (VBP) in the Medicare program to improve quality and patient outcomes. VBP is a set of strategies of performance-based payments linking monetary incentives to the performance of health care providers on set standards in a bid to attain value (Damberg et al., 2014). These strategies have been embraced by both private and public payers to improve quality and cut health care costs. Quality measures and pay...