NURS8100: Week 2 Discussion

Week 2: The Health Care System, Part 2 

As addressed in Week 1, many different policies and reform efforts have influenced health care delivery over the past century. Consider for a moment the health care reform efforts during the 1960s and the implementation of Medicare 

and Medicaid. How did these reform initiatives become policy? What challenges do these programs face today? What problems did they solve, and what new problems have arisen? 

The Centers for Medicare & Medicaid Services (CMS) continue to have a strong influence on the health care system and health care policy through financial incentives and reimbursement policies. For example, to improve continuity of care, Medicare is offering financial incentives to health care providers that become accountable care organizations. 

This week, you will have an opportunity for an authentic experience as you bring a health care issue of concern to the attention of your state or national politician. You will also consider the unintended consequences that may arise as a result of reform policy, such as the individual mandate. 

Learning Objectives 

Students will: 

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Analyze key health care reform legislation to determine positive results and potential unintended consequences 

Assess reform-related issues for health care 

Learning Resources 

Required Readings 

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

Chapter 5, “How Health Care is Organized – I: Primary, Secondary, and Tertiary 

Care” 

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Chapter 6, “How Health Care is Organized – II: Health Delivery Systems” 

McClellan, M. (2010). Accountable care organizations in the era of health care reform.American Health & Drug Benefits, 3(4), 242-244. 

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The PPACA of 2010 encourages the formation of accountable care organizations (ACOS) to improve the quality and efficiency of health care delivery. An ACO is a group of health care providers who coordinate care for their Medicare patients and share the financial incentives of health care improvement gains. 

Moore, K. D., & Coddington, D. C. (2010). Accountable care: The journey begins. Health Care Financial Management, 64(8), 57–63. 

This article provides information on the importance of health care provider organizations taking steps to become 

accountable care organizations (ACOs) and provides examples of systems that have historically functioned in this capacity. The authors also provide steps for developing and transitioning to an ACO structure. 

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. 

This report discusses how nurses can and should play a fundamental role in meeting the challenges of increased demand for health care brought about by the implementation of the 2010 Affordable Care Act. In addition, it stresses the need for nurses to be partners with other health professionals and assume leadership roles in redesigning health care in the United States. 

Institute of Medicine. (2010). Report brief: The future of nursing: Leading change, advancing health. 

This report brief highlights the four key recommendations from the Robert Wood Johnson and Institute of Medicine The Future of Nursing: Leading Change, Advancing Health report. The recommendations focus on nursing practice, education and training, partnerships with other healthcare professionals, and workforce planning and policymaking. 

HealthCare.gov. (n.d.). Understanding the Affordable Care Act. Retrieved from http://www.hhs.gov/healthcare/rights/index.html 

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This website introduces the Affordable Care Act and presents the timeline for implementation of the various provisions of the Act. 

HealthCare.gov. (n.d.). Understanding the Affordable Care Act: About the law. Retrieved from http://www.hhs.gov/healthcare/rights/law/index.html 

Read the full Affordable Care Act law at this website. An overview of the law is also 

provided along with an outline of how the Affordable Care Act helps reduce health 

insurance costs. 

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Required Media 

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

Note: The approximate length of this media piece is 7 minutes. 

In this media presentation, Dr. Kathleen White explains the structure of accountable care 

organizations (ACO) and discusses the benefits and challenges of becoming an ACO. 

0:00 / 7:25 

Laureate Education, Inc. 

Accessible player 

–Downloads– 

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Optional Resources 

d 

APRN Joint Dialogue Group Report. (2008). Consensus model for APRN regulation: 

Licensure, accreditation, certification & education. Retrieved 

from https://www.aacnnursing.org/Education-Resources/APRN-Education/APRN- 

Consensus-Model 

Fisher, E. S., & Shortell, S. M. (2010). Accountable care organizations: Accountable for 

what, to whom, and how. JAMA: Journal of the American Medical Association, 304(15), 

1715-1716. 

Fisher, E. S., Staiger, D. O., Bynum, J. W., & Gottlieb, D. J. (2007). Creating accountable care organizations: The extended hospital medical staff. JHealth Affairs, 26, w44-w57. 

doi:10.1377/hlthaff.26.1.w44-57 

McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., & Fisher, E. S. (2010). A national 

strategy to put accountable care into practice. Health Affairs, 29(5), 982–990. 

Kaiser Health News. (2011). Accountable care organization proposed regulations: Resources. Kaiser Family Foundation. Retrieved 

from http://www.kaiserhealthnews.org/Stories/2011/March/31/ACO-Documents-In-The- News.aspx 

Discussion: Unintended Consequences of Health Care Reform 

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The PPACA of 2010 fostered new provisions for health care and the structure of health care delivery. The individual 

mandate to obtain insurance is one provocative provision. While this provision attempts to increase access to health 

care, it raises questions on how the existing system could sustain the potentially large influx of newly insured 

individuals. 

Another provision calls for new models of health care provider organizations to ensure delivery efficiency and continuity of care. In this week’s media presentation, Dr. Kathleen White discusses the accountable care organization, which 

comprises a group of providers coordinating care across a variety of institutional settings. Yet becoming an accountable care organization may present a number of challenges. 

This week’s Discussion builds on Week 1, continuing the examination of those societal and organizational contexts that influence health care reform. The unintended consequences of reform policy on the health care system are also 

considered. 

To prepare: 

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Review this week’s media presentation and the other Learning Resources focusing on how reform may lead to improved quality, greater access, and reduced cost of care. Also think about the unintended consequences that may arise as a result. 

Consider the information presented about the individual mandate and accountable care organizations. What are 

some questions or concerns you might have regarding the individual mandate? What are the pros and cons associated with becoming an accountable care organization? 

With posting instructions in mind, select either the individual mandate or accountable care organizations as the 

focus of your Discussion this week. 

By Day 3 

Post a cohesive response that addresses the following: 

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In the first line of your posting, identify the topic you have selected-either the individual mandate or accountable 

care organizations. With regard to this topic, describe one or more positive results that could be achieved, and 

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

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

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: 

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Ask a probing question, substantiated with additional background information, evidence or research. 

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Share an insight from having read your colleagues’ postings, synthesizing the information to provide new 

perspectives. 

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Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library. 

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Validate an idea with your own experience and additional research. 

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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 

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To access your rubric: 

Week 2 Discussion Rubric 

Post by Day 3 and Respond by Day 6 

To participate in this Discussion: 

Week 2 Discussion