Restructuring of the U.S. health care delivery system

Introduction

US healthcare has recently changed and is still experiencing a lot of changes. The current healthcare system is considered broken and does not provide service to the patients, and the citizens at large. The current system is often focusing on providing episodic care where patients are always treated for acute conditions and no follow-up, patient/provider relationship, and wellness and provision.  It is the role of the health practitioners to help drive the changes that are necessarily required and make medical care more quality in service and cost-effective with better satisfaction to patients, the citizens, and the providers. Therefore the proposed changes in the health sector include the concepts of continuity or continuum of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics. In elaboration, these systems work as illustrated below.

Continuity or continuum of care

This system of care has a wide range of services that integrate both services and mechanisms to track patients over time through an inclusive collection that includes home care, extended care, acute care, wellness programs, ambulatory care, and many others. It is a patient-oriented care system that has a wide span of an entire life. With this integrated high-quality health services, cost-effective care for all, but mainly for patients with chronic and complex conditions. There are four integrated systems that depend on nursing experts that support continuity of care. They include community-based services, disease management programs, health information systems, and case management services (Hughes, 2006).

Accountable care organizations (ACO)

Accountable Care Organizations (ACOs) is a health care delivery system that is composed of physicians, clinicians, hospitals, and non-clinicians that work as a team to manage care for patients across the entire array of care. The ACOs work with the goal of giving high-quality, patient-centered care at an affordable cost (National Alliance for Quality Care, 2013). With the proposed ACOs, there is a focus on the achievement of the Triple Aim’ with better healthcare, improving quality, and reducing costs across the care continuum. This will be achieved through the six dimensions of quality that include safety, efficiency, patient-centeredness, timeliness, effectiveness, and equity. Therefore, nurses have the greatest role in ensuring that this system work through their roles as communicators, care coordinators, providers of advanced levels of care, and quality improvement managers (National Alliance for Quality Care, 2013).

Medical Homes

Patient-centered medical homes (PCMHs) are models of health care where the patients have a direct connection with their health provider. The provider coordinates a team of health professionals, arranges for appropriate care, and takes collective responsibility for any service given to the patients (Hughes, 2006). Through this approach of coordinated, interprofessional, and interdisciplinary care, there is maintained and continuous care, and the team is accountable for the continuum of care. PCMH employs approaches such as teamwork, care coordination, self-management, collaboration with other providers, and health information technology. There are healthcare arrangements for the patients through short and long-term goals, all through stages of life. Again nurses are important in the coordination of this system, particularly during the change in care. In this type of care, the patients are at the center stage in the coordination of their health care with reachable primary care (National Alliance for Quality Care, 2013).

Nurse-Managed Health Clinics

Nurse-managed health clinics (NMHCs) are those clinics that are reachable and provide community-based primary care to patients irrespective of their ability to pay. (Hansen-Turton, Bailey, Torres, & Ritter, 2010). In these clinics, nurses offer the greater part of care to underserved populations and they control their own practice. There is a team of experienced nurses and other health care specialists in partnership with doctors in jurisdictions where required. (American Association of Colleges of Nursing, 2013). NMHCs also provide clinical appointments for continuing nursing students and graduate nursing students. This program, therefore, ensures that there is increased enrollment in nursing programs to eliminate shortages of nurses. It is an opportunity or nursing students to incorporate classroom knowledge with community-based care (Sutter-Barrett, Sutter-Dalrymple, & Dickman, 2015; Cheater, 2010).

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Feedback from nurse colleagues

After sharing my thoughts with my colleagues I realized that there were varied opinions related to the changes that were very imminent in health care. Below is a summary of the response received from each of the three colleagues I had shared with.  Even though these responses are grouped for particular individuals, they were more of a discussion where each had his or her opinion.

First Colleague

The colleague considered here first really had a positive opinion of the changes that are to be implemented in nursing. He approaches his reasoning from the nurses’ angle and sees this as a boost to them.  According to him, these proposals are amazing and should be implemented. He reasons that the arrangements will move the nurses to the forefront and promote the “respect” they deserve in the provision of health care because they will be the coordinators. The image of the nurses as the doctors’ assistants is likely to diminish because ACOs give them so much more responsibility than just mere assistants. There is a leadership responsibility that is given to the nurses and their voice as the critical decision-makers when it comes to home care is a boost to our profession. According to him, the best arrangement of all the systems is the Nurse-managed health clinics because the nurses are put under full control of their practice and provision of health care.

Even though the first colleague’s view is only skewed towards the nurses as the front runners to benefit from this program, his views are still in line with the research on health reforms discussed above. He quotes the control that will be given to nurses under the NMHCs program as ideal for nurses. Again ACOs system gives the nurses a provider coordination role for nurses as they arrange for appropriate care for patients and also gives them a collective responsibility for any health service arranged for the patients. Therefore, the first colleague’s reasoning is well consistent with the discussion on health reforms.

Second colleague

The second colleague takes a different approach from the first colleague even though she concurs with him in applauding the reforms as a good move. She thinks of the positives to be enjoyed by the patients and the public at large. She views this in the eyes of a patient and a common citizen in need of health service. She also sees this program to provide better services to the patients at a sustainable cost. Since the system is patient-centered, the relationship between the provider and the patient as mentioned above under ACOs is likely to ensure that the patients are given quality. Again since the patient’s medical care are to be tracked over a lifetime through an inclusive collection, the patients’ records are likely to help the nurses in providing the best services to the patients. The second colleague emphasizes the idea that the health care costs in the United States are some of the most expensive in the world has surpassed most developed countries in their total healthcare expenditure per capita. Therefore, the move for reforms brings with it affordable health care that is will also be of better quality. Her idea is that even though the current health care program is expensive, it does not provide the best to the patients, and changing to a patient-centered will improve both service and cost.  The second colleague considers the roles of the nurses to have little change that does not add water to the current roles and sees it as achievable.

I consider the reasoning of the second colleague more elaborate and geared toward the right direction. Her reasoning is well in order according to the objective of the proposed health reforms of providing patient-centered care, high-quality, and affordable healthcare as discussed above. However, her view of the reforms in the role of nurses is not considerate.

Third colleague

Among the colleagues discussed, the third colleague is a little reserved in terms of the reforms.  He sees this in the eyes of a nurse and considers two angles of both advantages and disadvantageous. He gives more weight to the disadvantages and considers the advantages negligible. According to him, the nurses are yet to experience the worst in terms of the workload that if not taken into consideration before implementation will lead to a failure of the reform. He considers the current ratio of staff and fears that the nurse hiring rate has stayed due to the increasing nurse-to-patient ratio. His fear is especially of the hospital nurses that are likely to reduce after deployment leading to deteriorating services due to fewer RNs. He predicts that hospitals will be compressed from two angles cost and quality care. On the other hand, the third colleague sees this as a good opportunity for the nurses to take responsibility and elevate their profession but only appeals for more employment to correct the alarming nurse-to-patient ratio.

I see the third colleague as a little more reasonable when it comes to the role of the nurses. He looks at the reforms in a critical way that must be considered in terms of workload. However, according to my research, I never considered workload an issue hence a little contrary to my research.