Nursing practices are anticipated to develop and change with ongoing reforms and demands for healthcare facilities. These changes are most likely to result from drivers of change and regulations. As many Americans age, experience increased cases of chronic diseases, shortage of physicians, and other challenges in the healthcare system, the anticipated changes and growth will be transformational and disruptive. For instance, the concepts of care delivery models of continuity or continuum of care, accountable care organizations (ACOs), medical homes, and nurse-managed health clinics will play significant roles in the growth and changes in the practice of nursing (Haney, 2010). The Patient Protection and Affordable Care Act of 2010 (PPACA) has many provisions that aim to relate quality care against costs of care (Haney, 2010). It is vital for nurses to recognize that a single approach to reducing the cost of care may not be effective in the complex healthcare environment.
Continuity or continuum of care involves active cooperation between patients and their nurses in healthcare management with the aim of improving quality and ensuring cost-effective healthcare. Through continuity of care, nurses will have their patients’ confidence and act as patients’ advocates. Continuum of care gives nurses new opportunities to demonstrate their cost-effective models and abilities to coordinate patient care services through early identification of health issues and providing necessary interventions (Wilson, Whitaker, & Whitford, 2012). A nurse-led, team-based model can transform healthcare positively for both nurses and patients.
Through ACOs (collaboration among healthcare stakeholders to enhance quality and reduce costs), the law requires effective care delivery by depending on nursing services and care. ACOs are the new healthcare delivery models as ways to enhance the quality of care and reduce costs. The role of nurses, in general, is vital for the success of ACOs. ACOs are expected to fulfill various roles including the following. Any ACOs must be accountable for the “cost, quality and usages of Medicare assigned to them” (Haney, 2010). Every ACO must have a sufficient number of professionals (at least 5,000) to deliver quality care and reduce costs. They also have opportunities to enhance the use of evidence-based practices, evaluate and report quality and costs of standards, and coordinate healthcare provisions. ACOs can observe the use of technologies to enhance the quality of care and reduce costs. They also have the responsibility to promote the use of patient-centered methods or adopt individualized care plans.
Further, registered nurses and primary care nurse providers will work together to facilitate coordinated care plans. Nurse practitioners and specialists have opportunities to offer critical organizational leadership through the ACO model, particularly in poorly served regions.
The ACO model provides new opportunities for nurses to demonstrate how they use patient-centered care plans and other nurse-led models to save costs and increase the quality of care. In fact, nurses are most likely to benefit from ACOs if they would be allowed to collect data to ascertain efficacy and quality and implement their own nurse-led models to improve the healthcare system.
A medical home or healthcare home is a model for “offering patients with a vital primary care practice or provider who organizes care across various settings and providers” (Haney, 2010). A medical home model provides opportunities for nurses. This model relies on nursing activities for its success. It has been observed that the ability of the medical home to promote care through nurses may be impaired, to some extent, by certain multiple regulations (Haney, 2010). Fields, Leshen, and Patel (2010) established that medical homes could deliver improved quality of care through coordination and improved access when no physicians ran them. Most of the nurses who participated in the interview acknowledged nurse roles as vital for the success of medical homes. Nurses have the skills to review elements of primary care delivery and set new goals for stakeholders. These may include care required to improve chronic diseases outcomes, primary care, patient education, and patient care coordination. According to Naylor and Kurtzman (2010), the use of nurses to provide primary care is cost-effective. On this note, data generated by nurse-managed primary care homes may be used to enhance the quality of care, cut costs and identify barriers in other settings. Once policymakers understand how nurse-managed primary care homes have managed their resources and improved quality of care, they can be allowed to practice to the full extent of their training and professional capabilities. New improved results in costs and quality of care will also offer new opportunities for nurses.
Several factors have put pressure on the healthcare systems and they require efficient, effective, and economical approaches. Aging populations increased cases of chronic conditions and increasing costs of care are driving these reforms. New laws have been formulated and implemented to facilitate these reforms. In addition, different care delivery models are available. However, they require invaluable nurse education, skills and professional abilities to be successful. As a result, nurses have new opportunities to play various roles in developing new models, management and leadership positions to improve the quality of healthcare and reduce costs.
Fields, D., Leshen, E., & Patel, K. (2010). Driving quality gains and cost savings through adoption of medical homes. Health Affairs, 29(5), 819-826.
Haney, C. (2010). New Care Delivery Models in Health System Reform: Opportunities for Nurses & their Patients. Silver Spring, MD: American Nurses Association.
Naylor, M., & Kurtzman, E. (2010). The role of nurse practitioners in reinventing primary care. Health Affairs, 29(5), 893-899.
Wilson, A., Whitaker, N., & Whitford, D. (2012). Rising to the Challenge of Health Care Reform with Entrepreneurial and Intrapreneurial Nursing Initiatives. OJIN: The Online Journal of Issues in Nursing, 17(2), Manuscript 5.