Describe the difference between Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point-of-Service (POS) plans.
Health Care Reform
For the Health Care Reform PAPER, select ONE of the following questions that addresses/explores one aspect of health care systems or financing. Purpose: All health care delivery systems struggle to achieve what has been described by the Institute for Healthcare Improvement (IHI) as the “Triple Aim”. The term “Triple Aim” refers to the “simultaneous pursuit of improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care” (Lewis, 2014, para 3). Hood (2014) describes some of the challenges for today’s health care delivery systems in Box 9.1 (p. 210). The Patient Protection and Affordable Care Act (ACA) was a sweeping health reform statute signed into law by former President Obama in March of 2010.
The ACA is the most significant government expansion and regulatory overhaul of the health system since the advent of Medicare and Medicaid. The intent of the law was to expand insurance coverage, control health care costs, and to improve healthcare delivery systems. Now seven years into the implementation of the ACA, there is significant debate about the effects of the law on intended outcomes. In May 2017, the United States House of Representatives (2017) passed HR 1628, the American Health Care Act of 2017, with the intention of repealing and replacing the ACA. The bill narrowly failed in a vote of the United States Senate; alternate proposals have been proposed as individual bills and within other bills.
The debate on health care reform will certainly continue. This assignment gives you the opportunity to explore how healthcare is currently organized and financed, and discuss how the existing Affordable Care Act has affected population health, patient care quality and safety, and the practice of nursing. Prepare: Complete the “Health Care Reform” study guide, watch videos and read the articles provided in the module. Content: For the Health Care Reform PAPER, select ONE of the following questions that addresses/explores one aspect of health care systems or financing. Write a brief (2-3 page) paper in APA format that provides a clear description that answers the question, AND reflect on why this information is important to you in your practice as a nurse, as a family member and/or as member of your community.
Choose ONE topic/question: 1. Describe the difference between Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point-of-Service (POS) plans. 2. Describe the key provisions and processes of the Affordable Care Act of 2010 (ACA), including the major goals and features of the law. 3. Describe the positive and negative outcomes of the Affordable Care Act to date. 4. Describe the Medicare program, including eligibility, and program elements (Parts A, B, C, D). Describe Medicare expenditures for the most recent year. 5. Compare “Original” Medicare and Medicare Advantage Plans. 6. Describe the Medicaid program, including eligibility by age and income. 7. Describe the impact of Medicaid Expansion programs (for those states who implemented the programs as part of the ACA).
8. Describe the Children’s Health Insurance Program (CHIP), including eligibility for the program, and the impact of CHIP on child health. 9. Define the concept of Hospital Value-based Purchasing (also known as pay-for-performance or performance-based reimbursement). Provide examples of how hospitals are affected by value-based purchasing policies. Format: Apply APA format and style guidelines to write a 2- to 3-page paper, which should include a minimum of three references, one or more of which is an article from a peer-reviewed journal. No abstract is required for this paper. References: American Health Care Act of 2017, H.R. 1628, 115th Cong. (2017). Lewis, N. (2014, October 17). A primer on defining the Triple Aim [blog post]. Retrieved from http://www.ihi.org.
