¶ … Evolution of Nursing Roles in an Enlarged National Health Care System
The Affordable Care Act enables the provision of health insurance to 30 million people above the coverage figures prior to the enactment of the law. Because of this precipitous rise in the number of health insurance members, access to care as a function of the availability of primary care providers has been a leading issue in the transition to the nation-wide system of health care insurance. Public health models and nursing practice arrangements are changing in order to meet the immediate and anticipated care needs that have been brought to bear on the health care systems.
Public Health and Nurse Managed Health Centers (NMHCs)
From the earliest days of public health, the roles of nurses have been embedded in the social, educational, and political needs of communities. Health education has functioned as a springboard to community organizing, patient advocacy, and the development of integrated health care systems (Kulbok, et al., 2012). This same broad perspective is seen in the contemporary implementation of public health, the success of which depends on the skillful collaboration of public health nurses across agencies and in the community (Kulbok, et al., 2012). This orientation to community is evident in the community participation and ethnographic health promotion model" that serves as a foundation for addressing multi-causal, complex health-related problems in the community (Kulbok, et al., 2012). Nurse managed health centers or clinics are an exemplar of the community participation health promotion model.
Nurse managed health clinics operate as non-profits and typically provide care to underserved populations and offer an option for sliding scale fees (Kulbok, et al., 2012). Advanced practice nurses lead the provision of primary healthcare services at nurse managed health clinics, and focus the agency on disease prevention, health education, and health promotion.
Concepts of Continuity or Continuum of Care
The concept of continuity of care is grounded in the perspective of the patient. Specifically, the continuum of care is concerned with whether health care is perceived by the patient as coherent and linked across all facets of patient care, including the flow of good information, quality interpersonal skills, and effective care coordination. The concept of continuity of care has relevance to the evolution of healthcare that is top-of-mind and integral to current healthcare practice as it incorporates discrete elements of care that have traditionally been under the aegis of one organization or another, however, the state of flux may reposition elements of care such that ensuring the maintenance of coherency and the support of a linked continuum of care becomes a substantive challenge.
The distinct challenges of each type become salient when considering the definitions of the elements of care. Informational continuity can be said to be taking place when patients' current care is informed by prior health events and the past provision of healthcare services. Relational continuity ensures that the patient is viewed as and known as an individual and unique person, such that an enduring relationship between providers and patients exists and serves to connect patient care over time and to bridge events that are discontinuous because of the passage of time or different locations and/or providers. Management continuity is crucial to the provision of effective medical and health care for chronic conditions, and is characterized by strong links across different providers who serve the same individual patient.
Accountable Care Organizations (ACO)
The establishment of an Accountable Care Organization (ACO) is a voluntary effort to address the erosion of care quality for Medicare patients that has been an artifact of a poorly functioning reimbursement system ("CMS," 2005). The hospitals, physician groups, and other types of healthcare providers volunteer to provide high quality, coordinated care to Medicare patients ("CMS," 2005). The clear-sighted objectives of Accountable Care Organizations is to provide the right type and level of care to patients at the right time, and to ensure that services are not unnecessarily duplicated, and that medical errors are systematically prevented ("CMS," 2005). In addition to these laudable goals, Accountable Care Organizations are motivated to revamp services, spend health care dollars more effectively, and to deliver high quality patient care since doing so will enable the ACO to share a portion of the savings in Medicare program expenditures (see http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/Downloads/ACO-Menu-Of-Options.pdf) ("CMS," 2005).
Medical Homes
Across the country, states are addressing the costs of Medicaid spending by establishing patient-centered medical home (PCMH) models of care. Comprehensive preventive and primary care is offered in these...
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