Essay Writing Help on Health Policy Issue Paper

Health Policy Issue Paper

Introduction

The Patient Protection and Affordable Care Act (PPACA) is projected to ensure increased coverage of Americans to affordable, quality health care. In addition, the Act intends to bring about elaborate changes within the health care system to ensure improved efficiency and quality of health care delivered (Davis, Abrams & Stremikis, 2011). Various provisions of the PPACA will be covered in more details, whereby the nine titles of the Act will be examined. One of the key elements of the PPACA is the Accountable Care Organization (ACO), which will also be discussed into details. Moreover, the paper will assess the benefits and risks of implementing the ACO, its impact on health care delivery and services, and the effect of the role and work of Advanced Practice Nurse with regard to the implementation of ACOs.

1. Discuss and summarize key components of the PPACA (Patient Protection and Affordable Care Act)

            The PPACA (Patient Protection and Affordable Care Act) is the most important government regulatory and expansion overhaul of the U.S health care system in nearly 50 years. The key aim of PPACA is to fast track health insurance coverage of Americans so that a higher number of them can have access to affordable, quality health care (Lee, 2014; Hearshaw, 2013). In addition, PPACA is intended to transform the health care system with a view to reducing the overall cost of health care (Casalino, 2014). PPACA consists of nine titles, each dealing with a key aspect of health care reforms. Under title I, the PPACA hopes to attain a significant transformation of the United States’ health insurance. This will be achieved through shared responsibilities, such as the elimination of pre-existing discriminatory practices, and extending tax credits to families and individuals, thereby increasing coverage (Maniam, Black & Leavell, 2013). This will ensure that all Americans have access to affordable, quality health care.

Under title II, the PPACA extends eligibility for Medicaid to Americans, especially those of low socio-economic status. It also simplifies CHIP (Children’s Health Insurance Program) and Medicaid enrollment, and enhances the quality of Medicaid services for providers and patients. Title III deals with the improvement of efficiency and quality of health care for everyone, especially for Americans enrolled in Medicaid and Medicare. Under title IV, the PPACA seeks to orient the U.S health care system with a view to prevent chronic diseases and improve public health. On the other hand, title V deals with the health care workforce. In this case, the PPACA will encourage innovations in the recruitment, selection, retention, and training of health workforce for increased vibrancy, diversity, and competence. Under title VI, the PPCCA is committed to ensure integrity and transparency of federally sponsored and financed health programs.

Title VII involves increasing access to innovative medical therapies by embracing innovation and biologics price competition. Elsewhere, title VIII enables the PPACA to establish a novel, self-funded, voluntary long-term insurance CLASS (community living assistance services and support) program. Finally, title IX of the PPACA entails revenue provisions. Plan administrators and insurance companies will be subjected to a new 40 percent excise tax for health coverage plan whose annual premium exceeds the $ 23,000 and 18,000 thresholds for family coverage and single coverage, respectively.

2. Select one of the aspects of PPACA and discuss in detail

            The PPACA permits the use of ACOs (Accountable Care Organizations) to enhance the quality and safety of care, in addition to reducing Medicare health care costs. This is a voluntary program that was incepted on January 1, 2012. An ACO is a group of suppliers and providers of services (for example, physicians, hospitals, and other personnel who provide care to patients) whose main role is to provide coordinated care for Medicare patients (U.S. Government, Department of Health and Human Services, 2011). These are the patients who are not covered by Medicare Advantage private plan. The ACO program was started with the main goal of providing smooth, high quality care for Medicare beneficiaries at an affordable cost.

The ACO is designed in such a way that the patient is the center of attention. In addition, both providers and patients remain true partners in as far as care decisions are concerned. It is important however to emphasize that the provider and patient participate in an ACO on a purely voluntary basis (Casalino, 2014). The ACOs that will manage to reduce health care costs associated with Medicare and at the same time fulfill the set performance standards as regards quality of care, and prioritize on the interests of the patient above everything else, stand to be rewarded by the Medicare Shared Savings Program. Such an ACO is permitted to share in the accrued savings. However, they must first fulfill quality standards set in the following fundamental areas:

  • Caregiver/patient care experiences
  • Patient safety
  • Preventive health
  • Care coordination
  • Frail elderly/at-risk population health

3.      Critically analyze your selected aspect of the PPACA in terms of benefits and risks of its implementation

            An ACO enables physicians to be more involved in decision-making, in addition to facilitating shared governance. An ACO shall facilitate agreement among the various participants to accept control and accountability through a contracted network or ownership. More importantly, implementing the ACO model will afford benefits to hospitals, physicians, and other care providers in the form of enhanced services and care available to them. In addition, the government will experience reduced growth in Medicare costs (Casalino, 2014). However, implementing ACOs comes with certain risks. On the issue of ACOs, the PPACA is yet to issue any statutory cause of action. In addition, there is no state or federal preemption in place to deal with possible claims against ACOs in accordance with key provisions of the Act (Casalino, 2014). This is likely to result in an increase in ACO-related malpractice claims owing to certain key provisions of the Act. The PPACA encourages ACOs to execute patient care standards and to be directly involved in improving the efficiency and quality of patient care.

4. Impact of ACOs implementation on health care delivery and services

            Implementing ACOs will lead to lowered health care costs and improved quality of care. In addition, Medicare and health care providers stand a chance to share in the savings in the overall cost of health care (Quinn, 2014). Moreover, there will be a likely introduction of incentives, whereby the value and quality of care providers shall be rewarded, and not the volume of care.

5. Examine how the implementation of your selected aspect of the PPACA will impact the role and work of Advanced Practices Nurses

            Advanced Practice Nurses (APNs) have a fundamental role to play in ensuring that ACOs offer high quality health care services, albeit at lower costs. More importantly, APNs need to ensure that the high-quality care delivered by ACOs is patient-centered (Shortell, Casalino & Fishe, 2015). In order to fulfill these crucial roles, APNs must act as communicators, providers of advanced care, care coordinators, and quality improvement managers (Eid & Jefferson, 2014). As care coordinators, APNs within the ACO will be required to coordinate care across various health care settings, such as hospitals, doctor’s offices, home settings, or rehab centers. APNs within ACOs will also be called upon to communicate and translate treatment plans and care choices to the patients’ families. As quality improvement managers, nurses in the ACO will be required to analyze data in order to promote evidence-based medicine, and utilize such data to assess cost and quality measures.

Conclusion

            The PPACA is the most elaborate regulatory transformation of the U.S healthcare system in nearly five decades, since the inception of Medicaid and Medicare in 1965. Besides the noble goal of increasing the overall number of Americans with health insurance cover, it is also intended to gradually reduce the overall costs of health care. An ACO is a key element of the PPACA whose main aim is to provide smooth, high quality care for Medicare beneficiaries. The ACO model is projected to result in reduced growth in Medicare costs in addition to improving services and care available to hospitals, physicians, and other care providers. However, ACOs come with an added risk in the form of increased cases of malpractice-related claims as there lacks any state or federal preemption to deal with these. Nevertheless, it will lead to reduced health care costs and enhanced quality of care. The implementation of ACOs will demand that APNs assume the role of quality improvement managers, communicators, and core coordinators.

References

Casalino, L.P. (2014). Categorizing accountable care organizations: moving toward patient

centered outcomes research that compares health care delivery systems. Health Services

Research, 49(6), 1875-1886.

Davis, K., Abrams, M., & Stremikis, K. (2011). How the Affordable Care Act Will Strengthen

the Nation’s Primary Care Foundation. J Gen Intern Med., 26(10), 1201-1203.

Eid, D., & Jefferson, A. (2014). The Patient Protection and Affordable Care Act: causes and

effects. Annals of allergy. Asthma & immunology, 112/1(6-8), 1081-1206.

Hershaw, D. (2013). The Impact of the Patient Protection and Affordable Care Act on the

National Safety Net.  Journal of Emergency Nursing, 39/4(360-361), 00991767.

Lee, M.J. (2014). The patient protection and affordable care act: better coverage, worse access.

Will it really improve patient safety? Clinical orthopaedics and related research,

472/1(32-4), 0009-921X.

Maniam, B., Black, L., & Leavell, H. (2013). The Financial and Economic Effects of the Patient

Protection and Affordable Care Act (PPACA). Journal of the Academy of Business &

Economics, 13(1), 201.

Quinn, J. (2014). Accountable Care Organizations and Home Care: Strategies for Success.

            Home Healthcare Nurse, 32(10), 619-20.

Shortell, S.M., Casalino, L.P., & Fishe, E.S. (2015). How the Centre for Medicare and Medicaid

Innovation should test Accountable Care Organizations. Health Affairs, 29(7), 1293

1298.

U.S. Government, Department of Health and Human Services. (2011). Ultimate Guide to the

Patient Protection and Affordable Care Act (PPACA or ACA) – Understanding

Obamacare and Your Health Care Insurance Options, New Plans, Programs, Bill of

Rights, Full Text of Law. West Covina, California: Progressive Management.