NU665 RC Week 16 Healthcare Access & Quality Determinants Presentation Healthcare Access and Quality Determinants Create a PowerPoint based on the foll
NU665 RC Week 16 Healthcare Access & Quality Determinants Presentation Healthcare Access and Quality Determinants
Create a PowerPoint based on the following:
You are a psychiatric-mental health nurse practitioner who is practicing as part of a team in a medical home model facility. Patients on the panel are as follows:
68-year-old patient, diagnosed with depression, who has Medicare
34-year-old patient, homeless, diagnosis of Schizophrenia, who has Medicaid
43-year-old patient, diagnosed with Bipolar Disorder, private/work-provided health insurance
22-year-old patient, undocumented immigrant, diagnosed with PTSD and anxiety, who is uninsured
In your PowerPoint, address the following:
Provide an overview of the health care payment system in the United States.
How do the current (2017) changes in the ACA impact the patient profile? How do these policy changes impact the provision of care you provide?
Integrate the concept of quality determinants to with the conversation related to care provision and management. How is quality determined, measured, and documented?
What are the barriers to accessing healthcare in the United States?
Identify one policy issue related to psychiatric and mental healthcare that is currently being addressed by your national professional organization and discuss how NPs can become policy-aware, as well as act as patient advocates.
Your PowerPoint should be 15 to 20 slides (no more and no less). Your slides should not be narrative; rather, the use of bullets, charts, and pictures are encouraged. Please use the notes section of the PowerPoint to add narrative. APA formatting of all components is required, including a references list.
I have attached a sample power point assignment Sheri Saluga, MSN, RN
U.S. Healthcare System Payment Structure
Cost of healthcare in the U.S. is higher than any other
country.
Healthcare cost $3.3 trillion dollars
Cost per person was $9900
(Schreck, 2018).
(Schreck, 2018).
High cost healthcare has several negative ripple effects
2018).
(Schreck,
U.S. Healthcare System Payment Structure
Health care providers are paid by:
Private insurance
Government insurance programs
Personal, out of pocket
Government directly provides
some health care
(Schreck, 2018).
(Haughom, 2014)
Affordable Care Act
The Affordable Care Act (ACA) was enacted in 2010 by President
Barak Obama.
Purpose1. Availability
2. Affordability
3. Expansion of the market
4. Incentives for employers
5. Requires the purchase private health insurance
(Schreck, 2018).
Affordable Care Act
How it applies to mental health benefits:
Mental Health Parity and Addiction Equity Act (MHPAE)
2008
Mental health and substance abuse treatment equal to
medical/surgical treatment
Applies to small group, individual plans, and
Medicaid
Large group plans and Medicare excluded
Prescription medications
(APA, 2019).
Affordable Care Act
ACA changes from 2017
Repeal of the individual mandate
Eliminating cost sharing reductions
Increased used of Medicaid waivers
Increase in the association health plan
availability
Short-term limited duration insurance
)
(Solnick, 2017
Case Scenarios
PATIENT
68 year-old patient
Diagnosis- depression
COVERAGE
80% Covered by Medicare part B
Provider must accept Medicare
Medications per preferred drug list
Co-pay and deductible applies
Coverage varies by state
Falls under the parity law
Provider selection may be limited
Medications per the preferred drug list
Insurance- Medicare
34- year-old patient (homeless)
Diagnosis- Schizophrenia
Insurance- Medicaid
PATIENT
43year-old patient
Diagnosis- bipolar
Insurance- private/work provided insurance
22- year-old patient (undocumented
immigrant)
Diagnosis- PTSD/anxiety
Insurance- uninsured
COVERAGE
Depending on size of company (50+
employees)
Not required to provide mental health
coverage (large insurance plans)
If mental health coverage is provided, falls
under the parity law
Co-pay may apply
Unlimited or medically necessary visits
Prescription coverage may vary
Emergency services covered, under federal
law
Will have to pay for services
Community health centers provide low-cost
care
Provision of Care
ACA has expanded the provision of care
Care should be equitable
Private practice doctors
Medicare and Medicaid
(Bresnick, 2016)
Quality Determinants
Creation of Accountable Care Organizations (ACO)
AHRQ develops healthcare quality measures
Structural
Process
Outcome
(Agency for Healthcare Quality and Research [AHQR], 2015)
Quality Determinants
IOM six domains of quality healthcare
Safe
Effective
Patient-centered
Timely
Efficient
Equitable
(AHQR, 2015).
Quality Determinants
AHQR three aims for improving healthcare
1. Achieving better care
2. Achieving healthy people and communities
3. Making care affordable
(AHQR, 2017).
Centers for Medicare and Medicaid core measures
Barriers to Healthcare
Availability of appointments
Geographic
Provider shortages
Transportation
Language
Financial
Cultural
(Rayome, 2017)
Issues Related to Advance Practice
Nursing
Consensus model of nursing
Regulatory requirements for
APRNs vary
Obstacle to portability
Preventing access to care
(NCSBN, 2019)
Getting Involved
If your state is not in the consensus model
Sample letter to legislator
https://www.ncsbn.org/APRN_formletter_Legislator
web.pdf
Sample letter to board of nursing
https://www.ncsbn.org/APRN_formletter_Supporter
s_web.pdf
Other ways to support the consensus model
https://www.ncsbn.org/APRN_CommunicatingwLeg
islator_web.pdf
(NCSBN, 2019).
References
American Nurses Credentialing Center. (n.d.). APRN consensus model. Retrieved from https://www.nursingworld.org/certification/aprn-consensus-model/
Agency for Healthcare Research and Quality. (2015). Consider culture, customs, and beliefs: Tool #10. Retrieved from https://www.ahrq.gov/professionals/qualitypatient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool10.html
Agency for Healthcare Research and Quality. (2015). Types of health care quality measures. Retrieved from
https://www.ahrq.gov/talkingquality/measures/types.html
Agency for Healthcare Research and Quality. (2017). Overview of quality and access in the U.S. health care system. Retrieved from
https://www.ahrq.gov/research/findings/nhqrdr/nhqdr16/overview.html
American Psychological Association. (2019). What you need to know about mental health coverage. Retrieved from https://www.apa.org/helpcenter/parity-guide
Beaton, T. (2018). Affordable care act changes may bring a rocky 2018 for payers. Retrieved from https://healthpayerintelligence.com/news/affordable-care-actchanges-may-bring-a-rocky-2018-for-payers
Centers for Medicare and Medicaid Services. (n.d.). Core measures. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/QualityMeasures/Core-Measures.html
Commonwealth Fund. (n.d.). The U.S. healthcare system. Retrieved from https://international.commonwealthfund.org/countries/united_states/
Gold, J. (2011). Accountable care organizations, explained. Retrieved from
http://www.npr.org/2011/04/01/132937232/accountable-care-organizationsHealthinsurance.org. (2019). How Obamacare improved mental health coverage. Retrieved from https://www.healthinsurance.org/obamacare/how-obamacareimproved-mental-health-coverage/
Heath, S. (2018). Top challenges impacting patient access to healthcare. Retrieved from https://patientengagementhit.com/news/top-challenges-impacting-patientaccess-to-healthcare
Holland, S. (2018). New health plans discriminate against mental illness. Retrieved from https://www.nami.org/Blogs/NAMI-Blog/October-2018/New-Health-PlansDiscriminate-Against-Mental-Illne
McCoy, J. (2006). Obligation to provide services: A physician-public defender comparison. Ethics Journal of the American Medical Association , 8(5), 332-334.
Medicare.gov. (n.d.). Is my test, item, or service covered? Retrieved from https://www.medicare.gov/coverage/mental-health-care-outpatient
References
Medicare.gov. (n.d.). Is my test, item, or service covered? Retrieved from https://www.medicare.gov/coverage/mental-health-care-outpatient
Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming language barriers in healthcare: A protocol for investigating safe and
effective communication when patients or clinicians use a second language. BMC health services research, 15, 371. doi:10.1186/s12913-015-1024-8
National Alliance of Mental Health Ilness. (2019). Types of health insurance. Retrieved from https://www.nami.org/Find-Support/Living-with-a-Mental-HealthCondition/Understanding-Health-Insurance/Types-of-Health-Insurance
NCSBN. (2019). APRN consensus model. The consensus model for APRN regulation, licensure, accreditation, certification and education. Retrieved from
https://www.ncsbn.org/aprn-consensus.htm
Office of Disease Promotion and Prevention. (2019). Access to healthcare services. Retrieved from https://www.healthypeople.gov/2020/topicsobjectives/topic/Access-to-Health-Services
Schreck, R. (2018). Overview of health care financing. Retrieved from https://www.merckmanuals.com/home/fundamentals/financial-issues-in-healthcare/overview-of-health-care-financing
Substance Abuse and Mental Health Services Administration. (2018). Medicaid coverage of medication-assisted treatment for alcohol and opioid use disorders and
of medication for the reversal of opioid overdose. Retrieved from https://store.samhsa.gov/system/files/medicaidfinancingmatreport.pdf
Substance Abuse and Mental Health Services Administration. (n.d.). What immigrants and refugees need to know about the Affordable Care Act. Retrieved from
https://www.samhsa.gov/sites/default/files/immigrants-refugees-affordable-care-act-with-notes.pdf
U.S. Department of Health and Human Services. (2013). Affordable care act expands mental health and substance abuse disorder benefits and parity protection for
62 million Americans. Retrieved from https://aspe.hhs.gov/report/affordable-care-act-expands-mental-health-and-substance-use-disorder-benefits-and-federal-parityprotections-62-million-americans
Photos
Bomb
http://datalingua.com/Index5.htm
Coaching
http://mikejentes.com/wp-content/uploads/2012/11/Coaching.jpg
Disability
http://ts2.mm.bing.net/th?id=H.4593713461133641&pid=15.1
Diversity
http://www.corrections.com/system/article/image/30240/Diversity-g.jpg?1329854766
Emergency
http://ts2.mm.bing.net/th?id=H.4882708841302037&pid=15.1
Emergency preparedness
http://shopcybercoupons.com/images/Emergency-Preparedness.jpg
Hazardous
www.junkit.ca
Hospital
http://www.hopkinsmedicine.org/sebin/p/g/curtainwall2.jpg
Joint Commission
http://www.jointcommission.org/certification/certification_main.aspx
Leadership
http://betterboards.net/wp-content/uploads/2011/02/leadership-web.jpg
Magnet
http://nursecredentialing.org/Magnet
Mission statement
http://ts3.mm.bing.net/th?id=H.5031035550761186&pid=15.1
Sexual harassment
http://ts4.mm.bing.net/th?id=H.4756578584167435&pid=15.1
http://ts2.mm.bing.net/th?id=H.4584608116967593&pid=15.1
Succession planning
piercecfo.com
Teamwork
http://ts4.mm.bing.net/th?id=H.4825521380656243&pid=15.1
Tornado
Bresnick, J. (2013). Why mental healthcare is key to population health management. Retrieved from https://healthitanalytics.com/news/why-mental-healthcare-is-key-topopulation-health-management
Haughom, J. (2014). Whats good about U.S. healthcare. Retrieved from https://www.healthcatalyst.com/positive_healthcare_transformation/
NCSBN. (2019). APRN consensus model toolkit. Retrieved from https://www.ncsbn.org/739.htm
Rayome, A. (2017). The top 10 barriers to digital transformation. Retrieved from https://www.techrepublic.com/article/the-top-10-barriers-to-digital-transformation/
Solnick, C. (2017). Free affordable care act seminar. Retrieved from https://libn.com/2017/11/21/free-affordable-care-act-seminar/
Purchase answer to see full
attachment
