Tag Archives: nursing

Are health plan nurses measurably ready for the future?

The innovations and opportunities resulting from healthcare reform—accountable care organizations (ACOs) and patient-centered medical homes—rapidly expand the roles of nurse care managers. These models require population-based analysis and prioritization, proactive care gap closure and care coordination, and credible assessment of impact to determine if cost and quality are improving.

At the core of all these models and the transformative direction of health reform, are key design principles that include:

• Population-based analysis used to target and prioritize interventions
• Accountability for achieving quality and financial goals for defined populations
• Patient-centered care design that addresses medical as well as psychosocial needs
• Education and engagement strategies that directly involve the patient and family in achieving better health and preventing exacerbation of chronic care
• Medical homes and medical “neighborhoods” that integrate primary care, specialty care, and community programs in a manner that provides better resource use and easier access
• Care coordination that assists patients as they maneuver the complexities of the healthcare delivery system
• Proactive outreach that encourages timely preventive care and supports care compliance
• Transparent discussions and thoughtful choices made based on evidence-based options and costs of alternatives

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A toolkit for healthcare reform: What role will nurses play?

Some have anticipated a shortage of healthcare providers in the coming decades as the U.S. population ages. With that in mind, the Alliance for Health Reform has produced a toolkit focused on “nursing, the coming shortages, how [shortages] might be avoided, and how health reform is contributing to the changing role of nursing.” The following excerpt provides context:

Currently there are about 3 million licensed registered nurses in the United States. Most, about 60 percent, work in hospitals. Almost 266,000 are advanced practice registered nurses (APRNs).

It is projected that 260,000 additional nurses will be needed by 2025 to care for the increased population, the increase in insured population and the explosive care needs for chronic diseases in the population and geriatric care in older age groups.

Several factors are thought to contribute to the projected shortage in nursing. These include a decline in RN earnings relative to other career options, an aging nursing workforce, job dissatisfaction among nurses, and an aging, sicker population that will require more intense health care services.

An October 2010 report by the Institute of Medicine recommended that nurses be allowed to practice to the full extent of their education and training, yet scope of practice laws vary from state to state. Is the time right for states to update these laws to mitigate the shortage of providers especially in primary care and especially in rural areas?

Among the resources provided in the toolkit is Patty Jones’ paper entitled “The Nurse’s Role in Accountable Care,” which considers the important role registered nurses will need to fulfill if accountable care organizations (ACOs) are going to be successful under healthcare reform. Here is an excerpt from her paper:

Nurses currently work in a variety of organizations likely to be involved with [ACOs], including practitioner offices and clinics, hospitals, insurers, and community health organizations. As a result, they often are in a position to help address one of the key needs of accountable care: improving care delivery and coordination across a variety of settings and types of care.

…Most organizations will need to take stock of their current resources, fill in gaps, and re-engineer their process. Most can leverage their current resources and help ensure the success of their program by accurately assessing and augmenting the skills of their nursing staff.

Will ACOs accelerate acceptance of nurses as primary care practitioners?

An editorial in The Atlantic recently argued strongly in favor of the expansion of the role of nurses in primary care:

Should the ACA pass muster with the Supreme Court next month, an additional 30 to 33 million previously uninsured Americans will be covered — and even if ACA is not implemented in full, and in the end merely expands Medicaid, it will add 17 million to the insured ranks by 2020.

One of the best ways to alleviate this shortage is to expand the scope of practice for advanced practice registered nurses (APRNs), well-trained registered nurses with specialized qualifications who can make diagnoses, order tests and referrals, and write prescriptions. APRNs could provide a variety of services that primary care physicians now provide.

This issue remains contentious, but one of the most interesting points the author made concerned a frequent topic of this blog—the growth of accountable care organizations (ACOs):

Employers and patients are beginning to clamor for progress in this area and the turf wars may lose steam as we move away from fee-for-service and toward accountable care organizations, in which a team of providers takes responsibility for the well-being of a population in return for global rather than provider-specific payments.

A 2011 article on Gannett’s Nurse.com on the role of nurses in federally sanctioned ACOs referenced Milliman’s own Patty Jones on the topic:

According to Patty Jones, RN, MBA, a healthcare management consultant with the Seattle office of Milliman, an actuarial consulting firm, nurses are the logical choice to help patients navigate barriers to care and to educate them about how to best care for themselves. They already serve as health coaches for patients with multiple chronic illnesses, and they perform discharge and transition planning for those who are hospitalized. Jones predicted these roles will expand in an ACO.

You can read Patty’s paper on the topic of nurses in accountable care here.

Nurses say “Hello, ACOs”

Nurse.com gives the revised accountable care organization (ACO) regulations a positive grade:

It seems the public outcry [over the draft regulations released last spring] was heeded, and many groups, including the American Nurses Association and the American College of Nurse Practitioners, are encouraged by the changes. Some nurse leaders and educators predict nurses will be the key to success for these new programs, which emphasize care coordination, wellness, teamwork and health education — all areas of nursing expertise.

What’s next for nurses and ACOs?

Although ACO guidelines do not specifically spell out nursing roles, most policy experts see nurses’ most obvious positions as care managers, educators, hospital transition coordinators, leaders of quality assurance and — for advanced practice nurses — primary care providers.

“There is lots of opportunity for nurses because of what nurses bring to the table,” said Cheryl Schraeder, RN, PhD, FAAN, director of policy and practice initiatives at the Institute for Health Care Innovation, University of Illinois at Chicago College of Nursing.

According to Patty Jones, RN, MBA, a healthcare management consultant with the Seattle office of Milliman, an actuarial consulting firm, nurses are the logical choice to help patients navigate barriers to care and to educate them about how to best care for themselves. They already serve as health coaches for patients with multiple chronic illnesses, and they perform discharge and transition planning for those who are hospitalized. Jones predicted these roles will expand in an ACO.

What kinds of roles will nurses assume?

Judith Lloyd Storfjell, RN, PhD, FAAN, said the University of Illinois at Chicago is getting requests for nurse care managers who use clinical evidence to help coordinate care for patients, including connecting them with resources, communicating with providers and giving wellness information and education on disease processes. Storfjell is professor, associate dean and executive director at the Institute for Health Care Innovation, UIC College of Nursing. A number of nursing schools are adding programs and certifications for care management.

In addition to expanding their education and training, nurses who are interested in being part of an ACO system, or of any outcomes-oriented model, need to work both within their professional organizations and among their colleagues to make their value known, say nurse leaders and policy experts.

“The central focus of an ACO will be on care coordination in a manner that includes both quality and resource use,” Jones said. “There are an awful lot of opportunities that nurses are well suited for. Now is the time to figure out where you really have the interest, passion, or excel at something in addition to clinical skills, and develop that more.” 

 For more on nurses and ACOs, click here.

 

The nurse’s role in accountable care

The accountable care organization (ACO) model is sparking the imagination of leaders across the U.S. health system. Most are forging their own path, because guidelines and regulations are still murky. But for organizations interested in exploring the model, what is clear is that most already have professional resources in place that could be pivotal in implementing this promising approach to patient-centered care: registered nurses. A new reform briefing paper explores the role of nurses in ACOs.