Tag Archives: Patty Jones

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.

 

Indiana posts exchange papers

The state of Indiana has posted a number of issue briefs written by Milliman consultants. The issue briefs concern Indiana’s state exchange and health reform in general. The full library is available here. Of particular interest:

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.

Operational components of medical loss ratios

The Patient Protection and Affordable Care Act (PPACA) requires health insurance carriers to meet medical loss ratio (MLR) requirements on a state-by-state basis starting in 2011 (we have blogged about this before). This leaves insurers with a fairly short time frame in which to learn the intricacies of MLR calculations. Because specifications and interpretations are also likely to evolve over time, health plans will need to keep abreast of any regulatory changes and should consider performing annual operational audits that document their compliance efforts.

Read more in a recent healthcare reform briefing paper by John Phelan and Patty Jones.