Discussion: Unintended Consequences of Health Care Reform NURS 8100
Discussion: Unintended Consequences of Health Care Reform NURS 8100
Discussion: Unintended Consequences of
Health Care Reform
The PPACA of 2010 fostered new provisions for health care and the structure of health
care delivery. The individual mandate to obtain insurance is one provocative provision.
While this provision attempts to increase access to health care, it raises questions on
how the existing system could sustain the potentially large influx of newly insured
individuals.
Another provision calls for new models of health care provider organizations to ensure
delivery efficiency and continuity of care. In this week’s media presentation, Dr.
Kathleen White discusses the accountable care organization, which comprises a group
of providers coordinating care across a variety of institutional settings. Yet becoming an
accountable care organization may present a number of challenges.
This week’s Discussion builds on Week 1, continuing the examination of those societal
and organizational contexts that influence health care reform. The unintended
consequences of reform policy on the health care system are also considered.
To prepare:
Review this week’s media presentation and the other Learning Resources focusing on
how reform may lead to improved quality, greater access, and reduced cost of care.
Also think about the unintended consequences that may arise as a result.
Consider the information presented about the individual mandate and accountable care
organizations. What are some questions or concerns you might have regarding the
individual mandate? What are the pros and cons associated with becoming an
accountable care organization?
With posting instructions in mind, select either the individual mandate or accountable
care organizations as the focus of your Discussion this week.
By Day 3
Post a cohesive response that addresses the following:
In the first line of your posting, identify the topic you have selected—either the individual
mandate or accountable care organizations. With regard to this topic, describe one or
more positive results that could be achieved, and one or more unintended
consequence(s) that organizations or individuals may experience.
Briefly evaluate issues on the topic that may be a consideration for the organization you
work in and the nursing profession.
Read a selection of your colleagues’ postings.
By Day 6
Respond to at least two of your colleagues in one or more of the following ways:
Ask a probing question, substantiated with additional background information, evidence
or research.
Share an insight from having read your colleagues’ postings, synthesizing the
information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from
your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after
synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting
perspectives based on readings and evidence.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question
posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting.
Note what you learned and/or any insights you gained as a result of the comments
made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning
Resources and any additional sources.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 2 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 2 Discussion
Learning Resources
Note: To access this week’s required library resources, please click on the link to the
Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical
approach (7th ed.). New York, NY: McGraw-Hill Medical.
Chapter 5, “How Health Care is Organized – I: Primary, Secondary, and Tertiary
Care”
Chapter 6, “How Health Care is Organized – II: Health Delivery Systems”
McClellan, M. (2010). Accountable care organizations in the era of health care
reform. American Health & Drug Benefits, 3(4), 242–244.
Note: You will access this article from the Walden Library databases.
The PPACA of 2010 encourages the formation of accountable care organizations
(ACOs) to improve the quality and efficiency of health care delivery. An ACO is a group
of health care providers who coordinate care for their Medicare patients and share the
financial incentives of health care improvement gains.
Moore, K. D., & Coddington, D. C. (2010). Accountable care: The journey
begins. Health Care Financial Management, 64(8), 57–63.
Note: You will access this article from the Walden Library databases.
This article provides information on the importance of health care provider organizations
taking steps to become accountable care organizations (ACOs) and provides examples
of systems that have historically functioned in this capacity. The authors also provide
steps for developing and transitioning to an ACO structure.
Institute of Medicine. (2010). The future of nursing: Leading change, advancing
health. Retrieved from http://www.nationalacademies.org/hmd/Reports/2010/The-
Future-of-Nursing-Leading-Change-Advancing-Health.aspx
This report discusses how nurses can and should play a fundamental role in meeting
the challenges of increased demand for health care brought about by the
implementation of the 2010 Affordable Care Act. In addition, it stresses the need for
nurses to be partners with other health professionals and assume leadership roles in
redesigning health care in the United States.
Institute of Medicine. (2010). Report brief: The future of nursing: Leading change,
advancing health. Retrieved
from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-
Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf
This report brief highlights the four key recommendations from the Robert Wood
Johnson and Institute of Medicine The Future of Nursing: Leading Change, Advancing
Health report. The recommendations focus on nursing practice, education and training,
partnerships with other healthcare professionals, and workforce planning and
policymaking.
HealthCare.gov. (n.d.). Understanding the Affordable Care Act. Retrieved from
http://www.hhs.gov/healthcare/rights/index.html
This website introduces the Affordable Care Act and presents the timeline for
implementation of the various provisions of the Act.
HealthCare.gov. (n.d.). Understanding the Affordable Care Act: About the law.
Retrieved from http://www.hhs.gov/healthcare/rights/law/index.html
Read the full Affordable Care Act law at this website. An overview of the law is also
provided along with an outline of how the Affordable Care Act helps reduce health
insurance costs.
Required Media
Laureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy:
Reforming health care delivery: Accountable care organizations. Baltimore: Author.
Note: The approximate length of this media piece is 7 minutes.
In this media presentation, Dr. Kathleen White explains the structure of accountable
care organizations (ACO) and discusses the benefits and challenges of becoming an
ACO.
Accessible player
Optional Resources
APRN Joint Dialogue Group Report. (2008). Consensus model for APRN regulation:
Licensure, accreditation, certification & education. Retrieved
from https://www.aacnnursing.org/Education-Resources/APRN-Education/APRN-
Consensus-Model
Fisher, E. S., & Shortell, S. M. (2010). Accountable care organizations: Accountable for
what, to whom, and how. JAMA: Journal of the American Medical Association, 304(15),
1715–1716.
Fisher, E. S., Staiger, D. O., Bynum, J. W., & Gottlieb, D. J. (2007). Creating
accountable care organizations: The extended hospital medical staff. JHealth Affairs,
26, w44-w57. doi:10.1377/hlthaff.26.1.w44–57
McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., & Fisher, E. S. (2010). A
national strategy to put accountable care into practice. Health Affairs, 29(5), 982–990.
Kaiser Health News. (2011). Accountable care organization proposed regulations:
Resources. Kaiser Family Foundation. Retrieved
from http://www.kaiserhealthnews.org/Stories/2011/March/31/ACO-Documents-In-The-
News.aspx
NURS_8100_Week2_Discussion_Rubric
| Excellent | Good | Fair | Poor | |
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| RESPONSIVENESS TO DISCUSSION QUESTION
Discussion post minimum requirements: *The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct. |
Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*.
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Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*.
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Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*.
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Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*.
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| CONTENT KNOWLEDGE |
Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course.
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Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course.
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Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course
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Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course.
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| CONTRIBUTION TO THE DISCUSSION |
Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature.
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Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature
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Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas.
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Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas
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| QUALITY OF WRITING |
Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.
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Points Range: 5 (16.67%) – 5 (16.67%)
Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;.
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Points Range: 4 (13.33%) – 4 (13.33%)
Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.
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Points Range: 0 (0%) – 3 (10%)
Discussion postings and responses are well below doctoral -level writing expectations. They: · Use grammar and syntax that is that is unclear · Make many errors in spelling, grammar, and syntax; and –use incorrect APA format · Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints.
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| Total Points: 30 |
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