Advanced practice nurses are in a powerful position within a healthcare system as they spend much time in direct care for patients and know their challenges and needs. Nevertheless, according to the report by Heale and Rieck Buckley (2015), there is a lack of political strength of nurses because many of them are not involved in the political systems. There are many methods advanced practice nurses can use to promote change in existing policies, most of which do not require particular leadership skills. First, they can join a professional nursing organization to advocate for improvement collectively (Ryan & Rosenberg, 2015).
Second, they can take small steps, such as contacting legislators by phone or an e-mail to express an opinion on current policy. Moreover, as an advanced practice nurse, I understand that it is my primary task is to ensure the best quality of care for my patients. To do so, it is crucial to report inadequate working conditions that may affect my performance, such as long hours and the lack of staff (Manton, 2016).
I have only been involved in the political system by voting, which is also a vital step nurses should take. However, I am planning to advocate for more changes in the future. One of the areas in which I would like to see the public policy changed is the existing insurance system. As an advanced practice nurse, I often encounter patients whose insurance plans do not cover all of their healthcare needs; many of them are not aware of all of the aspects of their healthcare plans. Consequently, many individuals do not have access to care when they need it. I would advocate for making healthcare plans more transparent and understandable and offer individuals full guidance to ensure that all of their potential expenses are covered.
Polypharmacy and Policy
It is crucial to address the problem of polypharmacy as it may have severe effects on individuals’ health. According to the study by Maher, Hanlon, and Hajjar, (2014) around 50% of elderly patients take one or more medications that are unnecessary for their conditions. The reason for it may be the presence of several diseases and the lack of communication between physicians. Individuals may not be aware that it is possible to reduce the number of medications or that simultaneous administration may have adverse effects on their health. It means that it is vital to develop policies aimed to reduce the practice of multiple drug prescriptions.
The possible policy is the implementation of the deprescribing protocol in cases when individuals have multiple diseases and are likely to have multiple prescriptions. The protocol can involve several steps; the first one would ascertain all of the medications a patient takes regularly. Then, the risk of drug-related harm would be evaluated based on the number of prescriptions and individual factors. The third step would be the assessment of potential discontinuity of a drug. Finally, the selected drugs would be discontinued, and the outcomes of deprescribing would be monitored.
To increase the probability of success, several tools may be included in the design phase of the policy development process. The primary tool that can be used to eliminate polypharmacy is the algorithm for drug discontinuation (Scott et al., 2015). The algorithm considers the benefits and disadvantages of prescribed medications, the presence of symptoms after the discontinuation, individuals’ life expectancy, and possible drug withdrawal effects. The research from eight European countries shows that the implementation of deprescription policies and action plans for medication safety can have a significant positive impact on patient outcomes (McIntosh et al., 2018). It means that polypharmacy management is crucial to ensure the high quality of care for individuals, especially, elderly people.
Third-party payment has a significant impact on how people perceive the market of healthcare. Buff and Terrell (2014) note that health insurance distorts price sensitivity as individuals do not pay for medical services directly and may be unaware of the real costs of treatment. As a result, patients may think that they receive care for little price or for free although the actual cost of services may be very high. If there is no transparency in prices, healthcare providers and suppliers have no grounds for competition; the quality of their services decreases and the costs for insurance companies grow.
Buff and Terrell (2014) report that currently, individuals receive services, the marginal costs of which exceed their value. Moreover, because medical professionals work with third-party payers, they have to allocate their resources from the quality of care to administrative expenses. It means that the current payment system distorts the healthcare market and affects the quality of services significantly.
It is necessary to understand the reasons why many countries involve third-party intermediaries in the healthcare system. The functions of such organizations are the development of appropriate healthcare plans, provider network management, and management of claims, as well as analysis and reporting. It means that third-party intermediaries coordinate and arrange the relationships between insurance companies, healthcare providers, and patients. Although such a system may be beneficial for some governments, current studies report that engaging third-party organizations in care may have an adverse impact on costs both for hospitals and patients (Nagulapalli & Rokkam, 2015).
An establishment of a separate program for elderly citizens may solve several problems. For example, many care plans do not consider the needs of individuals having multiple chronic conditions (Rowe, Fulmer, & Fried, 2016). The program could also establish the benefits for those receiving end-of-life services to ensure a safe environment for patients with advanced serious illnesses. Moreover, as many elderly individuals need services of various physicians, a separate program could provide them with access to an interdisciplinary team of professionals.
Managed care plans are operated by insurance companies and healthcare providers and are designed to reduce healthcare costs. Their establishment is associated with rational investments in health (Shrank, Keyser, & Lovelace, 2018). To analyze how managed care reduces the costs of services, it is necessary to consider the factors that can affect them. According to Van Parys (2014), the primary changes that such plans offer are related to the number of hospital visits and the average cost per visit. The system of managed care allows individuals to have access to a network of healthcare providers, which ensures that services are offered at a discounted rate.
It is necessary to mention that managed care does not diminish the quality of care. For example, one of the reasons for it is that referrals can be made quickly, which means that adverse health outcomes caused by long wait times are prevented. Moreover, the study by Ndumele, Schpero, Schlesinger, and Trivedi (2017) shows that managed care plans can enhance the quality of preventive care, chronic disease management, and maternity care. The reasons for improvement may be patients’ increased access to immediate care and person-centered approach, which can be provided as all specialists work within the same system and have access to the medical history of individuals.
Accountable Care Organizations Improve Quality of Care
Accountable Care Organizations (ACO) are designed to make providers responsible for the cost and quality of care (Ryan, Shortell, Ramsay, & Casalino, 2015). The study by McWilliams, Landon, Chernew, and Zaslavsky (2014) addresses the benefits of the initiative. To evaluate the impact of ACO on the quality of care and its costs, the authors conducted surveys with more than 32,000 individuals attributed to the program and more than 250,000 beneficiaries assigned to other healthcare providers (McWilliams et al., 2014).
The participants noted significant changes in access to care, reporting that they were able to receive services timely. Moreover, patients that had severe illnesses reported enhanced quality of care due to the patient-centered approach and the simplified process of referral. The study by Nyweide et al. (2015) shows similar findings and adds that ACO beneficiaries had smaller increases in healthcare expenditures compared to individuals who were attributed to other healthcare programs.
The findings of the study show that patients may benefit from ACO (McWilliams et al., 2014). They reveal that there is care fragmentation and instability within the healthcare system, which may be addressed by ACO. By creating a single network for patients, the government ensures that they have access to timely services, which eliminates the potential adverse health outcomes. Moreover, ACO is associated with coordinated care, which means that medical professionals can work together within a shared system to improve the health state of each particular individual.
Buff, M. J., & Terrell, T. D. (2014). The role of third-party payers in medical cost increases. Journal of American Physicians and Surgeons, 19(2), 75-79.
Heale, R., & Rieck Buckley, C. (2015). An international perspective of advanced practice nursing regulation. International Nursing Review, 62(3), 421-429.
Maher, R. L., Hanlon, J., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety, 13(1), 57-65.
Manton, A. (2016). Emergency nurse as citizen: The power of political action. Journal of Emergency Nursing, 42(5), 373-374.
McIntosh, J., Alonso, A., MacLure, K., Stewart, D., Kempen, T., Mair, A.,… & Gennimata, D. (2018). A case study of polypharmacy management in nine European countries: Implications for change management and implementation. PloS One, 13. Web.
McWilliams, J. M., Landon, B. E., Chernew, M. E., & Zaslavsky, A. M. (2014). Changes in patients’ experiences in Medicare accountable care organizations. New England Journal of Medicine, 371(18), 1715-1724.
Nagulapalli, S., & Rokkam, S. R. (2015). Should governments engage health insurance intermediaries? A comparison of benefits with and without insurance intermediary in a large tax funded community health insurance scheme in the Indian state of Andhra Pradesh. BMC Health Services Research, 15. Web.
Ndumele, C. D., Schpero, W. L., Schlesinger, M. J., & Trivedi, A. N. (2017). Association between health plan exit from Medicaid managed care and quality of care, 2006-2014. JAMA, 317(24), 2524-2531.
Nyweide, D. J., Lee, W., Cuerdon, T. T., Pham, H. H., Cox, M., Rajkumar, R., & Conway, P. H. (2015). Association of Pioneer Accountable Care Organizations vs traditional Medicare fee for service with spending, utilization, and patient experience. JAMA, 313(21), 2152-2161.
Rowe, J. W., Fulmer, T., & Fried, L. (2016). Preparing for better health and health care for an aging population. JAMA, 316(16), 1643-1644.
Ryan, A. M., Shortell, S. M., Ramsay, P. P., & Casalino, L. P. (2015). Salary and quality compensation for physician practices participating in accountable care organizations. The Annals of Family Medicine, 13(4), 321-324.
Ryan, S. F., & Rosenberg, S. (2015). Nurse practitioners and political engagement: Findings from a nurse practitioner advanced practice focus group & national online survey. Web.
Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D.,… & Jansen, J. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827-834.
Shrank, W. H., Keyser, D. J., & Lovelace, J. G. (2018). Redistributing investment in health and social services — The evolving role of managed care. Web.
Van Parys, J. (2014). How do managed care plans reduce healthcare costs. Web.