Running head: QUALITY IMPROVEMENT 1

Quality Improvement

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Quality Improvement

Healthcare Models in Health Settings

With the introduction of Patient Protection and Affordable Care Act (PPACA) of 2010, a

number of provisions or models were integrated to ensure that not only patients receive quality

care, but also seek to relate quality to the cost of care (Haney, 2010). These models were

formulated to respond to the need of having a multipronged approach in patient care since

reducing the cost of care was insufficient. The models answered the needs of healthcare and

recognized nurses as critical in contributing to healthcare as leaders. Nurses form a fundamental

part of a team that ensure success of any patient-centered patient care delivery model. According

to Haney (2010), some of the models that were formulated following PPACA included the

Accountable Care Organizations (ACOs), Medical/health homes, and Nurse-managed Health

Clinics (NMHCs).

Nurse-managed Health Clinics (NMHCs) Model

I work in a Med-surge hospital setting where I witness underserved populations coming

to the hospital with complications costing them more than they can afford. There are expensive

surgeries that are often required to be conducted to manage the conditions these patients are

suffering from. The most effective model for my setting is NMHCs. NMHCs was established by

the PPACA to run a grant program that can fund health clinics managed by nurses. The main

purpose for NMHC was to provide a comprehensive primary health care and wellness to

vulnerable and underserved populations. Today, a number of patients from vulnerable

populations have benefited from this model and governments and health care organizations have

not only been able to cut the cost of care, but also afford quality care.

Advantages of the NMHCs Model

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The advantage of this model is that it is purely an arrangement made by advance practice

nurses (APNs). As provided in PPACA, these nurses have to be associated with universities,

colleges, schools, health facilities certified by the federal authority, social service agencies or an

independent nonprofit health (Haney, 2010). Nurse practitioners have the necessary skills and

capacity to propose a change model in the way primary care is given to patients. Within this

model, health care systems and the government are able to optimize patient outcomes while

containing healthcare costs. Primary care delivered by nurses has been shown to be cost-

effective. As the government strains to “bend the cost curve” this is a model that can be adopted

in the health setting where I work. Owing to the above reasons, this model has been used by

governments and healthcare organizations to tame cost and increase patient outcomes.

The Negative Side of the NMHCs Model

While NMHCs model has helped offer critical healthcare services to communities, they

have been challenged for being invisible and their financial unsustainability. Unlike Federally

Qualified Health Centers (FQHCs), NMHCs are known to intensely rely on donations and grants

from contracts and the private sectors (Pohl, Tanner, Pilon & Benkert, 2011). FDHCs often have

access to a significant amount of federal support which is based on the cost incurred while

serving the vulnerable and the underserved populations. As Pohl et al (2011) point out, NMHCs

are additionally challenged by a plethora of regulations imposed by the federal and state

government, as well as other third-party insurers. These regulations have been seen to

disadvantage the nurse practitioners serving as primary care providers. Although these demerits

do exist in the model, support should be revamped to ensure vulnerable populations have access

to affordable and quality care.

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References:

Haney, C. (2010). New care delivery models in health system reform: Opportunities for nurses

and their patients. Retrieved 24th January, 2017, from:

http://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-

Resolutions/Issue-Briefs/Care-Delivery-Models.pdf

Pohl, J.M., Tanner, C., Pilon, B., & Benkert, R. (2011). Comparison of nurse managed health

centers with federally qualified health centers as safety net providers. Policy, Politics &

Nursing Practice, 12(2):90-99