Reflection on Learning

Q1: Healthcare reimbursement has a significant influence on my nursing practice. Reimbursement directly affects patient care and the subsequent outcomes. Typically, the partial or total cost of a patient’s healthcare is either paid by the government or a health insurer. However, there are individuals who lack healthcare coverage and must reimburse the entire cost of the healthcare services they receive. When the healthcare institution is effectively reimbursed for the services it provides, it is able to pay its employees on time and purchase the required resources needed for healthcare services (Patterson, 2017). As a nurse, when the institution I work for is reimbursed as required, then I can carry out my duties more effectively since I have all the necessary material I require. More so, when all staff members are paid on time, their job performance and overall satisfaction are high. This translates to better service to patients. Thus, reimbursement has a direct impact on the effectiveness of my nursing practice.

Q2: The value-based insurance design (VBID) greatly influences clinical outcomes and cost issues. The VBID Model facilitates the modernization of the Medicare Advantage (MA) while working to lower costs and improve health outcomes for the enrollees of MA. The VBID Model ensures that Medicare Advantage Organizations (MAOs) can target benefit design to MA patients on the basis of socioeconomic characteristics and chronic conditions (Ma et al., 2019). Also, it incentivizes the utilization of the benefits of Part D prescription drugs through rewards. Medicare hospice benefits may also be offered by MAOs as part of the VBID. Another importance of the VBID Model is that it ensures all participating plans engage their clients via timely and structured healthcare and wellness planning, for instance, advanced care planning. (Yeung, 2019) All these benefits offered by VBID ensure that the model improves the clinical outcomes of patients while keeping any associated costs at a minimum.

References

Ma, Q., Sylwestrzak, G., Oza, M., Garneau, L., & DeVries, A. R. (2019). Evaluation of value-based insurance design for primary care. Am J Manag Care, 25(5), 221-227.

Patterson, M. (2017). Review of literature: The clinical nurses’ perception of their role in hospital reimbursement. Pursuit-The Journal of Undergraduate Research at the University of Tennessee, 8(1), 12.

Yeung, K. (2019). Value-based insurance design: current evidence and future directions. Journal of managed care & specialty pharmacy, 25(7), 738-741.