Hello. My name is Gina. I live in the sunny state of Florida. I celebrated my 31st wedding anniversary
this year and am the proud mother of five grown children. Two of our children are married, we have two
(expecting one more) grandchildren. My oldest son just started law school (wife just finished med
school), son number four graduates in May from the Eastman School of Music (opera singer). The last
son just returned from summer study abroad in Beijing, China and starts back to school as a junior at
Emory University. Yes. I am almost an empty nester!
I am currently completing the Health Care Management Certificate to polish and update my knowledge
base and writing skills (APA is always changing). I have an MBA (2006) and I have over 30 years of
Healthcare experience from clinical to administrative. At this season of my life I now have the time to
just “do me.” I love gardening (my red and pink hibiscus are gorgeous) and exercising (yoga, walk/jog
three days a week). This is my first course at Liberty University, and I look forward to learning alongside
each of you.
Your plan after this course (For example: How many courses to graduation? Do you plan to begin a new
job as a result of your degree? Do you plan to continue your education towards a higher degree?)
What you would like to learn from this course?
Post 1
For decades, health care policy experts have wrestled with ways to solve problems of access, cost, and
quality in US health care. The current consensus is that the solution to all three lies in changing financial
incentives for providers and delivering care through integrated systems. The currently favored vehicle for
this, both in the public and private sectors, is through Accountable Care Organizations (ACOs). Medicare
has several models and has fostered rapid growth in the number of operative ACOs. At least an equal
number of private ACOs are in operation. Whether or not these organizations will fulfill their promise is
unknown but there is reason for cautious optimism. Allergists can and should be part of the process of
this transformation in our health care system. They can be integral to helping these organizations save
money by reducing hospitalizations and improving the quality of allergy and asthma care in the
populations served. In order to accomplish this, allergists must become more involved in their medical
communities and hospitals.
Barnes, A. J., Unruh, L., Chukmaitov, A., & van Ginneken, E. (2014). Accountable care organizations in the
USA: Types, developments and challenges. Health Policy, 118(1), 1–7.
https://doi.org/10.1016/j.healthpol.2014.07.019
Little is known about new partnerships formed under the ACO model.
Lewis, V. A., Tierney, K. I., Colla, C. H., & Shortell, S. M. (2017). The new frontier of strategic alliances in
health care: New partnerships under accountable care organizations. Social Science & Medicine, 190, 1–
10. https://doi.org/10.1016/j.socscimed.2017.04.054
The study evaluated 785 hospitals which operate ACO in contrast to 1,446 hospitals without an ACO.
Findings In total, 89 percent of hospitals using ACO’s are located in urban communities and 87 percent
are not-for-profit. Hospitals with a higher case mix index are more likely to have an ACO. Practical
implications ACOs allow healthcare organizations to expand their geographic markets, achieve greater
efficiencies, and enhance the development of new clinical services. They also shift the focus of care from
acute care hospitalization to the full continuum of care. Originality/value This research found ACOs with
hospital and physician networks are an effective mechanism to control healthcare costs and reduce
medical errors.
Jeffrey Harrison, author, Aaron Spaulding, author, & Debra A. Harrison, author. (2018). Accountable care
organizations: a strategy for future success? International Journal of Organization Theory & Behavior, (2),
113. https://doi.org/10.1108/IJOTB-03-2018-0019
Thank you Fredrick for your response and insight.
Shi and Singh (2019) emphasized the focus of the Affordable Care Act is to improve health care and
lower costs. Specifically, to manage these costs patients especially with chronic diseases are assigned to
Accountable Care Organizations. For example, about 6 million patients on Medicare receive care in an
ACO (p. 6). However, little is known about new partnerships formed under the ACO model ( Lewis,
Tierney, Colla & Shortell , 2017). In a recent study Jeffrey, Aaron and Harrison (2018) reported 785
hospitals had ACO’s and 89 percent of the hospitals were in urban communities and 87 percent were
not-for-profit.
Although much discussion is written regarding the ACO models for Medicare beneficiaries, there are
other populations that may also benefit from the structuring or integrating of care. It is quite common
for patients with multiple conditions to seek healthcare services from various practitioners and none of
which know that such medications or recommendations have been prescribed. Such duplication of
services is not only costly but dangerous for the patient. The ACA encourages doctors and hospitals to
work together and coordinate services (Shi and Singh, 2018, p. 6). However, Barnes, Unruh, Chukmaitov,
and van Ginneken (2014) posited whether or not these organizations will fulfill their promise is unknown
but there is reason for cautious optimism.
Regardless to the challenges of the Accountable Care Organizations, the bible offers instructions
regarding the values or coordinating and organizing. I Corinthians 14:40 says “But all things must be
done properly and in an orderly manner.”
References
Barnes, A. J., Unruh, L., Chukmaitov, A., & van Ginneken, E. (2014). Accountable care organizations in the
USA: Types, developments and challenges. Health Policy, 118(1), 1–7.
https://doi.org/10.1016/j.healthpol.2014.07.019
Jeffrey Harrison, author, Aaron Spaulding, author, & Debra A. Harrison, author. (2018). Accountable care
organizations: a strategy for future success? International Journal of Organization Theory & Behavior, (2),
113. https://doi.org/10.1108/IJOTB-03-2018-0019
Lewis, V. A., Tierney, K. I., Colla, C. H., & Shortell, S. M. (2017). The new frontier of strategic alliances in
health care: New partnerships under accountable care organizations. Social Science & Medicine, 190, 1–
10. https://doi.org/10.1016/j.socscimed.2017.04.054
Shi, L., & Singh, D. (2019). Essentials of the U.S. Health Care System. Burlington, MA: Jones and Bartlett
Learning.
Post 2
Thank you, Danielle!
You shared “The success of all ACO’s include individuals learning to take more responsibility for their
own health.”
Since the introduction of Medicare and Medicaid in 1965, the American health care system has steadily
grown in complexity and cost (Gillick, 2017). The government established the Affordable Care Act in 2010
to manage the cost and quality of healthcare. However, these changes demand certain requirem-ents
from practitioners and patients. For example, for practitioners, these changes:
“will most likely demand more paperwork, changing protocols, learning and implementing new
policies, accepting new work schedules, implementing new quality standards, and pursuing
additional education or credentials. Unlike never before more emphasis will be placed on
measuring and reporting on the quality of the care we deliver in our labs, intensive care units,
and operating rooms” (Galloway, 2014).
The patient will need to be more knowledgeable of their medical needs, the insurance coverage
available for certain tests and procedures, as well as the knowledge base of the practitioner. It is not
uncommon for healthcare providers to order lab tests and procedures that was previously ordered by
another physician, however, the information never relayed. Hence, the insurance company refuses to
cover the payment and the patient is left with the bill. Proverbs 16:16 says “How much better is it to get
wisdom than gold! And to get understanding rather to be chosen than silver!
Shi and Shingh (2019, p. 7) explained collaboration is challenging “ due to cultural and clinical
differences between primary and behavioral health providers.” Hopefully however, patients working with
Accountable Health Organizations will benefit from integrated care and such scenarios of lack of accurate
information and decrease in unnecessary duplicate billing .
Reference:
Gillick, M. R. (2017). Old and Sick in America : The Journey Through the Health Care System. Chapel Hill:
The University of North Carolina Press. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&AuthType=shib&db=e864sww&AN=1613606&site=eds-live&scope=site
Galloway, S. G. (2014). Kathleen Mears Memorial Lecture: Personal Accountability: Your Key to Survival in
Health Care Reform. Neurodiagnostic Journal, 54(3), 211–226.
https://doi.org/10.1080/21646821.2014.11106806
Shi, L., & Singh, D. (2019). Essentials of the U.S. Health Care System. Burlington, MA: Jones and Bartlett
Learning.
Post Forum 2
What purpose does an understanding of the history of health care delivery serve?
In the book of Ecclesiastes 1:9, rabbinic scholars believe that King Solomon wrote, “What has been is
what will be, and what has been done is what will be done, and there is nothing new under the sun
(ESV). With respect to the need for health care services, the human body will always suffer from various
ailments and will always need care. Shi and Shingh (2019) shared scholars examine the history of the
health care delivery system in order to better meet the demands of the growing population (p. 50). For
example, historically, health care givers (such as a neighboring mid-wife or any persons with
the knowledge of herbs and concoctions) offered services to the sick in the home. Doctors came to the
homes only for the very serious illnesses untreatable by locals. Doctors charged low prices and often on
installments.
Economically, rural area patients sometimes paid for care with animals, baked goods, services or other
types of bartering (think of “Little House on the Prairie or the “Waltons” television shows). Later
hospitals existed yet they existed as religious and altruistic establishments that served poor people, the
mentally challenged and the aged. Emergency clinics relied upon affluent network supporters for
financing, and medical clinic staff individuals were primarily volunteers. Historical events that improved
health care quality during the years 1860–1960, including innovation in health care financing, care
delivery and workforce diversity (Sheingold & Hahn, 2014) However, today, “In the United States, the
financing of health care delivery is a tangled web of insurance companies, employers, state and federal
government, and individual health care consumers” (Kreidler, 2018).
Which factor or factors have been predominant in shaping U.S. health care?
In the 21st Century, health care systems across the world are focusing policy efforts on improving the
quality of healthcare delivered to their population (Sheinhold & Gold, 2014). According to Shi and
Shingh (2019, p. 51), some of the factors that have been dominant in shaping U. S. health care include:
the social fabric of the American society, technological advances, economic constraints, political
opportunism and ecological forces factors
The Social Fabric of the U.S.: America’s social fabric is made of a diverse body of people from all over the
world. The diversity is due to demographic shifts, immigrants, health status and urbanization. For
example, Davis and Roberts (2010) reported “the Baby Boomer generation is composed of 78 million
Americans who are just beginning to reach their retirement years. Most Boomers have at least one
chronic health problem, and these significantly increase the expense of providing medical care”.
Technological Advances: The US is one of the most technologically advanced countries in the world. The
advances are in scientific research, new treatments, facilities and equipment and information
technology. However, these advancements have caused rapid increases in the cost of health care
services
Economic Constraints: Some of the economic constraints include the rising health care costs (as
mentioned earlier), Private and public health insurance, and family incomes.
Political opportunism: Health care policy decisions are generally based on the President’s agenda,
political maneuvers, power of interest groups, laws and regulations, and political party ideology. For
example. President Obama initiated the Affordable Care Act in 2010 to help provide access to health care
services to Americans who otherwise would not be able to receive care.
Ecological forces: New diseases shape US healthcare, drug resistant infections and Global and Transport.
For example, new infectious diseases such as, SARS, MERS, Ebola, chikungunya, avian flu, swine flu and
Zika US healthcare require additional training for health care workers for the identification and
treatments for these new diseases. In addition, costs related to pharmacological treatments, isolation
and hospitalization and many other services need for the infected population.
Is EBM a worthy goal for U.S. health care delivery? Why or why not?
Liu, Ni, Jia, Wan and Tang (2018) shared “Evidenced- based Medicine whose philosophical origins extend
back to mid-19th century Paris and earlier, is the conscientious, explicit and judicious use of current best
evidence in making decisions about the care of individual patients.” I suggest that is a worthy goal for the
U.S. health care delivery as it provides a strong foundation for the administration for health care
services.
Reference:
Davis, G. L., & Roberts, W. L. (2010). The healthcare burden imposed by liver disease in aging Baby
Boomers. Current Gastroenterology Reports, 12(1), 1–6. https://doi.org/10.1007/s11894-009-0087-2
Kreidler, M. L. (2018). Financing of Health Care Delivery. Financing of Health Care Delivery -- Research
Starters Business, 1. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&AuthType=shib&db=e6h&AN=29964524&site=eds-live&scope=site
Liu, W., Ni, M., Jia, W., Wan, W., & Tang, J. (2018). Evidence-based medicine in neurosurgery: an
academic publication view. Neurosurgical Review, 41(1), 55–65. https://doi.org/10.1007/s10143-016-
0742-7
Sheingold, B. H., & Hahn, J. A. (2014). The history of healthcare quality: The first 100 years 1860–1960.
International Journal of Africa Nursing Sciences, 1, 18–22. https://doi.org/10.1016/j.ijans.2014.05.002
Shi, L., & Singh, D. (2019). Essentials of the U.S. Health Care System. Burlington, MA: Jones and Bartlett
Learning.
Week 2 Post 2 Reply1
Thank you for your post Bonnie!
You shared: Regarding the statistics on illnesses, diseases, and medications- “Without knowing these
statistics from 2012, we would not know if the medications and treatment plans patients are receiving
are working and healing them more than they were in the previous years.”
“Over half of Americans have a chronic illness, with 25% having more than one. For both clinical and
economic reasons, the increasing number of persons living with chronic conditions represents a public
health issue of growing importance” (Anekwe & Rahkovsky, 2018). Patients with chronic diseases require
continuous medical attention from health care practitioners and often high cost medications. To meet
the needs of this growing population, the government created Medicare and Medicaid, however, this
cost had created a burden for federal and state budgets (Shi & Singh, 2019, p. 67).
Employers can use historical healthcare statistics for the development of Employee wellness programs.
The company can better manage health care expenditures by monitoring the health statistics of
employees. “Wellness programs focus on either disease management; treating chronic illnesses, such as
hypertension and diabetes; lifestyle management; or preventing chronic illnesses through health
promotion” (Saliba & Barden, 2017). The scriptures discuss the importance of healthy living. The apostle
Paul exhorted the Corinthian church in 1 Corinthians 6:19-20 “Do you not know that your bodies are
temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you
were bought at a price. Therefore, honor God with your bodies” (NIV).
Many people with chronic conditions are learning how to track their own conditions with tools such as
electronic blood pressure monitoring devices or continuous glucose monitoring or using apps to track
activity levels. However, “although technology facilitates tracking, limited evidence supports the efficacy
of specific tools to accomplish successful illness management” (Anekwe & Rahkovsky, 2018).
Health care statistics are also be used as you mentioned in the treatment plans for patients. For
example, in a study on hopelessness and perception of patients diagnosed with cancer, researchers were
able to use the scores based on the Beck Hopelessness scale to determine how to provide certain types
of support for patients with cancer (Nehir, Tavşanli, Özdemir & Akyol, 2019). Proverbs 17: 22 says “A
cheerful heart is good medicine, but a broken spirit saps a person’s strength” (NLT). Therefore, providing
services (or medication support) to cheer a patient’s heart could provide healing and decrease economic
demands as well. The health care statistics could also be broken done into categories, such as age, race,
types of cancer, sex, nationality etc. Detailed demographics could aid practitioners to be more specific
with treatments.
Reference:
Anekwe, T. D., & Rahkovsky, I. (2018). Self-Management: A Comprehensive Approach to Management of
Chronic Conditions. American Journal of Public Health, 108, S430–S436.
https://doi.org/10.2105/AJPH.2014.302041r
Nehir, S., Tavşanli, N. G., Özdemir, Ç., & Akyol, T. (2019). A Determination of Hopelessness and the
Perception of Illness in Cancer. Omega: Journal of Death & Dying, 79(2), 115–131.
https://doi.org/10.1177/0030222817704336
Saliba, Y., & Barden, S. (2017). Counselors and Workplace Wellness Programs: A Conceptual Model.
Professional Counselor, 7(2), 104–113. Retrieved from http://search.ebscohost.com/login.aspx?
Shi, L., & Singh, D. (2019). Essentials of the U.S. Health Care System. Burlington, MA: Jones and Bartlett
Learning.
Week 2 Post 2. Reply 2
The bill for health care products and services is largely paid collectively by society through insurance and
taxes (Emanuel, 2018). These costs are including but not limited to medical care, diagnostic care, medical
procedures, medications, transportation, case management, surgical interventions etc. (Stajduhar, Cary,
Choppa, & Gamez, 2019). However, for the general public these charges are rarely seen because many
(not all) have insurance and are only required to pay co-payments and meet deductibles for medical
services.
For example, the exact costs of pharmaceuticals are not known to the average consumer. Emanuel
(2018) explained “health care costs essentially are prices multiplied by volume. No category of spending
accounts for as much of the cost difference between the United States and other high-income countries
as pharmaceuticals. Moreover, the total US pharmaceutical expenditures are $1443 per capita. In
comparison, total spending on drugs in Germany is $667 per capita; in the Netherlands, $466 per capita;
and in Sweden, $566 per capita. These differences are almost all a result of prices, not volume.”
I believe that pharmaceutical companies directly market their products to consumers to encourage them
to push their providers to write prescriptions for a medication. Often drug manufacturers advertise their
products in magazines and commercials with well known actors or pop stars to develop interest for the
products. Pharmaceutical companies send free samples to doctors’ offices, offer lunches or parties for
health care workers or sponsor large scale events to market their products. In the end, drug
manufacturers can demand whatever price they want for the product and the consumer (via copay,
insurance, and out of pocket costs) will continue to pay the bill. No questions asked-if they feel that the
drug is needed.
Another area for healthcare cost inflation is in the area of imaging. Healthcare in the US is highly
specialized (Shi and Singh, 2019, p. 52). It is quite common for patients to go to physicians with (for
example) a stomachache and the physician orders several high-priced images (xrays, ct scans, MRIs, bone
scans, barium enema scans and numerous other diagnostic tests) costing the consumer thousands of
dollars. This may be due to the concern of physicians that they could be sued for millions of dollars if a
medical illness is “missed.” Emanuel (2018) posited “imaging, accounts for approximately 7% of the cost
difference between the United States and the Netherlands and again is the result of both high prices and
high volumes and that reducing average computed tomography and magnetic resonance imaging scan
prices by 33% could reduce overall health care costs by an estimated $118 per capita.”
Proverbs 11:14 says “Where there is no guidance, a people falls, but in an abundance of counselors there
is safety” (ESV). I believe that it is our responsibility to pool together our knowledge and resources to
create a healthy community where the wealthy and the marginalized can benefit.
Reference:
Emanuel, E. J. (2018). The Real Cost of the US Health Care System. Obstetrical & Gynecological
Survey, 73(8), 449–451. https://doi.org/10.1097/01.ogx.0000544554.59124.26
Shi, L., & Singh, D. (2019). Essentials of the U.S. Health Care System. Burlington, MA: Jones and Bartlett
Learning.
Stajduhar, L. E., Cary, J. R., Choppa, N. J., & Gamez, J. N. (2019). Performing a Review of Past Medical Bills
to Determine the Reasonableness of Costs. Journal of Life Care Planning, 17(2), 51–55. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&AuthType=shib&db=ccm&AN=137994231&site=eds-live&scope=site
Week3 Post 1 Initial
“Health care providers face pressure to reduce costs and enhance patient satisfaction. One approach is
to employ primary care providers such as nurse practitioners and certified nurse midwives” (Kraus &
DuBois, 2017). Although Non-Physician practitioners (NPs and CNMs) receive less advanced training
than physicians in many instances of primary care, they can substitute for physicians (Shi and Singh,
2019, p. 90).
Nurse Practitioners:
Nurse Practitioners, Shi and Singh (2019) explained are people who have completed a program of study
leading to the competence as RNs in an expanded role. The original concept of the NP role was to
expand nursing practice in order to provide high-quality, accessible health care to patients (Ryder, Jacob
& Hendricks, 2019). “The shortage of primary care providers and the provisions of the Affordable Care
Act (ACA) have spurred discussion about expanding the number, scope of practice (SOP), and
independence of primary care nurse practitioners (NPs). Such discussions in the media and among
professional organizations may insinuate that changes to the laws governing NP practice will engender
acrimony between practicing physicians and NPs. However, we lack empirical, descriptive data on how
practicing professionals view NP independence in primary care” (Kraus & DuBois, 2017).
Wolff-Baker & Ordona (2019) posited nurse practitioners (NPs) provide more than 825,000 Home Based
Primary Care (HBPC) visits per year. Their training and education uniquely prepare them to address
whole person aspects of health, including medical, psychosocial, and quality of life realms. Despite
proven benefits of NPs providing HBPC, Medicare regulatory barriers disallow NPs from certifying or
recertifying Medicare home health or certifying terminal illness for hospice patients. These barriers
decrease patient access to timely care and increase Medicare costs. Family nurse practitioners are also
an essential member of the military medical team. They were incorporated into the Army medical
system almost as soon as there was an academic program to develop the role in primary care settings
(Kraus & Dubois, 2017).
Certified Nurse Midwives
Midwifes were first discussed in the scriptures in Exodus 1:17. Pharaoh commanded Shifra and Puah
(Jewish midwives) to kill all newborn Jewish boys. The scriptures say, “The midwives, however, feared
God; so they did not do as the king of Egypt had spoken to them, but they enabled the boys to live”
(NIV). “Such attendants were probably then (1 Samuel 4:20), as they usually are now, the older female
relatives and friends of the mother. The duties which they had to perform are enumerated in (Ezekiel
16:4) division of the cord, washing the infant in water, salting with salt and swathing in swaddling
clothes” (Bible Study Tools, 2019).
Certified nurse midwives are registered nurses with additional training from a midwifery program (Shi &
Singh, 2019). Fullerton, Schuiling, and Sipe (2019) explained facing rising numbers of insured with
implementation of the Affordable Care Act, policy makers are interested in building teams of providers
that can accommodate a growing demand for primary care services. Certified nurse-midwives are
designated by nursing professional organizations as advanced practice nurses. The United States nursing
profession is advancing toward adoption of the Doctor of Nursing Practice degree, as the entry into
practice credential for advanced practice nursing. There is no evidence to date to demonstrate
differences in clinical practice outcomes between certified nurse-midwives and certified midwives
(Fullerton, Schuiling, & Sipe, 2019).
Interestingly, across the globe, midwives are the largest group of maternity care providers despite little
known about midwifery practice. Hastings-Tolsma et al. (2018) found in a survey completed by 141
midwives that most were older, Caucasian and held a master's degree. A majority worked full-time, were
in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was
most commonly provided for Hispanic and White women; approximately a quarter could care for greater
numbers of patients. An ageing midwifery workforce, not representative of the race/ethnicity of the
populations served, is underutilized with practice requirements that limit provision of services. Hastings-
Tolsma et al. argued health policy changes are needed to ensure unrestricted practice.
Reference:
Bible Study Tools. (2019). Midwife Defined. Retrieved from
https://www.biblestudytools.com/dictionary/midwife/
Fullerton, J. T., Schuiling, K. D., & Sipe, T. A. (2019). The doctorate of nursing practice and entry into
midwifery practice: Issues for consideration and debate. Nurse Education in Practice, 36, 97–100.
https://doi.org/10.1016/j.nepr.2019.02.001
Hastings-Tolsma, M., Foster, S. W., Brucker, M. C., Nodine, P., Burpo, R., Camune, B., … Callahan, T. J.
(2018). Nature and scope of certified nurse-midwifery practice: A workforce study. Journal of Clinical
Nursing, 27(21–22), 4000–4017. https://doi.org/10.1111/jocn.14489
Kraus, E., & DuBois, J. M. (2017). Knowing your limits: A qualitative study of physician and nurse
practitioner perspectives on NP independence in primary care. Journal of General Internal Medicine,
32(3), 284–290. https://doi.org/10.1007/s11606-016-3896-7
Ryder, M., Jacob, E., & Hendricks, J. (2019). An inductive qualitative approach to explore Nurse
Practitioners views on leadership and research: An international perspective. Journal of Clinical Nursing,
28(13–14), 2644–2658. https://doi.org/10.1111/jocn.14853
Shi, L., & Singh, D. (2019). Essentials of the U.S. Health Care System. Burlington, MA: Jones and Bartlett
Learning.
Wolff-Baker, D., & Ordona, R. B. (2019). The Expanding Role of Nurse Practitioners in Home-Based
Primary Care: Opportunities and Challenges. Journal of Gerontological Nursing, 45(6), 9–14.
https://doi.org/10.3928/00989134-20190422-01
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