Examine the relationship between healthcare coverage (insurance), quality care, and reimbursements (payments) to health care organizations. Select two different major national (U.S.) insurance health plans. You may choose Medicaid, Medicare, HMO, PPO, or private insurance plans. You can choose your own personal insurance plan if you prefer. Review healthcare coverage options offered by both plans that benefit (facilitate) and hinder (limit) access to care. Examples of healthcare coverage (insurance) options that facilitate, or limit access include medication coverage, primary care physician office visits, specialist’s physician office visits, emergency care, lab or blood work and diagnostics, wellness care, prevention services or surgery (these are just a few examples). You will also explore the role of Diagnosis Related Groups (DRGs) and charity care within healthcare facilities (hospitals) and how charity care impacts the vulnerable or uninsured population. Finally, summarize nursing interventions or considerations for your selected patient to provide high quality, safe healthcare considering nursing-sensitive indicators in his/her unique scenario.
National Health Coverage Plans, Reimbursements, and Quality
Baccalaureate education includes learning opportunities of healthcare policy, finance, and regulatory environments (AACN, 2008).
Introduction & Healthcare Coverage and Vulnerable Populations
Describe the importance of healthcare coverage (insurance).
End with a clearly worded purpose statement for this project.
Discuss two ways healthcare coverage is beneficial (helpful) for the vulnerable/ uninsured populations.
Diagnosis Related Groups
Describe the purpose of Diagnosis Related Groups (DRGs).
Explain the impact of DRGs on length of stay and payment of services.
Discuss how payments for DRGs are now impacted by quality indicators and measures.
Select a Major Healthcare Plan
(Label heading with the name of the plan Ex: Preferred Provider Option Plan)
Summarize two care options provided by the plan that facilitates access for your selected patient. Summarize two care options that limit access to care for your selected patient.
Select a Second Major Healthcare Plan
(Label heading with the name of the plan Ex: Medicaid)
Repeat this activity with the same patient. Summarize two care options provided by the second plan that facilitates access for your selected patient. Summarize two care options that limit access to care for your selected patient.
Impact of Nursing Interventions
Summarize at least four priority nursing interventions or considerations to promote self-care for your selected patient to provide high quality, safe healthcare considering nursing-sensitive indicators. Provide a rationale for each of your selected nursing decisions.
Conclusion