National Health Coverage Plans, Reimbursements, and Quality
National Health Coverage Plans, Reimbursements, and Quality
For this assignment, you will examine the importance of healthcare coverage (insurance). You will also examine how reimbursements (payments) from health plans are impacted by quality of care. Start by selecting two 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. You will review coverage options offered by both plans that benefit and hinder patient’s access to care. Examples of coverage options that facilitate or limit access include medication coverage, primary care physicians, specialists, emergency care, lab or blood work and diagnostics, wellness care, prevention services, surgery (these are just a few examples). You will also explore the role of Diagnosis Related Groups (DRGs) and charity care within healthcare facilities and how charity care impacts the vulnerable or uninsured population.
**We will not discuss deductibles and costs of the plans as this will not be the focus of this this assignment.
This assignment requires a minimum of four current (no more than 10 years old), relevant, peer-reviewed, references. Prepare a 3-5 page (does not include title page and references page) APA formatted paper (no more than 5 pages)
OR
6-7 slide power point presentation (does not include title or reference slides) following the rule of 7 (no more than 7 bullet points per slide, no more than 7 words per line) using the presenters notes section in proper APA format
addressing the following:
Introduction
Write an introductory paragraph that describes the importance of healthcare coverage (insurance). End with a clearly worded purpose statement.
Healthcare Coverage and Vulnerable Populations
Discuss two ways healthcare coverage would be beneficial (helpful) for the vulnerable/ uninsured populations.
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 the patient. Summarize two care options that limit access to care for the patient.
Select a Second Major Healthcare Plan – (Label heading with the name of the plan)
Summarize two care options provided by the plan that facilitates access for the patient. Summarize two care options that limit access to care for the patient.
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 of care.
Charity Care
Describe the role of charity care within an acute care health facility (hospital). Discuss how vulnerable populations and the uninsured are helped (impacted) from the charity care provided by healthcare facilities (hospitals). Explain how charity care can benefit the facility.
BSN410 Healthcare Delivery and Quality Outcomes
Module 5 Assignment
Global Health Goals and Health Disparities
This assignment is designed for you to examine global health goals and health disparities. You will select one Millennium Developmental Goal (MDG) and explore a specific outcome measurement (indicator) for a country of your choice to determine the progress towards achieving the MDG. In addition, you will explore nursing roles that would be helpful in achieving the MDG.
We use the term “health disparities” to describe the phenomenon of different health outcomes of varied groups within a particular community. Access the Virtual Library and search in the CINAHL full text database the term “health disparity.” Choose at least two articles that describe health disparities of a particular population or group of people (gender, ethnic, or cultural minority).
This assignment requires a minimum of two current (no more than 10 years old), relevant, peer-reviewed, references.
Prepare a 3-5 page (does not include title page and references page) APA formatted paper (no more than 5 pages)
Or
6-7 slide power point presentation (does not include title or reference slides) following the rule of 7 (no more than 7 bullet points per slide, no more than 7 words per line) using the presenters notes section in proper APA format
addressing the following:
Introduction
Include an introductory paragraph that explains the importance of the World Health Organization and the Millennium Developmental Goals (MDGs). Provides details. End with a clearly worded purpose statement.
Global Health Goals
Select one MDG and include a description of that goal and discuss how the MDG is important to global health.
Country and Goal Progress
Select any country (from module four list). Explain the country’s current status in relation to the outcome measurement being used to represent progress of the chosen MDG. Describe how the country is on track to meet this MDG or not. Include data and details.
Nursing Roles
Select two nursing roles and explain how each role can help the country achieve the chosen MDG. Provides details.
Health Disparity and Findings
Explain the term health disparity and discuss how health disparities can impact vulnerable or underserved populations. Choose one population or particular group (ethnic or cultural, underserved, vulnerable group) and describe a health disparity occurring among this group. Includes evidence, facts, and details.
Nursing Strategies
Discuss how nursing can help to eliminate this disparity or health inequality. Discuss two nursing strategies for improving the health disparity or health inequality (such as access to care, health education, health promotion and prevention, earlier screenings).
.
BSN410 Healthcare Delivery and Quality Outcomes
Module 7 Assignment
Final Project
Health Care Priority Issue
For our final project, we will examine how priority healthcare issues should be examined by nursing. We will select a key healthcare priority issue and a population. You will find articles that describe nursing interventions designed to improve patient outcomes for your population and healthcare priority issue. Finally, you will discuss why Quality Improvement is important for patients and then you will describe how nursing values can be used to help improve patient care. Write a 5-7 page APA style paper (excluding title page and reference page). No more than seven pages of content will be accepted. A minimum of five scholarly references will be required.
Access the Priority Areas for National Action: Transforming Health Quality and read Chapter 3: Priority Areas for Quality Improvement, pages 41-45.
Select ONE priority area (priority healthcare issue) and identify a population you would like to explore. Conduct research to locate information to write about the following:
Specifically, the paper should include the following components:
Health Care Priority Issue
Identifies a healthcare priority issue. Describes the healthcare priority issue, the population it involves, and significance of the healthcare issue by using specific facts and details. Ends with a clearly worded purpose statement.
Rationale and Importance to Nursing
Discuss the rationale for choosing the priority healthcare issue and describe why this issue is important to nursing. Provides details.
Nursing Interventions and Outcomes
Clearly identify two nursing actions or interventions designed to improve care that is measured in patient outcomes. From two nursing articles, select a total of two (no more or less than two) key nursing interventions that improved patient outcomes and explain how the nursing interventions improved each of the two patient outcomes. Provide details.
Quality Improvement Initiative and Patient Care
Using the interventions from the articles/studies, describe how you would recommend a Quality Initiative (QI) to improve patient care within a healthcare facility (hospital) and explain why this QI would be important to implement for patients. Provides details.
Nursing, Quality, and Outcomes
Discuss why it is important for nursing to be involved in quality initiatives and explain how two professional nursing values can help to improve patient care. Provides details
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