The nation’s health reform law—the Patient Protection and Affordable Care Act—may provide the greatest opportunity yet to take to scale some highly successful nurse-led models of care that are improving patient outcomes and reducing health costs.
Two such evidence-based programs were the focus of a moderated discussion with nurse leaders, health policy experts and advocates in late June in Washington, D.C. The event was organized by Raise the Voice, a campaign of the American Academy of Nursing that highlights nurse-led and nurse-designed solutions to improving health care delivery. It is funded by the Robert Wood Johnson Foundation (RWJF).
The two programs served as a springboard for the panelists’ discussion, which was moderated by National Public Radio’s Scott Hensley.
The Living Independently for Elders Center in Philadelphia provides comprehensive care to frail seniors who wish to stay in their own homes. A team of primary care nurse practitioners, physicians, social workers and physical, occupational, art and recreational therapists provide round-the-clock services, including health care, recreational activities, meals, physical therapy and personal care services.
The Family Health and Birth Center in Washington, D.C. serves low-income mothers and their children who receive services provided by midwives and nurse practitioners who are backed by a hospital and physician obstetrical, gynecological and pediatric consultants. The Center has helped reduce the rates of preterm births, low birth weight babies, and c-sections while helping raise the breastfeeding rates among the population it serves.
Panelists also described other care models that are reducing costs, improving outcomes and increasing patient and caregiver satisfaction while serving high-need populations, including seniors, American Indians and Alaskan natives and low-income women and families.
The Patient Protection and Affordable Care Act could pave the way to expand such innovative evidence-based programs that address the needs of underserved populations, several speakers said.
For instance, most Medicare spending is for chronically ill patients who do not have the benefit of care coordination, said Ken Thorpe, Ph.D., professor and chair of the Department of Health Policy and Management in the Rollins School of Public Health at Emory University and co-director of the Emory Center on Health Outcomes and Quality. Some 20 percent of hospital readmissions of Medicare recipients are preventable. Providing preventive services and coordinated care can improve the health of Medicare patients, reducing their hospital readmissions and improving their overall health. That, in turn, can reduce costs, he said.
Tine Hansen-Turton, M.G.A, J.D., chief executive officer of the National Nursing Centers Consortium and a Raise the Voice Edge Runner, noted that coverage may not equal care. She identified a number of potential barriers to successful reform, including insurance companies that do not credential and reimburse nurse practitioners; state laws that prevent nurse practitioners from practicing to their full scope of practice; and the fact that the National Committee for Quality Assurance will not certify nurse practitioners to run medical homes.
Panelists agreed that removing barriers that prevent nurses from working to the full scope of practice should be a high priority. Matt Salo, director of the Health and Human Services Committee of the National Governors Association, noted that the recession is complicating reform implementation. All governors must implement reform by 2014, he said, but no state has a budget that will allow for hiring to do so, he warned. In fact, states are laying-off and furloughing workers rather than hiring.
Ultimately, said Ellen-Marie Whalen, N.P., Ph.D., senior health policy analyst and associate director of health policy at the Center for American Progress, we need to establish a new paradigm for health care delivery. Traditionally, we have considered what is best for the health care system; we now need to look at what is best for the patient.