Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses

Classmate 1

Dr. Wyse and class,

Value-based insurance (VBI) reimbursement influences clinical outcomes and healthcare expenses by providing financial motivation for patient care to meet certain expectations and goals. Organizations and providers are reimbursed based on the efficiency and outcome of their care – instead of the fact that they provided care (Terrell & Bobbitt, 2020). This model of reimbursement encourages more aggressive interventions to help reduce hospital readmission rates, poor chronic disease management, and healthcare payments for suboptimal care. This reimbursement method serves as motivation for health entities to practice in a way that leads to improved clinical outcomes. However, VBI reimbursement also has some caveats. Healthcare practices are being altered to do more with less as reimbursement requirements become more challenging – which can lead to patient safety concerns and future challenges. For example, chlorhexidine gluconate wipes have been hailed as the savior of central-line-associated bloodstream infections. However, several bacteria are becoming resistant to this preparation – weakening its antimicrobial effects (Leshem et al., 2022). This is creating resistant microbes that will need alternate treatment methods.(Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)

The role of the DNP-prepared nurse in influencing nursing practice with regard to reimbursement is multifaceted. First, nurses should be present where discussions are occurring regarding payment models, reimbursement initiatives, and clinical outcomes for their organizations. Nurses have the unique perspective of understanding the daily patient care setting and what interventions will realistically benefit patients and employees in that environment (Brewington, 2021). Secondly, nurses must be proactive in working together to determine best practices to meet payor standards for reimbursement. DNP-prepared nurses can help analyze the benefits of chronic disease management programs and how improving these services for patients can improve treatment outcomes (Waxman, 2018). Finally, nurses must be included in creating policy that positively improves patient care and organizational sustainability. Increasing economic and financial literacy skills can provide DNP-prepared nurses with the advantageous business knowledge to enhance their ability to lead healthcare organizations.(Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)

References

Brewington, J. G. (2021). The journey: Nurses on boards coalition preparation and support work group. Nursing Administration Quarterly, 45(1), 18–25. https://doi.org/10.1097/NAQ.0000000000000446

Leshem, T., Gilron, S., Azrad, M., & Peretz, A. (2022). Characterization of reduced susceptibility to chlorhexidine among gram-negative bacteria. Microbes and Infection, 24(2), 1-6. https://doi.org/10.1016/j.micinf.2021.104891

Terrell, G. E., & “Bo” Bobbitt, J. D. (2020). Introduction to value-based reimbursement: How to get started. The Journal of Medical Practice Management, 36(2), 64–67.

Waxman, K. T. (2018). Financial and business management for the Doctor of Nursing Practice (2nd ed.). Springer.

CLASSMATE 2

Analyze how value-based insurance reimbursement influences clinical outcomes and healthcare expenses.

Value-based insurance reimbursement influences clinical outcomes and healthcare expenses in several ways. It is a program designed to promote quality care and provide better patient outcomes and experiences (Entress & Anderson, 2020). Healthcare insurance through the Affordable Care Act offers affordable healthcare to many individuals who do not otherwise have access to and coverage for healthcare services (Eriksson et al., 2020)(Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses). Value-based insurance reimbursement is a pay-for-value program that governs the practices of healthcare institutions, and providers, holding them accountable for practicing at high standards and issuing high-quality care to patients (Entress & Anderson, 2020). This is also a way to improve equity and access to care, especially for the underserved, uninsured, and underrepresented populations. VBC governs the cost of standardized services to prevent overpricing for services (Eriksson et al., 2020). It has effectively promoted disease prevention by providing reimbursement incentives for providers and healthcare facilities that put healthcare improvement initiatives in place and promote quality of life for those newly diagnosed with disease or illness and those who have been chronically ill. (Entress & Anderson, 2020 & Eriksson et al., 2020).(Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)

Determine the role of the DNP-prepared nurse in influencing nursing practice regarding reimbursement.

The DNP- prepared nurse is equipped with the knowledge and skills required to impact healthcare on many fronts positively.  The DNP-prepared nurse has the influence as a leader to lead change by redesigning how care is delivered (May et al., 2021). This can be done by influencing clinical practice change as we are currently preparing to do in this program with the implementation of performance improvement and quality initiatives that support healthcare outcomes. As an advocate, the DNP-prepared nurse can take a stand for policy change at the local and national levels through participation and membership on committees that effect change (May et al., 2021). He or she can stand up and sound a voice against practices that do not follow or support healthcare access, and equity, and hold others like lawmakers, institutions, and other providers accountable for providing value and accountable care.  While governing and elevating care practices making sure others are adhering to required standards and ensuring desired outcomes and patients’ needs are met, the DNP-prepared nurse sets the example in all settings even without reimbursement incentive because it is the right thing to do as advanced practice healthcare providers.(Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)

References

Entress, R. M., & Anderson, K. M. (2020). The politics of health care: Health disparities, the Affordable Care Act, and solutions for success. Links to an external site. Social Work in Public Health, 35(4), 152-162. https://doi.org/10.1080/19371918.2020.1767750Links to an external site.(Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)

Eriksson, T., Tropp, H., Wiréhn, A. B., & Levin, L. Å. (2020). A pain relieving reimbursement program? Effects of a value-based reimbursement program on patient reported outcome measures. BMC Health Services Research, 20(1), 805–805. https://doi.org/10.1186/s12913-020-05578-8Links to an external site.(Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)

May, N., Start, R., Ferket, K., Allard, B. L. & Randazzo, G. (2021). Preparing nurse leaders for value-based care: A toolkit to guide practice transformation. The Journal of Nursing Administration, 51(7/8), 355–358. https://doi.org/10.1097/NNA.0000000000001027Links to an external site.(Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)

Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses-Responses

Response to Classmate 1

Thank you for an informative and engaging discussion. I agree that value-based insurance reimbursement offers healthcare providers and organizations financial incentives for patient care to ensure patients get value for their money. The primary aim is to improve healthcare quality and lower costs through these financial incentives that provide healthcare services and consumers options (Yeung, 2019). This approach encourages health plans to cover preventive care, wellness vests, and treatments, including medications to manage blood pressure and diabetes at low or no cost, saving money and reducing future costs on costly medical procedures. Value-based insurance designs align with the ACA of 2010, which focuses on increasing quality and efficiency in healthcare delivery. Nurses play a critical role in healthcare reimbursement. DNP-prepared nurses are equipped with healthcare economics knowledge and are financially savvy to increase the organization’s revenue by increasing reimbursements (Duquesne University, 2018). DNP-prepared nurses understand that increasing healthcare quality and engaging in policy development to increase staff adherence to insurance requirements can help increase reimbursement.(Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)

References

Duquesne University. (2018, July 17).  The Role of Business and Finance as a DNP-Prepared Nurse. https://onlinenursing.duq.edu/role-business-finance-dnp-prepared-nurse/   (Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)

Yeung K. (2019). Value-Based Insurance Design: Current Evidence and Future Directions. Journal of managed care & specialty pharmacy, 25(7), 738–741. https://doi.org/10.18553/jmcp.2019.25.7.738(Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)

Response to Classmate 2

Hello,

Thank you for the great post. I agree that value-based insurance (VBI) reimbursement impacts clinical outcomes by aligning healthcare services with the value concept. This approach was initially designed to increase the cost-sharing of specific treatments. However, the design has shown that it can improve clinical outcomes, even cost-sharing for low-value treatments (Fendrick et al., 2017). Research shows that high-value services are underused, and interventions with minimal marginal benefits are overused because people are required to pay some out-of-pocket amount for health services at some point. However, with VBI, patients are encouraged to select options with more clinical benefits, discouraging low-value services and improving clinical outcomes. Nurses are elemental in implementing value-based systems and designs because they better understand patient needs. DNP-prepared nurses take more leadership roles and, therefore, can influence healthcare quality through policy formulation and other interventions (Duquesne University, 2018). DNP-prepared nurses understand the intricacies of health insurance and reimbursement and can help increase revenue through increased reimbursement.(Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)

References

Duquesne University. (2018, July 17).  The Role of Business and Finance as a DNP-Prepared Nurse. https://onlinenursing.duq.edu/role-business-finance-dnp-prepared-nurse/   (Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)

Fendrick, A. M., Martin, J. J., & Weiss, A. E. (2017). Value-based insurance design: more health at any price. Health services research, 47(1 Pt 2), 404–413. https://doi.org/10.1111/j.1475-6773.2011.01358.x(Comprehensive Essay on the Influence of Value Based Insurance Reimbursement on Clinical Outcomes and Heakthcare Expenses)