Introduction
In recent years, quality has become one of the main topics of discussion in improving health care. In today’s society, the public health industry is defined as a market economy, which raises the question of financial incentives in this area. Moreover, this practice includes reimbursement issues for people in need of medical care. Thus, society is focused on creating payment programs that could make life easier for patients and improve the health care system.
Brief History
As mentioned above, improving the quality of health care is a debatable issue. In this regard, it seems necessary to introduce payment programs. Such programs are aimed at rewarding those health care providers who provide clients with the highest quality service. They support the achievement of many goals, including increasing successful patient care, reducing the cost of medical services, and improving the level of health among the population. One such introduction is the establishment of the Managed Care Organizations (MCO) and Accountable Care Organizations (ACO) programs.
MCO is one of the oldest payment programs and has been successfully operating in the country for a long time. The very beginning of managed care can be traced back to around 1929 (Daniel-Robinson & Moore, 2019). During this time, Oklahoma State physician Michael Shadid came up with the idea of founding a medical cooperative (Daniel-Robinson & Moore, 2019). It was aimed at supporting the population who do not have nearby hospitals or specialized doctors to provide qualified assistance. Shadid initiated a fundraiser to open a general hospital and put together the necessary payment schedule to cover the costs. Thus, by 1934, the population supported the staff, due to which the number of specialist doctors expanded (Daniel-Robinson & Moore, 2019). After that, the program continued to develop throughout the country and supported the population in need of assistance.
Accountable Care Organizations is a more modern branch of payment programs and is relatively recent. The term itself appeared in 2006 and was proposed by Dr. Elliott Fisher (Kaufman et al., 2019). This happened during a public meeting where Medicare payment issues were discussed. Fisher and other medical professionals agreed with the view that health care providers should share the responsibility of caring for patients in order to achieve the best quality in healthcare. Since 2010, the program has continued to steadily expand and infiltrate the healthcare market.
Populations MCO and ACO
MCO provides assistance to many residents of the country and takes into account the needs of the population in medical services. However, their primary target audience for treatment are children and adolescents who need specialist doctors. The organizations cover the child population in 37 states, which is approximately 75% (Gordon et al., 2018). In addition, programs are now trying to introduce more assistance and health services to the adult population. This includes people with low incomes and those with wages below the living wage. Initially, these organizations were aimed at helping farmers who did not have proper medical facilities in the immediate area. However, with the advent of more medical facilities, programs have shifted the spectrum to the poor and children.
ACO is a much more modern organization and their vision and assistance to certain segments of the population has not changed significantly since the programs were introduced. Thus, organizations provide permanent assistance to children whose parents cannot afford expensive treatment and are forced to seek help from the state and commercial programs. The most important factor is that in the first place, they focus on people with chronic diseases. Since diseases of these types are permanent and require a large amount of money from a person, ACOs provide qualified assistance aimed at reducing costs while maintaining the disease.
Role as an APRN
In all programs aimed at helping the population and improving the quality of healthcare, the nurse plays a leading role. Nurses at MCOs can be described as a kind of link between patients, doctors and other healthcare professionals and insurance companies. APRN has frequent interactions with children and people with low incomes. The role of a nurse is to protect patients and their interests, which has a positive effect on them. However, when interacting with people from low social strata, the nurse may have potential problems. First of all, here there is a possible misunderstanding from the point of view of the difference between education and primary knowledge. Thus, one must take into account the fact that such patients need more thorough explanations. Additionally, their ethical standards may differ significantly from those of medical workers. This should be treated with understanding and take into account their social status.
At ACO, a nurse provides valuable services as a properly educated certified nurse. They provide primary health care for people with chronic diseases and aim to provide services to people of all ages. The positive influence of the nurse lies in establishing communication and explaining to patients the situation in which they find themselves. However, when dealing with patients with chronic diseases, it is important to understand that many are ill for a long time and do not turn to treatment. Thus, the nurse is faced with the problem of explaining that in some conditions the patient opens the possibility of remission.
Conclusion
In conclusion, it should be said that both the MCO and ACO programs are aimed at helping people with low social income. MCO has a history of nearly a century and has expanded its range of care over the years. The ACO is a more modern organization, but has undergone several changes and increased its supply to the healthcare market. Thus, their main goal is to improve the health status of the population, regardless of their money.
References
Daniel-Robinson, L., & Moore, J. E. (2019). Innovation and opportunities to address social determinants of health in Medicaid managed care. Institute for Medicaid Innovation, 1-24.
Gordon, S. H., Gadbois, E. A., Shield, R. R., Vivier, P. M., Ndumele, C. D., & Trivedi, A. N. (2018). Qualitative perspectives of primary care providers who treat Medicaid managed care patients. BMC Health Services Research, 18(1), 1-8. Web.
Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2019). Impact of accountable care organizations on utilization, care, and outcomes: a systematic review. Medical Care Research and Review, 76(3), 255-290. Web.
