[Free Guide] 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
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
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
- Summarize the key points of your project.
**You will not discuss the deductibles or costs of the insurance plans as this is not the focus of this this assignment.
Additional Instructions:
1. All submissions should have a title page and reference page.
2. Utilize a minimum of three scholarly resources.
3. Adhere to grammar, spelling and punctuation criteria.
4. Adhere to APA compliance guidelines.
Step-by-Step Guide to Answering the National Health Coverage Plans Assignment
1. Understand the Purpose of the Assignment
This assignment evaluates your ability to:
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Analyze the relationship between health insurance coverage, access to care, quality outcomes, and reimbursement
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Compare two major U.S. health insurance plans
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Explain Diagnosis Related Groups (DRGs) and charity care
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Apply nursing-sensitive indicators to patient-centered care
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Demonstrate knowledge of healthcare policy, finance, and quality improvement
You should write from a baccalaureate-prepared nursing perspective.
2. Choose Your Patient Scenario (Before Writing)
Select one patient and use the same patient throughout the paper.
Example patient characteristics:
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Older adult with chronic disease
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Low-income adult
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Uninsured or underinsured individual
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Patient with multiple comorbidities
Your patient context will guide:
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Insurance access analysis
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Nursing interventions
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Quality-of-care considerations
3. Organize Your Paper Using Required Headings
Use APA Level 1 headings and follow the assignment order exactly.
4. Introduction & Healthcare Coverage and Vulnerable Populations
What to Include:
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Briefly explain why healthcare coverage is essential in the U.S.
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Discuss the relationship between:
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Insurance coverage
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Access to care
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Health outcomes
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Clearly state the purpose of the paper at the end of the introduction.
Required Discussion:
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Explain two ways healthcare coverage benefits vulnerable or uninsured populations, such as:
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Improved access to preventive care
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Reduced emergency department overuse
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Improved chronic disease management
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5. Diagnosis Related Groups (DRGs)
A. Purpose of DRGs
Explain:
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What DRGs are
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Why Medicare developed DRGs
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How they classify hospital inpatient stays
B. Impact on Length of Stay and Payment
Discuss:
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Fixed reimbursement per DRG
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Incentives to reduce length of stay
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Risk of premature discharge
C. Quality Indicators and DRGs
Explain how DRG payments are now tied to:
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Hospital-acquired conditions
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Readmission rates
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Value-based purchasing programs
6. Select the First Major Healthcare Plan
Heading Example:
Preferred Provider Organization (PPO)
(or Medicare, HMO, Private Insurance)
What to Discuss:
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Brief description of the plan
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Two care options that facilitate access for your patient
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Example: specialist access, preventive services, diagnostic testing
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Two care options that limit access for your patient
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Example: referral requirements, network restrictions, prior authorization
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⚠️ Do NOT discuss deductibles or costs
7. Select the Second Major Healthcare Plan
Heading Example:
Medicaid
Repeat the same analysis using the same patient:
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Two ways the plan facilitates access to care
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Two ways the plan limits access to care
Compare access differences logically and objectively.
8. Impact of Nursing Interventions
Required Content:
Identify at least four priority nursing interventions or considerations.
Each intervention must include:
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Description of the nursing action
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Rationale tied to:
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Nursing-sensitive indicators
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Patient safety
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Quality of care
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Examples of nursing-sensitive indicators:
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Patient education and self-management
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Care coordination
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Medication adherence
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Prevention of complications
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Readmission reduction
9. Conclusion
Summarize:
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Importance of healthcare coverage
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Key differences between the two plans
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Role of DRGs and quality-based reimbursement
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Importance of nursing interventions in improving outcomes
Avoid introducing new information.
10. Scholarly Sources and APA Requirements
Required:
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Minimum of three scholarly references
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Nursing journals
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Government sources (CMS, AACN)
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Peer-reviewed healthcare policy literature
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APA Requirements:
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Title page
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Reference page
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In-text citations
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Proper grammar and formatting
11. Common Mistakes to Avoid 🚫
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Discussing insurance costs or deductibles
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Changing patients between sections
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Listing benefits without analysis
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Weak nursing rationales
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Missing purpose statement
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Poor APA formatting
12. Final Checklist Before Submission ✅
✔ One consistent patient scenario
✔ Two major U.S. health plans analyzed
✔ DRGs clearly explained
✔ Quality and reimbursement linked
✔ Four nursing interventions with rationale
✔ Minimum three scholarly sources
✔ APA title and reference pages
✔ No discussion of insurance costs
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