Health Policy & Health Systems

Population Wellness

Providing population-based health care services will improve long term health care Focus is managing health versus managing illness Preventative and Primary Health care is central to keeping clients well Secondary & Tertiary care is the diagnosis and treatment of illnesses in individuals As US health care changes and works out its many issues with rising costs, the focus for health care will be health promotion and prevention. Hopefully if clients can be healthy; they will stay healthier longer; thus reducing health care costs over their lifetime. Population-based health care services are those that provide services to the larger population such as: clean water, safe roads, immunizations. This tier takes into consideration socioeconomic factors- poverty, education, living conditions. If these needs are considered and provided to the population, then hopefully the overall health will improve. See next slide for health care services within health system

Restorative Care

Rehabilitation; Sports medicine; Home care

Preventative Care

Screenings; Immunizations; Counseling

Policy Adoption

the best intervention...or the one most agreed upon is selected

Agenda setting

a health issue or problem is identified. The process of defining and identifying the issue will include many steps, but overall it will include why it is an important issue/problem, what are the causes, who it effects, what are the boundaries for correcting/making improvements, what other opinions or assumptions are relevant to this health issue

Regulatory Agencies

Can be independent agency; semi-independent organization; or part of the executive branch. -Established many times by legislature to implement and enforce laws via rule-making process. -Rules developed by these agencies have the force of law; usually these rules are make through a public administrative process. Example: *Health care is an industry highly regulated...policies must be carried out or health care institution may be penalized.

Competency

21 competencies have been recommended by Pew Health Professions Commission for nurses working in 21st century; 5 of those were considered essential for all health care workers (see next slide) Considered a tool to measure how well nurses are practicing; a guide for professional nursing development through a nursing career Another way to ensure quality within organizations and patient safety

Future: A Nurses role in U.S. Health Policy & health systems

According to Institutes of Medicine (2011) report, nurses need to: Practice to the full extent of their education and training Achieve higher levels of education and training through an improved education system that provides seamless progression. Become full partners with physicians and other healthcare providers in redesigning the health care in the US. Improve data collection and information infrastructure for effective workforce planning and policy making. Future of Nursing The nurse's role in patient care is more than just tasks: medication administration, procedures, assisting with ADLs. The role of a nurse is multifactorial and the expectation within society is that nurses will be full partners and participants in redesigning the progression and delivery of health care in America. Although NUR 111 focuses on the building blocks...foundations of nursing care, there is so much more to what nurses do, can do, and will be expected do within a career. Consider the future.... What will you do to keep your practice current? How will you remain competent throughout your nursing career? What steps can nurses take to be a participant in redesigning the healthcare delivery system?

Continuing Care

Assisted Living; Psychiatric or older adult day care

Access to health care

Barriers to accessing healthcare? No insurance Have not been insured long enough Cost: No means to pay; high cost Shortage of primary care providers Location: limited resources in community These are just a few reasons that people do not have access to healthcare. Culture can play a role in accessing care as well. According to Healthypeople.gov the uninsured are less likely to receive healthcare; more likely to have poor health; have a decreased life expectancy. The decreased or lack of access to healthcare may lead to: Unmet health needs Delays in receiving appropriate care Inability to get preventive services Otherwise preventable hospitalizations Retrieved from Healthypeople.gov (2015) National health policy issue driven by economics The insured can access health care with greater ease than the uninsured Access to health care through federal or state sponsored clinical facilities: Funding may not last Long wait times May not meet the needs if have critical illness US Health care system is strained Will see more clients over next years as many receive insurance through the Affordable Care Act. Healthy People 2020 Goals: Increasing and measuring access to appropriate, safe, and effective care, including clinical preventive services. Decreasing disparities and measuring access to care for diverse populations, including racial and ethnic minorities and older adults. Increasing and measuring access to safe long-term and palliative care services and access to quality emergency care. It will take all stakeholders at all levels of governments to participate in the plan for increasing access to health care. The forces of politics, negotiation and federal policy will be needed to see improvement. What can nurses do? Nurse are a key player in accessing care. Whether it is the advanced practice nurse or the frontline nurse, the continuation of educating the public to take care of their health and practice preventative care and encourage health promotion is a foundational principle.

Centers for medicare & Medicaid services (Cms)

CMS Introduction Video Is part of the Department of Health and Human Services (HHS) Has the authority to investigate complaints of noncompliance & make decisions regarding the interpretation, implementation, and enforcement of certain regulations adopting administrative simplification standards. Has authority with respect to the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Affordable Care Act (ACA). When electronic technology was created and became a norm for all healthcare providers, there was a concern that the publics privacy and health information could be invaded and placed at risk. Congress incorporated into HIPAA some provisions that mandated the adoption of Federal privacy protections for individually identifiable health information. CMS is responsible for making sure that healthcare providers, institutions, and healthcare clearinghouses follow national standards to ensure security and privacy when electronic health care transactions occur and code sets or unique health identifiers are created and placed into records. That is what is meant by enforcement of administrative simplification standards. If HIPAA violations occur, the Office for Civil Rights is responsible for investigation and enforcing violation fines.

Nursing Shortage

Critical shortage of nurses expected as baby boomers get older Average age of nurses in workforce is mid-forties Nursing Faculty shortages and reduced clinical site availability

Policy Implementation

Educate all stakeholders (people that will be affected or have a vested interest) about the change to policy; Implement the new policy/process...usually have a start date for new policy/process and an end date for old policy/process.

Secondary Acute Care

Emergency Care; Acute medical-surgical care

U.S. Department of Health & Human Services (hhs)

HHS mission & goals: To help more Americans achieve the security of quality, affordable health care for themselves and for their families; To keep food and medical products safe; To protect against chronic and infectious diseases; To help Americans find jobs; To help parents access affordable child care; To explore the frontiers of cutting-edge biomedical research; and To fulfill our obligations to tribal communities for health care and human services. Mission: "to enhance and protect the health and well-being of all Americans. We fulfill that mission by providing for effective health and human services and fostering advances in medicine, public health, and social services." HHS.gov (2015) Agencies within HHS: Centers for Disease Control and Prevention National Institutes of Health Food and Drug Administration Substance Abuse and Mental Health Services Administration.

Issues in Health care delivery & Nursing

Health care organizations are being evaluated on the basis of outcomes such as prevention of complications, patients' functional outcomes, and patient satisfaction. As health care organizations seek out to be competitive and deliver quality care, there are many opportunities for nursing to improve their product as well. The IOM competencies are goals for nursing and all health care providers to be the best they can be and offer patients and families safe and evidence based care.

Quality and Safety

Health care practices must change to improve patient safety. Nurses must be included in the gathering of data collection in their particular setting and analyzing the results to recognize a need for improvement. This can decrease infection rates, prevent falls, decrease medication errors. Awareness can change practice.

challenges

Health care system challenges: Clients with little or no insurance- unable to meet financial obligations Clients wait too long for treatment- very sick...more difficult to treat Shorter length of stay requirements with sicker clients Sicker clients may need rehab or restorative placement before discharging to home Administrative leader challenges: Reduce health care costs; maintain high-quality care Improve access and coverage for clients Encourage healthy behaviors As Heath care systems battle rising costs in healthcare, institutions are more business oriented versus service industry. This has caused some conflict among many health care professionals. How does a business put a price on caring or run a business with time constraints (set discharge time or date) when individual bodies react differently to treatments and heal at different rates? Many professional healthcare organizations have come together to form ideas and set priorities for overcoming these challenges. The Institutes of Medicine (IOM) calls for more partnership among healthcare workers. The National Priorities Partnership have set the following national priorities: Population Health- increased focus on wellness and prevention Safety Care Coordination Palliative care Overuse- Reducing waste, leading to more effective and affordable care Patient and Family Engagement (patient centered care)

Health Policy: Political Decision Making

Health policy at different government levels: Executive branches (federal and state governments) Examples: Obama Administration and Drug Control Policy NC Drug Control Legislatures (state and national) Courts & Judiciary (state and national) Regulatory Agencies

TJC: Benefits of Accreditation

Helps organize and strengthen patient safety efforts Strengthens community confidence in the quality and safety of care, treatment and services Provides a competitive edge in the marketplace Improves risk management and risk reduction Provides education to improve business operations Provides professional advice and counsel, enhancing staff education Provides a customized, intensive review Enhances staff recruitment and development Provides deeming authority for Medicare certification Recognized by insurers and other third parties Provides a framework for organizational structure and management May fulfill regulatory requirements in select states Provides practical tools to strengthen or maintain performance excellence

Patient Satisfaction

Hospital Consumer of Assessment of Healthcare Provider and Systems (HCAHPS)... measuring patient perception of the hospital experience. The Nursing environment affects the patient experience. The patient survey data is feedback for the organization to see what needs to be improved upon. It is also an indicator of patients desire to recommend this hospital to others.

Nursing informatics and Techno Advancements

Informatics has been identified as a competency for nurses. Data in the medical record is recorded in many ways throughout an organization. How does a nurse know where to find it or how to document? Equipment is evolving and many times will be updated within a few years and requires new education Sometimes use of new equipment or technologic advancements actually creates inefficiency and creates greater workload Changes how nurse and healthcare workers communicate with one another Nurses need to be included in design; evaluation and implementation of new technological advances/equipment. They are the end-users. Need more bedside nurse input.

Tertiary Care

Intensive Care; Subacute Care

Policy Formation

Interventions for creating change to the identified health issue are proposed and considered

Policy Evaluation

Is the new policy/process meeting the objectives? Achieving the desired goals?

Licensure

Legal authority to perform or exercise a function or practice within a profession Implies competency assessment at the point of entry into a profession Offers the public protection by restricting use of title and scope of practice to the licensed professional State Board of Nursing holds nurses accountable for professional scope of practice and standards defined within Nursing Practice Act State Board of Nursing is a regulatory agency. The state has a responsibility to protect the public from individuals who do not remain competent or have the qualifications to practice nursing. Nurses have a responsibility to remain competent and stay up to date regarding health policy or evidence based practice. Licensure also gives nurses some freedom to move about especially in compact states- where nurses can cross state borders and practice.

Health care regulation

Limit overuse of diagnostic and treatment services Diagnostic related groups (DRGs): Set amount of cost reimbursement per patient for diagnosis (no matter the length of admission or use of services) ICD-10: Coding of services so that specifics of treatment plan can be identified Capitation: Providers receive payment per person enrolled in health care plan whether they seek care or not Care Management: Manage length of stay by planning for discharge needs as soon as admitted; Discharge as soon as safely possible Diagnostic Related Groups: Click on hyperlink ICD-10: click on Hyperlink These are just a few ways that healthcare is being regulated today. Managed care is a broad term that has a goal of keeping clients as healthy as possible (preventing readmissions; focusing on preventive and maintenance care; early intervention and outpatient care). This will help keep health costs down and assist the health care institution with receiving capitation payments. Nurse have a major role in managed care; including reviewing charts and keeping health care providers abreast of clients needs and assisting with achieving discharge goal. From a quality standpoint, Medicare and other third party payers will no longer pay medical costs related to poor quality including medical errors, hospital acquired infections. Nurses have a role in maintaining quality care by following policies and procedures....yet also being a part of the creation and revision of institutional policy and procedure. This requires nursing staff to volunteer their time and be available for these committees.

Division of health service regulation (Dhsr)

Mission: "to provide for the health, safety and well-being of individuals through effective regulatory and remedial activities including appropriate consultation and training opportunities and by improving access to health care delivery systems through the rational allocation of needed facilities and services." DHSR (2015) Oversees medical, mental health and adult care facilities, emergency medical services, and local jails. Provides that care clients receive within those facilities is safe, appropriate, and meets their needs. Provides Certificate of Need: make certain that health care facilities and medical equipment are developed only when needed Sections that fall under DHSR: Acute and Home Care Licensure Section Adult Care Licensure Section Complaint Intake Unit Construction Section Health Care Personnel Registry Section Healthcare Planning and Certificate of Need Section Mental Health Licensure and Certification Section N.C. Medical Care Commission Nursing Home Licensure and Certification Section Office of Emergency Medical Services Radiation Protection Section

The Joint Commission (Tjc)

Mission: "To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value." JointCommission.org (2015) Offers accreditation to healthcare organizations Offers certification for different programs (diseases, quality care, etc.) Clients and families can report a patient safety event to TJC and they will investigate claim. Founded in 1951 as an independent, not-for-profit organization that offered hospitals voluntary accreditation. Supported by American College of Physicians and American Medical Association 2002 published first National Patient Safety Goals; updated yearly 2011 Department of Health and Human Services and TJC join in collaborative effort and goal to make health care safer and less costly by targeting and reducing the millions of preventable injuries and complications from health care-associated conditions.

Evidence Based Practice

New research coming out frequently that can alter nursing practice and patient care. Nurses need to be exposed to new research and practice guidelines and change or have the ability to make changes as necessary to remain safe.

Health Policy: Nurse advocacy

Nurses: Have solid foundation of education and experience in healthcare Have a place in determining policy Are advocates for clients, families, and peers Are indispensable to elected and appointed officials who need realistic insight in healthcare issues Nursing Organizations: American Nurses Association (ANA) State Nursing Associations- North Carolina Nurses Association (NCNA) Nursing Professional Advisory Committee (N-PAC) Nursing Organizations are a great way for nurses to be informed, become involved , and be represented. Examples: ANA- Professional organization that represent interests of nurses; lobbies Congress and Regulatory agencies on health care issues that affect nurses. Specialty professional organization that represents interest of nurse within a specialty (AORN- Assoc. of periOperative Nurses; Emergency Nurses Association) N-PAC: comprises of nursing representatives across the nation, uniformed and civil participants, who advise and give counsel to leaders such as Surgeon General, HHS, and other government health agencies.

Issues in Health care delivery & Nursing

Nursing shortage Competency Evidence Based Practice Quality and Safety in Health care Patient Satisfaction Nursing informatics and technological advancements

Health Policy: Implementation

Once policies are created, who will implement them or follow through with the process of education/collecting data/evaluating and reporting back results? Some are regulatory agencies. These agencies may be very big and have a vast of other groups/foundations/divisions that will do the work! Example: Food and Drug Administration There are other private or established groups that have resources (financial, technology, etc.) and can assist with policy dispersing or completing research to evaluate health policy. Example: Centers for Disease Control and Prevention (CDC)

Occupational Health and Safety Act (OSHA)

Part of the United States Department of Labor Mission: "to assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance." US Dept of Labor, 2015 Covers workers in all 50 states, District of Columbia and US jurisdiction; most private sector employees. OSHA At A Glance

Primary Care (Health Promotion)

Prenatal & well baby care; family planning

Executive Branches

President and state governors oversee agencies and implementation of laws and health policy. Control vast resources (budgets) and have the power to influence health policy goals and veto decisions.

TJC: Certification

TJC Certification Programs include: Disease specific (ex: MI, COPD, Pneumonia, Bariatric Surgery) Palliative care Integrated Care Perinatal Care Primary Care Medical Home Health Care Staffing Services Benefits of Certification: Improves quality care to clients Provides an evidence based standard for providing care Includes team approach so that many stakeholders are involved Provides structure and management for plan of care *There are other entities besides TJC that offer certifications as well.

Courts & Judiciary

This agency assists with balancing out peoples rights ensuring protection to populations that may be affected by health policy. They may challenge health policy created by government when values and interests have not been considered.

Legislatures

US Congress and state legislatures can create laws and establish funding for agencies that will carry out the law or implement the policy. Example: NC Nursing Practice Act is regulated by NC General Assembly; defines the practice of nursing within North Carolina

Health policy

is built through several steps. The steps may require consideration of: evidence, quality, safety, ethical issues, economic value, and current law or legal concerns. Goal directed decision making about health that is the result of an authorized, public decision-making process. Those actions, non-actions, directions, and/or guidance related to health that are decided by governments or other authorized entities Examples of this definition would be: State-mandated immunizations The adoption of a federal or state funded health program. Healthy Hunger Free Kids Act of 2010: Where a percentage of students within a school are eligible for free or reduced price school lunches under the school lunch program established under the Richard B. Russell National School Lunch Act.