Running head: EVOLVING PRACTICE OF NURSING AND PATIENT CARE DELIVERY MODELS 1 8 EVOLVING PRACTICE OF NURSING AND PATIENT CARE DELIVERY MODELS Evolving Practice of Nursing and Patient Care Delivery Models Ishwari Basnet Grand Canyon University: NRS-440V February 27th, 2016 Evolving Practice of Nursing and Patient Care Delivery Models Hello everyone! I Ishwari Basnet,I am a registered nurse and work in medical \surgical\mental health unit for more than ten years. I would like to welcome you all in this informal education session. Today, I would like to discuss about the changing role of nurses and concept of continuum of care and the new health care delivery models such as Accountable Care Organizations (ACOs), medical homes, and nurse -managed health clinics. Evolving practice of Nursing and Health Care Models Health care system is changing; it is not just focused on the curative care but the disease prevention and wellness. Also, the new healthcare reform has approach to the development of healthcare delivery models with the changes in nursing role from acute care settings to community health care. Patient Protection and Affordable Care Act (PPACA) formed at 2010 support the establishment of ACOs, medical homes and nurse-managed health clinics; also new payment policies. With the formation of Affordable Care Act (ACA), health has transformed from traditional treating approach to the preventive and wellness. Nurse’s role has also changed from front-line caregiver to the care integrators and coordinators and help in providing the health services to the underserved people. All the health models are focused on the concept of continuity of care which is defined as “a concept involving an integrated system of care that guides and tracks patient over time through a comprehensive array of health services spanning all levels of intensity of care” (Evashwick, 1989). It covers the delivery of healthcare over a period of time and for all levels and stages of care. Let’s talk about the three types of health care delivery model. Accountable Care Organizations (ACOs) In accordance to the Center for Medicare and Medicaid services, “Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients” (Cms.gov, n.d.). The ACO is the new unit built by the ACA; the health reform law 2010 which take care of the cost and quality of the care received by the patients. The main aim of ACO is to deliver flawless and high-quality care at the right time to the patients, especially the chronically ill patients. The ACO include the specific group of providers and suppliers assigned by the ACA and they encourage the active participation of nurse practitioners (NPs), clinical nurse specialists (CNSs) etc with physicians and physician assistants. As nursing leadership is encouraged in ACO, registered nurses can ...

1. Running head: EVOLVING PRACTICE OF NURSING AND
PATIENT CARE DELIVERY MODELS
1
8
EVOLVING PRACTICE OF NURSING AND PATIENT CARE
DELIVERY MODELS
Evolving Practice of Nursing and Patient Care Delivery Models
Ishwari Basnet
Grand Canyon University: NRS-440V
February 27th, 2016
Evolving Practice of Nursing and Patient Care Delivery Models
Hello everyone! I Ishwari Basnet,I am a registered nurse and
work in medical surgicalmental health unit for more than ten
years. I would like to welcome you all in this informal
education session. Today, I would like to discuss about the
changing role of nurses and concept of continuum of care and
the new health care delivery models such as Accountable Care
Organizations (ACOs), medical homes, and nurse -managed
health clinics.
Evolving practice of Nursing and Health Care Models
Health care system is changing; it is not just focused on the
curative care but the disease prevention and wellness. Also, the

2. new healthcare reform has approach to the development of
healthcare delivery models with the changes in nursing role
from acute care settings to community health care. Patient
Protection and Affordable Care Act (PPACA) formed at 2010
support the establishment of ACOs, medical homes and nurse-
managed health clinics; also new payment policies. With the
formation of Affordable Care Act (ACA), health has
transformed from traditional treating approach to the preventive
and wellness. Nurse’s role has also changed from front-line
caregiver to the care integrators and coordinators and help in
providing the health services to the underserved people. All the
health models are focused on the concept of continuity of care
which is defined as “a concept involving an integrated system
of care that guides and tracks patient over time through a
comprehensive array of health services spanning all levels of
intensity of care” (Evashwick, 1989). It covers the delivery of
healthcare over a period of time and for all levels and stages of
care. Let’s talk about the three types of health care delivery
model.
Accountable Care Organizations (ACOs)
In accordance to the Center for Medicare and Medicaid services,
“Accountable Care Organizations (ACOs) are groups of doctors,
hospitals, and other health care providers, who come together
voluntarily to give coordinated high quality care to their
Medicare patients” (Cms.gov, n.d.). The ACO is the new unit
built by the ACA; the health reform law 2010 which take care of
the cost and quality of the care received by the patients. The
main aim of ACO is to deliver flawless and high-quality care at
the right time to the patients, especially the chronically ill
patients. The ACO include the specific group of providers and
suppliers assigned by the ACA and they encourage the active
participation of nurse practitioners (NPs), clinical nurse
specialists (CNSs) etc with physicians and physician assistants.
As nursing leadership is encouraged in ACO, registered nurses
can lead in quality assurance and develop the improvement
initiatives (Nursingworld.org, n.d.).

3. Medical Home/Health Home
Medical homes (patient-centered medical homes, PCMH),
similar to Accountable Care Organizations are primary health
care delivery model focused on the deliverance of the primary
care that is patient-centered, managed, synchronized,
accessible, ample and believe in quality and safety. “The
medical home is not a final destination instead, it is a model for
achieving primary care excellence so that care is received in the
right place, at the right time, and in the manner that best suits a
patient's needs” (Pcpcc.org, n.d.). This medical health model
helps in solving the health care costs problem with the support
of primary care providers such as physicians, nurse practitioners
and certified nurse-midwives. Nurses being front-line healthcare
workers play a vital role in this model as they can actively
participate in health promotion and disease prevention, order
and interpret laboratory tests and other studies and refer the
patients who need specialized care.
Nurse-Managed Health Centers (NMHCs)
NMHC is another initiation developed by ACA to promote the
primary care, disease prevention and control of chronic
conditions in the medically underserved and rural areas of
United States. NMHC’s are managed by the nurses that include
all the nurse practitioners, clinical nurse specialists, nurse
midwives, and public health nurses. They provide many health
services especially in the needed communities such as diagnosis
and prescription to illness, pre- and post- natal care and referral
to specialists (About Nurse-Managed Care, n.d.). This care
model maintain the nurse managed clinics with the aim of
enhancing access to primary care in the communities of
medically underserved and/ or vulnerable populations, boost up
the nursing practice and leadership for the nursing students by
serving as clinical training sites and maintain the patient and
workforce data.
To conclude, ACOs, medical homes and NMHCs are the

4. concept of new health care delivery model created by the ACA
to minimize the issues of health care cost and easy access of
quality health care. These models are mainly patient-centered,
competent, accessible and cost effective. The establishment of
these types of health care delivery models has changed the role
of nursing and set new parameter for the nurses. Nurses have
advanced beyond the role of front-line healthcare workers to
become care coordinators, efficiency experts and prove to be
the backbone of most of these delivery care models. Nurse play
as a care integrators and focused on the continuum care from
the acute care to the community health settings through these
models. Moreover, with the advancement of health technology
and health reforms, preventive base health care has taken the
priority than the curative care and nurse role is very important
towards preventive health care too. Therefore, the opportunities
for the nurses are increasing and the demand of the educated,
skilled and professional nurses are vital during this changing
time of health care system.
Thank you for hearing me and participating in this session. If
you have any queries, please feel free to ask. I would look
forward to hearing your opinion.
Thanks!
Summary of the Feedback
After this author gave the presentation, all the nurse colleagues
took part in discussion session about the benefits and changes
that new health reforms and the health care models brought in
health care system of the country. This paper will summarize
the feedback received from three colleague nurses and forecast
the role of nursing.
Nurses who took the active participation in the discussion have
their own point of view regarding the healthcare reforms and
change of nursing role. However, majority of the number have
similar point of view about my presentation and support the new
healthcare reform. They also appreciate the new health care
delivery models and the role of nursing in these care models.
‘Nurse A’, BSN nurse graduated from Bangladesh and working

5. here in United States at recent times, talked about her
experience she had as a nurse back in Bangladesh. She
expressed that it was totally different; nurses are the front-line
caregivers and are not allowed to take any decision; only follow
the orders of the doctors. The role of nurse in health care
system differs according the location and time. The emergence
of importance of community health is providing the
opportunities to the nurses in developed countries like the USA
and this new health reform is being following by many
developing countries as well. She is very happy and ambitious
with this new healthcare reforms and healthcare models.
Moreover, the role of nursing has been changing from the front-
line caregiver to the care integrators and from acute care
settings to the community. Nurses’ role in community settings
is the major advancement in healthcare system such as NMHCs.
Nurses can work as a leader of the organization in the
community setting with self directed, critical thinking, and
independent decision making qualities. She focused on NMHCs,
where nurses are being encouraged to practice to the full extent
of their skills and take significant leadership roles in health
policy, planning, and provision. Therefore, new healthcare
reforms help to provide nursing role a new perspective and lead
to an innovation healthcare system.
‘Nurse B’ was also very excited about the healthcare reform as
it believes on the potential of nurses for the transformation of
US health care system. She focused on importance of the new
health reform because of increasing chronic disease and cost
and also taking on preventive care over the curative care. The
new healthcare delivery models (ACOs, NMHCS, medical
homes) will enhance the preventive care services leading the
management of the chronic diseases in the community settings.
This will help in reducing the problem of rising the cost of
health services and can make aware about the disease
prevention and health promotion. Moreover, preventive care
services will require huge number of educated nurse workforce
and leadership to improve the community’s health care. She

6. further added up that the nurses are the fundamental to the
patient-centered care delivery model. The nurses have the
capability of building a strong relationship and coordination
with the patients and the health care providers’ team and lead in
organizing and functioning of different health care models.
According to her, the concept of the new health care delivery
model of providing the facilities to the underserved people is
commendable.
‘Nurse C’ has different point of view regarding the healthcare
reforms and healthcare models. She expressed her anxiety about
the quality of the services provided by the hospitals and
healthcare models when large number of people will be flooded
into it for the treatment. She explained that Affordable Care Act
(ACA) will benefit large number of people causing the crowd
that will definitely affect the hospitals and health systems to
take care of the influx of the new patients. That is increase in
administrative cost, much more paper work, disease and care
management, over-seeing and time dealing with Medicare for
the millions of newly insured patients. She added that increase
in number of patient will imply to the must increase in number
of healthcare providers and nurses. If the strong and enough
approach are not taken for the fulfillment of the need of nurses
and healthcare providers then it will directly affect the quality
of care. Moreover, it will affect the status and motivation of the
existing nurse workforce. Therefore, she highly looked forward
for the high-quality of health services provided to the patient
that is she believed in quality rather than quantity.
To conclude, nurses are the major part of health care system and
the role of nursing has changed and advanced with the
implementation of the health care reform and health care
delivery system. These types of reforms and models have
transformed the entire health care system of the United States
from acute care settings to community and benefitted many
underserved people. However, knowledge and information of
the health reforms should be given to everyone.

7. References
About Nurse-Managed Care. (n.d.). Retrieved February 24,
2016, from National Nursing Centers Consortium:
http://nncc.us/index.php/about-nurse-managed-care
Cms.gov,. (n.d.). Accountable Care Organizations (ACO) -
Centers for Medicare & Medicaid Services. Retrieved 23
February 2016, from https://www.cms.gov/Medicare/Medicare-
Fee-for-Service-Payment/ACO/
Evashwick, C. (1989). Creating the continuum of care. Health
matrix, 7(1), 30-39.
Nursingworld.org,. (n.d.). Accountable Care Organizations.
Retrieved 23 February 2016, from
http://www.nursingworld.org/MainMenuCategories/Policy-
Advocacy/Positions-and-Resolutions/Issue-Briefs/ACOs
Pcpcc.org,. (n.d.). Defining the Medical Home | Patient-
Centered Primary Care Collaborative. Retrieved 24 February
2016, from https://www.pcpcc.org/about/medical-home