Welcome fellow nurses and other medical professionals or advocates. Like me, you are surely aware of the vastly and quickly changing climate in the medical community when it comes to things like continuum of care, accountable care organizations, medical homes and nurse-managed health clinics. I will speak about all of these things and what the future would seem to hold for each of them. When it comes to the overall continuum of care, the Affordable Care Act was certainly a game-changer and will greatly shape the future of the United States medical system. There has been a swelling in the efforts by many healthcare providers to manage what is often called the "continuum of care" for patients. The doctors and health systems that exist out there are being formed and shaped into a number of different structures and agreements with the aim to achieve essentially one basic thing….to manage the care of patients across all of the care settings that they will encounter and from birth to death. These changes must take place because there are issues like lack of coordination in the hospitals of America, a lack of recognition about the financial implications involved, the perspective of the patient is at stake and so forth (Dunn, 2015).

When it comes to the future of accountable care organizations, or ACO's, the implications are no less massive and upcoming. Indeed, rather than getting a fee for each service, there is a fee paid based on the quality of the healthcare that is delivered. In other words, outcomes are more of a focus than the volume of patients that are being treated, evaluated and processed. Not everyone is on board when it comes to ACO's as some Pioneer ACO's, nine in total, left a program that was centered on the quality vs. quantity paradigm. A lot of the feedback about the idea and results surrounding ACO's is good but it is clear that not everyone is sold on the idea of ACO's and it remains to be seen how this will all evolve in the coming years and decades. (Budryk, 2014).

As for nurse-managed health clinics, or NMHC's, the need for these facilities is clear. However, there is a rather glaring funding shortage when it comes to such facilities, at least as of 2012. Such was the assertion of Tine Hansen-Turton. She gives the example of a woman who had chronic back pain. She had gone to other clinics and places of medical practice but got little to no positive results from it. However, a NMHC was able to find the source of the problem and they helped her in a way that the prior facilities could not, for whatever reason. It is clear that nurses can fill the void that is being created by doctors leaving Medicare, physician shortages in general and for those patients for which money is an issue. However, it all costs money and there seems to be a lack of focus on providing the necessary money to take care of our country's medical needs. Hopefully, this will change in a post-Affordable Care Act World (RWJF, 2015). Much the same thing can be said of medical homes (Commonwealth, 2015).

In closing, I would say that we all need to focus on evidence-based practice, what works and what is best for us all as we move forward.

Reactions

The following reactions are notated as follows in no particular order and with no names, ages, organizations or so forth attached. For each item, there will be a summary of what the nurse or other person said and there will then be a response from the author of this report based on prior research and knowledge about the ACA and the other assorted details surrounding healthcare in a post-ACA world. Unless cited otherwise, the responses below are the opinion, viewpoint and general prior knowledge of the author of this report.

Comment: One person noted that the spending projections regarding the Affordable Care Act are definitely not going to fall in line with what actually happens in terms of actual spending. She cited that Social Security, Medicare and so forth are wildly exceeding what was originally planned in terms of size and scope and that "ObamaCare would be the same way.

Response: It is indeed true that government programs almost always exceed the spending outlays that are originally planned. There are actually much more recent examples than Social Security (started in the 30's) and Medicare (started in the 60's). For example, Cash for Clunkers (the car trade-in initiative done during the...

Indeed, economics is not an exact science and projecting just how people will react can be a tricky thing to pull off at times. One fact that is hard to admit but impossible to ignore is that there is a finite amount of money and resources out there and people will die despite the best efforts of medical professionals and personnel. It is part of life and part of what we must all deal with.
Comment: Paying based on quality is not the best idea. It sounds good because it does indeed sound like that organizations are being held accountable, hence the term Accountable Care Organization. However, when the volume is excessive and massive, many offices don't have the time to drill down and get to the nub of what is really going on. That story about the nurse clinic was nice and all but some offices are slammed. For example, this past winter there was a terrible outbreak of viral bronchitis. As such, we had a lot of people coming through our doors. However, we couldn't rush through them and assume viral for all because some of them may have simple colds or they could have pneumonia or they could have bacterial bronchitis and so forth. At the same time, if we slow down and due our due diligence, that is just going to make wait times longer, patients will forgo care and this will hurt both us and them in a lot of ways.

Response: The person makes some valid points. When it comes to situations like that, the first question that comes to mind is whether the office in question is properly staffed. If they are not, the question becomes why they are not properly staffed. If it is lack of funding and resources, then that would be a quandary. This is something that non-profits and government agencies on tight budgets would fight with a lot. However, when it comes to for-profit organizations, the question has to be asked whether they can simply not afford it or if they are cutting corners at the organization. The author would say that every situation is different and that both quality and proper staffing levels need to be in place in all instances…regardless of the underlying system.

Comment: I guess I'm just not comfortable with the government running healthcare. They seem to have proven with Medicare and other programs that they allow so much fraud and waste. I just wonder why we can't find a private sector solution.

Response: There is a lot of credence to the fact that public agencies and governments are not the best at keeping down fraud and waste. However, the fact that most healthcare organizations are for-profit cannot be ignored because it automatically brings their motives and decision-making into question. Obviously, there are some people that are paranoid (like those that thing some treatments are known but withheld because the "money is in the medicine) and there are surely many profit-based organizations that do a great job. However, appearance of or the possibility of mixed and improper motives is important to keep in mind. As such, just dumping on the government is not fair because profit-based organizations have their own issues. The author would just make the following point….not all government-ran operations are wasteful, not all non-profits squirrel away donations for exorbitant salaries and not all profit-based organizations pinch pennies at the expense of lives. However, there are examples of all three if one looks hard enough. However, ballooning that to indict the whole community (any of the three) is not fair or proper. People that over-generalize and demagogue the issue are not helping at all.