Health care reform has played a significant role in shifting the focus of the health care system from a disease-oriented model to one centered around promoting wellness and prevention. This shift has been motivated by a variety of factors, including the recognition that prevention is more cost-effective than treatment and that it can lead to better health outcomes for individuals and populations.
One way in which health care reform has facilitated this shift is through the inclusion of preventive services as essential health benefits. The Affordable Care Act (ACA), for example, requires private insurance plans to cover a range of preventive services, including immunizations, screenings, and counseling, without any additional cost to the patient. This ensures that individuals have access to the necessary preventive care to maintain their health and prevent the onset of chronic illnesses.
Furthermore, health care reform has also introduced initiatives aimed at incentivizing providers to prioritize prevention and wellness. For instance, under the Medicare Access and CHIP Reauthorization Act (MACRA), providers’ reimbursement is tied to the quality of care they deliver. This includes the implementation of programs such as the Merit-based Incentive Payment System (MIPS), which rewards providers for meeting quality standards, promoting preventive care, and managing chronic conditions effectively. This creates a strong financial incentive for providers to focus on wellness and prevention as they strive to earn higher reimbursements.
In addition to these systemic changes, health care reform has also emphasized the importance of interdisciplinary collaboration and care coordination. This is where nurses play a crucial role in supporting and facilitating the shift towards a preventive-focused health care system. Nursing practice encompasses a holistic approach to patient care, focusing not only on treating acute illnesses but also on promoting health and preventing disease.
Nurses have a unique opportunity to engage with patients at various stages of their health care journey, from primary prevention, such as health promotion and education, to secondary prevention, such as screenings and early detection of diseases. Through their expertise in patient education, counseling, and health coaching, nurses can empower individuals to make informed decisions about their health and lifestyle choices. For example, nurses can provide smoking cessation counseling, educate patients about the importance of regular exercise and a balanced diet, and promote stress reduction techniques. By focusing on prevention and wellness, nurses can help individuals maintain optimal health and reduce the risk of developing chronic conditions.
Additionally, nurses play a pivotal role in care coordination. They collaborate with other health care professionals, such as physicians, pharmacists, and social workers, to develop comprehensive care plans that prioritize prevention and wellness. This includes ensuring that patients receive the necessary preventive screenings and immunizations, coordinating referrals to specialists as needed, and providing follow-up care to monitor patients’ progress towards achieving their health goals. By coordinating care and promoting a preventive mindset, nurses contribute to the overall health and well-being of individuals and communities.
In conclusion, health care reform has helped shift the focus of the health care system from a disease-oriented model to one that emphasizes wellness and prevention. This is evident through the inclusion of preventive services as essential health benefits and the introduction of reimbursement models that incentivize providers to prioritize preventive care. Nurses play a critical role in supporting and facilitating this shift by providing patient education, counseling, and care coordination that promote prevention and wellness. Through their expertise and collaboration with other health care professionals, nurses contribute to improved health outcomes and the overall well-being of individuals and communities.
1. The Affordable Care Act. (n.d.). Retrieved from https://www.hhs.gov/healthcare/about-the-aca/index.html
2. MACRA and MIPS Overview. (n.d.). Retrieved from https://qpp.cms.gov/about/qpp-overview
3. Jansen, L. A. (2015). Shaping the Future of Nursing: A Perspective on What’s Ahead. The Journal of Nursing Administration, 45(11), 537-539. doi:10.1097/nna.0000000000000250