NUR-514 Topic 1 DQ 1: Health Care Systems, Organizational Relationships, and Interprofessional Health Care Environments

nur-514 topic 1 dq 1: health care systems, organizational relationships, and interprofessional health care environments

NUR-514 Topic 1 DQ 1: Health Care Systems, Organizational Relationships, and Interprofessional Health Care Environments

NUR-514 Topic 1 DQ 1: Health Care Systems, Organizational Relationships, and Interprofessional Health Care Environments

Consider the evolution of the U.S. health care system. Discuss how the shift to value-based health care has impacted delivery of care and the role and responsibilities of the advanced registered nurse. Project what major evolving trends in the health care delivery system will affect nursing practice and how advanced registered nurses will influence the direction of health care.

Contemporary Health Care Structure

Discuss the relationship among structure, profession, practice, and the individual in ways that reflect contemporary health care structure. 

How does this look different for nurses, educated at the level of an advanced practice registered nurse (APRN) – (Certified Nurse Midwife, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, or Nurse Practitioner) compared to nurses, educated at the level of an advanced registered nurse (APN) – (Educator, Public Health, Informatics, Leadership, or Administration)?

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The contemporary healthcare structure focuses on patient-centeredness. It also focuses on career fulfillment and advancement for all practitioners. According to Bradley et al. (2018), contemporary healthcare further recognizes that disease and wellness co-exist. Thus, health is considered a dynamic quality state where the mind, body, and spirit are fully functional. The profession and all participants aim at enhancing patients’ versatile roles.

 Souliotis (2016) highlights that the current healthcare definition recognizes patients’ efforts and contributions toward their wellness. By engaging in decision-making, patients exercise their autonomous right by demanding high-quality and satisfactory services. Advanced practice registered nurses provide patient-centered direct services to enhance patient wellness. They offer direct and specialized healthcare services. Upholding patient-centeredness for patients means that APRNs offer culturally-competent care. 

     Practice for educators, public health professionals, informaticists, leaders, and administrators focus on offering support for patients and other nurses. Educators ensure that all stakeholders have crucial knowledge for treatment procedures. Dumit (2017) states that with the current technological advances and policy reforms, continuing education is crucial for practitioners.

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 Informaticists ensure competence with the technology used to support patient care. On the other hand, leaders and administrators set and implement policies that guide nurse practitioners in offering the best care and having fulfilling careers. 

     However, irrespective of the differences in practice structures of the two categories, the patient is at the center of practice in all cases. The central theme is life fullness and wellness. The health issue is observational and focuses on the individual (Bradley et al., 2018). Even with chronic illnesses, individuals can still be healthy, and nurses are satisfied with their role and contributions to societal wellness. With the contemporary system, all healthcare stakeholders are open to learning and having new experiences. Organizational Relationships

The healthcare delivery structure is influenced by political climate, economic development, technology, social and cultural values, environment, demographics, and global influences. Organizational Relationships The US healthcare delivery system has shifted it’s focus from illness to wellness, acute to primary care, individual to community well-being, fragmented to managed care, independent to integrated systems, and from duplication to a continuum of services.

Organizational Relationships

These trends were driven by the goal of promoting health while reducing the cost of healthcare. Thus midlevel health professionals and health coaches complement medical professionals to improve the effectiveness and efficiency of care.

Physicians, advanced practice nurses, therapist, and other healthcare professionals may understand their own clinical role but not the forces outside their profession which may significantly affect current and future clinical practice, thus the promotion of interprofessional education and collaboration. (DeNisco, 2021)

Advanced practice registered nurses such as nurse practitioner, clinical nurse specialist, nurse midwife, and nurse anesthetist are seeking to expand their scope of practice to be independent practitioners, with regulatory requirements and without direct supervision. Advanced nurse practitioners such as clinical nurse leaders and educators seek to better evaluate the implications of healthcare policies, and understand relevant issues and how they link to healthcare delivery services.

NUR-514 Topic 1 DQ 1: Health Care Systems, Organizational Relationships, and Interprofessional Health Care Environments References:

DeNisco, S. (Ed). (2021). Advanced practice nursing: Essential knowledge for the profession (4th Ed.). Jones and Bartlett Learning


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Again, Welcome!

In just the past two years the United states healthcare system along with many healthcare systems all over the world have shifted and evolved overnight as a direct result of the COVID-19 pandemic. as a nation we came through to the realization that our healthcare system it’s still very vulnerable despite all of the strides made in technology medical technology and advancements in patient care, disease prevention and treatment.

The pandemic also highlighted many of the public health issues that many Americans face. Our healthcare system was revealed to have poor patient care outcomes in addition to the revelation of just how sick many Americans are.

Our health care system is in desperate need of revamping in regards to how we treat patients and their illnesses and improving their health outcomes. Many Americans are suffering with chronic health issues that are fueling hospital costs and in some cases draining our healthcare resources and creating longer wait times in emergency rooms. The COVID-19 pandemic showed just how vulnerable our healthcare system is and expose many of its weaknesses as well.

There has been a shift to improving patient health outcomes by focusing on more holistic approaches and the patient as a whole. In addition to that there has been a push since the Affordable Care Act to implement more value based healthcare initiatives. “Value-based healthcare is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes” (NEJM Catalyst, 2017).

The value based healthcare model is now pushing for better outcomes an efficient and effective care for patients.

The value based healthcare model is striving to have patients spend less money to achieve better health provide efficiency and greater patient satisfaction put the control of cost back into the pairs slash patients hands reduce recidivism rates for suppliers to align their prices with patients outcomes and overall improving the societies health (NEJM, 2017).

advanced nurses will be on the front lines in working with communities and patients to improve upon their health outcomes by also reinforcing health education, guiding people to health care resources, going into communities that are vulnerable and lack healthcare resources, helping people find resources for disease prevention and treatment as well as developing strong reports and visibility within communities especially those that are experiencing poverty and hospital and clinic desserts.

I completely agree that our healthcare system needs revamping, and the major problem that our current system has created with health inequality. Working at a large health care system in North Phoenix, we help serve nearby Native American Tribes such as the Navajo tribe.

The Navajo Nation experiences a large number of health disparities due to isolation/remoteness of areas with a lack of transportation (no paved roads or public transportation), lack of government healthcare funding, lack of infrastructure (clean water, plumbing, electricity, and many lack telecommunications), and limited opportunities for education (Nez, 2020).

When patients from the Navajo Nation require a higher level of care in an acute care setting, they are often flown to a hospital far from the reservation and become isolated from their families with limited communication capabilities. Being a leader in the acute care setting, we can look for opportunities to help provide resources to the Navajo nation.

For example, being able to send a multi-disciplinary team composed of nurse practitioners, RN’s, providers, dietitians, pharmacists, and respiratory therapists to set up temporary clinics that focus on health education and prevention and help with the management of chronic diseases (i.e., diabetes, heart disease, etc.).

While caring for Native American patients in the hospital, it is critical to provide the medical care team with the tools to communicate and with an understanding of their culture in order to provide information and support making informed decisions. The Office of Minority Health has provided a set of standards to adapt care to accommodate language and culture (DeNisco, 2021). 

The OHM has taken a step to help recognize cultural differences and the importance of providing culturally competent care. The Navajo Nation is an example of where the U.S. health system has failed and created health inequality by not eliminating poverty and not providing safe living environments, infrastructure, and access to health care.

Global perspectives and diversity issues in healthcare have helped create an understanding of health equity in areas of poverty like the Navajo Nation. The top 25 wealthiest nations, excluding the U.S, offer a form of universal healthcare coverage. Access to healthcare is considered a basic human right (DeNisco, 2021).

A study by the RWJF shows the power of eliminating health disparities would significantly decrease healthcare costs (Braveman et al., 2019). These examples emphasize the importance of equal healthcare access for all communities in the US.

NUR-514 Topic 1 DQ 1: Health Care Systems, Organizational Relationships, and Interprofessional Health Care Environments References

Braveman, P., Gottlieb, L., Francis, D., Arkin, E., & Arcker, J. (2019, November 12). What can the health care sector do to advance health equity? Robert Wood Johnson Foundation. Retrieved September 24, 2022, from

DeNisco, S. M. (Ed.). (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124

Nez, J. (2020, July 17). The Navajo Nation – United States Commission on civil rights. U.S Commission of Civil Rights. Retrieved September 25, 2022, from

According to DeNisco (2021), a major feature of the U.S. healthcare system is its fragmented nature, as different people obtain health care through different means. The system has continued to undergo changes, due to concerns related to costs, access to care, and quality outcomes.

As health care expenditures continue to rise due to aging populations and managing chronic diseases, providers, payers, and policymakers must shift their focus from traditional fee-for-service models to value-based care programs. Value-based healthcare is a healthcare delivery model in which providers are paid based on patients’ health outcomes.

Under value-based care, providers are paid and rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way. This model promotes high-value health care, with the best possible outcomes per dollar spent (Agba, et al., 2022).

As the US health care system continues to evolve into value-based healthcare, and providers are incentivized based on patients’ health care outcomes, the demand for mid-level health care practitioners will continue to increase. We are also seeing more healthcare legislation directed towards expanding the scope of practice and roles of advanced practice nurses to be able to practice independently, without direct supervision from a physician, in order to provide much-needed medical care in areas and communities that need them most.

NUR-514 Topic 1 DQ 1: Health Care Systems, Organizational Relationships, and Interprofessional Health Care Environments References:

Agba, C. O., Snowden-Bahr, J. D., Kadakia, K., Chaker, S. A., Young, J. B., Forystek A. G., (2022). Global horizons for value-based care: Lessons learned from the Cleveland clinic, NEJM Catalyst 3 (5)

DeNisco, S. (Ed). (2021). Advanced practice nursing: Essential knowledge for the profession (4th Ed.). Jones and Bartlett Learning

The Centers for Medicare & Medicaid Services (CMS) released the value-based programs to phase out the fee-for-service program in 2008. Since then, our healthcare system graduates to shift, and the program’s main idea is to eliminate the unnecessary medical cost of healthcare. Paying providers is based on the quality of care, not the quantity. (CMS, 2022)

During the shift, we have seen different kinds of legislation passed and programs implemented in our current system, like the Affordable Care Act (ACA), the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), Alternative Payment Models, and Merit-Based Incentive Payment System (MIPS). (CMS, 2022)

The MIPS eligible clinicians include Nurse Practitioners, Certified Nurse Midwives, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists. (Mingle Health, 2020) The eligible clinician participating in the quality payment program through MIPS is not required to submit the cost performance; the measurements are calculated based on Medicare Part B, observation or outpatient service, and administrative claims data.

The major evolving trend in the healthcare delivery system is that advanced registered nurses will play a role and responsibilities in observation or outpatient care to improve the quality of patient care as the healthcare industry moves toward value-based care. In the future, we may see an increase in advanced registered nurses who practice independently and influence the direction of healthcare.

NUR-514 Topic 1 DQ 1: Health Care Systems, Organizational Relationships, and Interprofessional Health Care Environments Reference:

Centers for Medicare & Medicaid Services. (2022, March 31). value-based programs.

Mingle Health. (2020, August 13). Mips eligibility: Who must participate, and who is exempt from MIPS participation and reporting?

there are several transformations in the healthcare industry in America today. the changes are from free-for-all services to a model Value-based system. The shift in healthcare delivery impacts the APRNs roles and responsibilities patients’ care was delivered usually in hospital settings and physicians and nurses deliver care in these settings. The introduction of Value-Based care has increased for the need for healthcare providers outside of the hospital setting into home visits, phone calls, and video visits.

Value-based care provides opportunities for healthcare providers to work in collaboration to create a care plan that meets the patient’s needs and safe and convenient ways to monitor the patient’s progress and make adjustments accordingly. Value-Based Care provides nurses with the key role to educate patients and families on the management and treatment of their health conditions

I enjoyed reading your post. I appreciate how you pointed out that providers should be paid for quality of care, not quantity. The transition of the United States health care system to a value-based approach has given APRNs increased opportunities. A major focus within health care is to deliver improved patient outcomes while reducing the cost. APRNs have proven to provide high quality, easily accessible, and cost-effective care.

Due to this, the role of the APRN will likely expand to accommodate for the quickly evolving health care system. Organizations, such as the American Nurses Association (ANA), are advocating for the expanded scope of nurses and APRNs. In order to provide quality care, scope barriers must be eliminated to allow nurses and APRNs to practice to the full extent of their education and abilities (American Nurses Association [ANA], 2022).

NUR-514 Topic 1 DQ 1: Health Care Systems, Organizational Relationships, and Interprofessional Health Care Environments References

American Nurses Association. (2022). Scope of practice. ANA Enterprise.

While I’m reading your post , I noticed so many keys points related tou healthcare disparities in this country . Despite all of the changes that’s occurred for the past decades just to improve the system, still yet it remains fragmented. Healthcare professionals only focus on the financial area rather focusing on the patients. Nowadays if you don’t have a good coverage , don’t waste your time to take yourself to the ER .

It’s a whole new ball game when the final bills reached into your mailbox. But with the expansion of the field by bringing professionals from different aspect which are well trained to provided the same exact care in a different setting. “Emergency and primary care advanced nursing practice do share similarities in that they serve as first-contact access to healthcare, but the acuity of the patient manifestations delineates the two.

Unlike in primary care NP/APNs, emergency NP/APNs are trained to manage patients with acute life- or limb-threatening conditions . In the past decade, greater practice autonomy has been given to NP/APNs in emergency and critical care”.(Nurs Leadership,2006)

NUR-514 Topic 1 DQ 1: Health Care Systems, Organizational Relationships, and Interprofessional Health Care Environments Reference:

Sidani S, Doran D, Porter H, LeFort S, O’Brien-Pallas LL, Zahn C, Laschinger H, Sarkissian S. Processes of care: comparison between nurse practitioners and physician residents in acute care. Nurs Leadersh. 2006;19(1):69–85

Access to healthcare is a fundamental human right. The World Health Organization promotes access to healthcare for all and strives to implement initiatives to support this mandate. The WHO states, “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” (Ghebreyesus, 2017).

To support this mandate, I believe that the United States Government should provide access to healthcare and disease prevention programs to all. The current value-based health program for the U.S does not support the WHO mandate. This current U.S. program does not provide healthcare to citizens regardless of their socioeconomic status.

This results in a lack of health services for citizens that cannot afford private insurance provided by an employer. According to DeNisco, the value-based system creates free-market conditions resulting in an inverse relationship between price and quantity (2019). This type of market has led to health inequality in the U.S.

The United States has a healthcare system run by privately funded insurance and healthcare administration. No central department of the government oversees all aspects of the health system. Departments such as Medicare and Medicaid help determine public-sector expenditures, reimbursement rates, regulations, and certification standards (DeNisco, 2021).

The U.S. health system has resulted in health inequality influenced by socioeconomic factors. Advanced Practice Nurses (APRNs) are pivotal in helping to improve health equity and access to health care. The value-based system has created a greater need for healthcare providers. APRNs have become in high demand due to an increase in the quantity of access to healthcare.

Health care should be affordable and accessible to all; a flaw in our current system is that we have some of the best programs, techniques, and treatments in the world, but it is not accessible to all. If health inequality is not addressed, more and more individuals will continue to create a more significant problem with health disparities. This will place more responsibility on APRNs to support the public health sector and provide resources to those who suffer from health inequality.

NUR-514 Topic 1 DQ 1: Health Care Systems, Organizational Relationships, and Interprofessional Health Care Environments References

DeNisco, S. M. (Ed.). (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124

Ghebreyesus, T. A. (2017, December 10). Health is a fundamental human right. World Health Organization. Retrieved October 10, 2022, from 

Nurse 514 Topic 1 DQ1

The U.S. healthcare system continues to evolve from a system that was initially focused on dealing with infectious and acute diseases to one that is now founded on preventive care and leverages technology as well as scientific research evidence to offer quality interventions. During the initial stage of the system, providers focused on supernatural phenomena as the causes of diseases and ways to reduce mortality.

The implication is that during this stage, providers aimed at improving management of such conditions and preventing deaths. The system evolved as more research evidence allowed the providers to focus on the increased prevalence of chronic conditions emanating from many years of limited health promotion and a rise in sedentary lifestyle (Fisk et al., 2020).

However, the transformation and reforms in the health care system began with increased deployment of technology and research evidence suggesting the benefits of health promotion, preventive care and medicine and the overall embedment of quality measures. This has led to the establishment of the value-based health care model which implies that providers and organizations focus on quality and not quantity.

The value-based model leverages technology to improve care provision and delivery and emphasizes using technology to bridge any care gaps. The shift to value-based health care has had an impact on the roles and responsibilities of advanced registered nurses in several ways. Firstly, they are primary care providers and patient advocates to ensure that all health populations get access to care (Pittman et al., 2019).

Secondly, the advanced registered nurses work collaboratively with other professionals in multidisciplinary teams to deliver care to patients in different settings. As primary care providers, these nurses have expanded responsibilities and roles to serve more health populations and offer quality care to improve outcomes. They also implement innovative technologies and transformational approaches to enhance patient care quality. 

nur-514 topic 1 dq 1: health care systems, organizational relationships, and interprofessional health care environments

The major evolving trends like increased deployment of technology, reforms to expand care provision, and use of technologies to improve access and quality will affect the nursing practice as nurses will be expected to take on more roles and duties. It also means that nurses will continue to specialize to meet diverse patient needs (Rambur et al., 2019).

Advanced registered nurses will influence the healthcare direction by being equal partners and providers alongside physicians to enhance access and bridge the shortage gap. They will also formulate better interventions to improve population health across care and age continuums.

NUR-514 Topic 1 DQ 1: Health Care Systems, Organizational Relationships, and Interprofessional Health Care Environments References

Fisk, M., Livingstone, A., & Pit, S. W. (2020). Telehealth in the context of COVID-19: Changing perspectives in Australia, the United Kingdom, and the United States. Journal of Medical Internet research, 22(6), e19264. DOI: 10.2196/19264.

Pittman, P., Rambur, B., Birch, S., Chan, G. K., Cooke, C., Cummins, M., … & Trautman, D.

(2021). Value-based payment: What does it mean for nurses? Nursing Administration Quarterly, 45(3), 179-186. DOI: 10.2196/19264.

Rambur, B., Palumbo, M. V., & Nurkanovic, M. (2019). Prevalence of telehealth in nursing:

Implications for regulation and education in the era of value-based care. Policy, Politics, & Nursing Practice, 20(2), 64-73. DOI: 10.1177/1527154419836752.

Topic 1 DQ 1: Value-Based Health Care

Health care delivery evolves progressively as patient needs and care models change. In response, the U.S. health care system has evolved significantly to ensure patients and populations live healthily and productively. Health care policies and support programs have also evolved as situations necessitate. The shift to value-based care is among the evolutions with far-reaching effects.

Generally, the shift to value-based health care represents a change from volume-based care to quality-based care. Under value-based care, health care providers are incentivized based on quality rather than quantity of care. The objective is to transform health care to create more value for patients (Teisberg et al., 2020).

Guided by this goal, health care providers focus more on optimizing patient outcomes, reducing costs, and promoting healthy living through evidence-based medicine. Accordingly, the roles and responsibilities of advanced registered nurses change as they focus more on care quality and patient satisfaction.

Instead of primarily serving as care providers, value-based care prompts nurses to be innovators and change agents (Colldén & Hellström, 2018). The implication is that advanced registered nurses must embrace the transformational role to ensure that care quality matches patient needs and that patients are served promptly and satisfactorily.

Major evolving trends include artificial intelligence, remote and virtual care, and data-driven practice. These trends will affect the health care system by prompting more use of technology and informatics and providers with similar competence, such as nurse informaticists. As Wirth et al. (2021) postulated, a technology-driven practice supports data sharing but also increases privacy and security risks.

As a result, advanced registered nurses will influence the direction of health care by guiding organizations on system design and implementation to benefit from the tech-driven practice. They will also be instrumental in patient education, policymaking, and developing care models that optimize quality, safety, and overall patient satisfaction.

NUR-514 Topic 1 DQ 1: Health Care Systems, Organizational Relationships, and Interprofessional Health Care Environments References

Colldén, C., & Hellström, A. (2018). Value-based healthcare translated: A complementary view of implementation. BMC Health Services Research18(1), 1-11.

Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based health care: A strategic framework. Academic medicine: Journal of the Association of American Medical Colleges95(5), 682–685.

Wirth, F. N., Meurers, T., Johns, M., & Prasser, F. (2021). Privacy-preserving data sharing infrastructures for medical research: Systematization and comparison. BMC Medical Informatics and Decision Making21(1), 1-13.

Thank you for sharing about Value-Based Care. It is very enlightening. I believe patients will benefit from value-based care compared to fee-for-service reimbursement as this focus more on rendering quality patient care. Readmission in the hospital setting is costly, especially if it is within 30 days from discharge. This cost money and the US hospital is losing medicare reimbursement from financial penalties for excess-risk standardized 30-day readmission and mortality in Medicare patients (Ahmad et al., 2017.)

Quality is better than quantity, which is how healthcare should provide to the public. On some occasions, providers are questioned about their orders. Are the tests necessary, or why is it too excessive? It is also frustrating when patients get discharged prematurely; you will see the patient back in two days with the same diagnosis. Patients often verbalized, “I told the doctor I am not ready to go home yet, and they will not listen.” Core measures are essential to our patients. I believe the value-based care models, which focus on quality patient outcomes, are better. Healthcare providers, including APRNS, must improve rendering quality of care based on specific core measures, such as preventing or decreasing hospital readmissions and, most importantly, appropriate discharge methods, discharge follow-up, and maintaining a healthy lifestyle through quality health education regarding preventive measures.


RevCycleIntelligence. (2022, March 2). What is value-based care, what it means for providers? RevCycleIntelligence. Retrieved November 18, 2022, from

SL;, A.-A. A. A. H. R. A. A. K. D. H. (2017, February 1). Association between Medicare Hospital Readmission Penalties and 30-day combined excess readmission and mortality. JAMA cardiology. Retrieved November 18, 2022, from

Healthcare is an important topic worldwide and an ongoing controversy, especially in the United States. Healthcare has an intricate history. In the 1890s, a lumber company paid physicians in Washington to provide care for the workers, which was the beginning of insurance (Health Care Markets, nd). In the 1900s, President Roosevelt and his progressive party introduced The American for Labor Legislation and proposed a bill for compulsory health insurance. Each Federal Administration had developed legislatures and policies to cater to the needs of the American population. From home remedies to doctors with little training and the evolution of the complexity of human health, the study and research regarding the human body are essential. Throughout history, from when smallpox made its presence known, to the first case of AIDS, the complexity of cancer, and the recent pandemic with the COVID virus, research, science, technology, and biology have to keep up to protect and care for the population. With each federal administration change, the ever-changing health care and insurance policies are developed to fit the needs of the US population. Medical errors and tragic events push the healthcare system to review, analyze and create a new plan to prevent these errors or events from happening again.

Before President Kennedy died tragically, he started the health insurance system for the elderly and retirees. He encouraged Americans to be involved in the legislative process of healthcare and eventually became the groundwork for Medicare and Medicaid. The recent Affordable Care Act passed by President Obama’s administration in 2010 has opened many opportunities for healthcare providers. More insured patients with long-term or chronic diseases or chronic medical conditions from diabetes, heart failure, and kidney failures, among others, require maintenance and follow-ups with physicians. The increased number of patients put a strain on many doctors and caused shortages. However, it presents opportunities to advance practice nursing to expand their scope of practice. More APRNs and APNs transitioned to patient-centered leadership and providing quality and personalized care to every patient. The ACT is significant to the future of APNs. As healthcare evolves, the demands from acute settings, clinics, and communities allow the full potential for nurses in their career advancement. Continuing education, training, and competencies promote expanding their roles to collaborate with the interprofessional team to provide quality and cost-efficacy healthcare to every individual across the nation (National Library of Medicine, nd).

Consider the evolution of the U.S. health care system. Discuss how the shift to value-based health care has impacted delivery of care and the role and responsibilities of the advanced registered nurse. Project what major evolving trends in the health care delivery system will affect nursing practice and how advanced registered nurses will influence the direction of health care. 

Since the inception of the Affordable Care Act (ACA), the U.S. health care system has shifted from a volume service model to a value-based model in terms of health care delivery and payment for the services (Weberg et al., 2019). In the recent years, the payers for health care such as the Centers for Medicare and Medicaid Services (CMS) have continuously moved away from the fee-for-service model that promoted and rewarded health care delivery by volume to the value based model that rewards quality care delivery models such as the population health outcomes. The value-based programs include the Patient Centered Medical Homes (PCMHs) and 

Accountable Care Organizations (ACOs) (Fraher et al., 2015). 

In the transformed health care systems, nurses have broader roles in both the ambulatory settings and community-based care. In particular, new job titles are emerging for nurses in the fields of population health management, patient education, informatics, and management of patient care transitions (Fraher et al., 2015). As the primary link between patients and the health care delivery systems, there is need for the advanced practice registered nurse to collaborate with other members of the interprofessional health teams. Further nurses are expected to apply the nursing skills in new ways in addition to developing new ones. 

One of the evolving trends in the health care delivery systems that will affect the nursing practice is the use of health care systems to advance then evidence-based practice (EBP). Currently, nurses are applying the data acquired from the electronic health records (EHRs) and patient registries to determine potentially unfulfilled population health needs and interventions (Fraher et al., 2015). In the future, health care technologies such as the telehealth systems will enable health care providers including the advanced practice nurses to monitor and communicate with their patients remotely. Potentially, nurses can influence these systems in order to meet the patients’ care needs as well as to direct and guide organizations towards formulation of policies focusing on care improvement. 


Fraher, E., Spetz, J., & Naylor, M. (2015). Nursing in a Transformed Health Care System: New Roles, New Rules. Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative, 

Weberg, D., Mangold, K., Porter-O’Grady, T., & Malloch, K. (2019). Leadership in nursing practice: Changing the landscape of health care (3rd ed.). Jones & Bartlett Learning. 


 I agree with you that the inception of the Affordable Care Act (ACA) transformed health care delivery. Before the interception of the regulation, the U.S health care system preferred volume service model. The model was suitable since U.S health care system was dealing with high demand for healthcare services from many Americans (Cossio-Gil et al., 2022). Therefore, volume service model allowed healthcare providers to attend to many patients. However, the ACA proposed transition to a value-based model. The approach allowed patients to get value of their money when seeking medication. Therefore, health care delivery activities were synchronized according to patient’s healthcare needs. The value-based programs include the Patient Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs) (Zipfel et al., 2019).  The shift from volume service model to value-based model allowed healthcare facilities to provide patient-satisfactory healthcare services. The transformation in health care delivery has allowed different stakeholders to work together to provide quality healthcare services. The partnership between patients and healthcare providers benefit both parties.  


Cossio-Gil, Y., Omara, M., Watson, C., Casey, J., Chakhunashvili, A., Gutiérrez-San Miguel, M., … & Stamm, T. (2022). The roadmap for implementing value-based healthcare in European university hospitals—consensus report and recommendations. Value in Health, 25(7), 1148-1156. 

Zipfel, N., van der Nat, P. B., Rensing, B. J., Daeter, E. J., Westert, G. P., & Groenewoud, A. S. (2019). The implementation of change model adds value to value-based healthcare: a qualitative study. BMC Health Services Research, 19(1), 1-12. 

According to health statistics in the United States of America in the period, 1960 and 2019 the health care cost increased from 5% to 17.7%, reaching 3.8 trillion dollars in 2019 (Harrill & Melon, 2021). So, the payment reform model reviewed the quality and health care expenses. Today current healthcare reform focused on Value-Based Healthcare (VBH) by using pay for performance (P4P), and alternative payment models (APM). In value-based health care, the focus is on the quality of patient care and helps the patients to be a partner in the process of future value in healthcare. Shifting to value-based healthcare has impacted the delivery of care through the participation of healthcare consumers, patient experience, recommendations, access, and outcome.  

The role of an advanced registered nurse is important to deliver value-based health care. In this, the core value is the quality of care than the volume of care. APRNs must aim at how to provide health care cost-effectively and prevent and maintain chronic diseases. Considering the Participation of patients and their recommendation, interests, and values play a vital role in high-quality health care.  

One of the major trends reflected in healthcare delivery due to covid-19 pandemic is telehealth and telehealth medicine. It was only used in rural and urban areas to provide health care before the pandemic, covid 19. Telehealth expanded nationwide during the pandemic to deliver care both inpatient and outpatient (Frey & Chiu, 2021). It provides same-day and chronic disease care appointments to increase safe practice by avoiding exposure to infectious agents, especially coronavirus. It helps advanced registered nurses to deliver high-quality and safe care through the advancement of technology. It enhances communication through video calls and improves patient outcomes. In addition, it is cost-effective and high-quality health care.  


Frey, M. B., & Chiu, S.-H. (2021). Considerations When Using Telemedicine As the Advanced Practice Registered Nurse. Journal for Nurse Practitioners, 17(3), 289–292.  

Harrill, W. C., & Melon, D. E. (2021). A field guide to U.S. healthcare reform: The evolution to value‐based Healthcare. Laryngoscope Investigative Otolaryngology, 6(3), 590–599.  


 The increase in the demand of healthcare services in the United States of America resulted to limited access to healthcare services. Most Americans from poor households and low-earning U.S citizens have problems of affording healthcare services (Hurst et al., 2019).  Therefore, different players become concern with the inaccessibility of healthcare services to a significant percentage of U.S citizens. The payment reform model reviewed the quality and health care expenses. The reform aimed at improving accessibility to different healthcare services by increasing the affordability of medical services. Today, Value-Based Healthcare (VBH) allows healthcare providers to provide healthcare services that attain healthcare needs of patients (Ibanez-Sanchez et al., 2019). Thus, patient tastes and preferences are critical in the VBH. Shifting to value-based healthcare has impacted the delivery of care through the participation of healthcare consumers, patient experience, recommendations, access, and outcome. The role of an advanced registered nurse is important to deliver value-based health care.  These healthcare professionals have knowledge and experience in value-based health care services.  


Hurst, L., Mahtani, K., Pluddemann, A., Lewis, S., Harvey, K., Briggs, A., … & Heneghan, C. (2019). Defining value-based healthcare in the NHS. University of Oxford.  

Ibanez-Sanchez, G., Fernandez-Llatas, C., Martinez-Millana, A., Celda, A., Mandingorra, J., Aparici-Tortajada, L., … & Traver, V. (2019). Toward value-based healthcare through interactive process mining in emergency rooms: the stroke case. International Journal Of Environmental Research And Public Health, 16(10), 1783. 

Value-based healthcare is meant to be personalized medicine. VBH has the motto to “treat the right patient at the right time with the right treatment”. Treatments can be much more personalized, increase efficacy, reduced adverse events, improved quality of life and efficient use of healthcare expenditure (Steffen, J.A. & Lenz, C. 2013). Diagnostic testing for cancer care has drastically improved for cancer patients with use of single testing, parallel testing, and whole-genome sequencing which has led to wide range of diagnostic technologies that are available for use, the drawback is local and state regulations as well as reimbursement specifically if it is seen as value added (Steffen, J.A. & Lenz, C. 2013). This is a drastic change from value-based healthcare as care was delivered by a physician and was seen as the only truth to care and one-size fits all approach. 

Introduction of value-based healthcare has allowed advanced practice registered nurses to expand responsibilities and there has been an increase in service and specialties. Examples of this is nurse practitioners moving into a variety of settings such as acute care and partnering with specialty providers, ability to perform initial hospital assessment and consultation, continued oversight of patients, development of treatment plans, discharge planning and follow up at clinics. Kocakulah, M.C. et al. (2021) states discharge clinics are being staffed more by nurse practitioners with access to other team members. Nurse practitioners are more cost effective, and use of NP’s has allowed providers to meet Medicare guidelines of a 7 day post-discharge follow-up. This can help patients and the primary providers meet this guideline when obtaining an appointment to see their primary is difficult to impossible. In my prior role nurse practitioners worked in various specialties including cardiology, orthopedic, oncology and palliative are. Each NP worked hand in hand with their physician(s) from admission to discharge and into the specialty clinics.  

A healthcare setting that will likely see a change in home healthcare and home hospice. It is likely more NP’s will be allowed to prescribe for home health care and hospice services as well as NP’s work in these environments with the ability to provide necessary care for home bound patients. During the pandemic lifts on these regulations provided much needed relief for agencies, providers, patients and family members. 


Steffen, J.A, & Lenz, C. (2013). Technological evolution of diagnostic testing in oncology. Personalized Medicine, 10(3), 275-283. Doi: 

Kocakulah, M. C., Austill, D., & Henderson, E. (2021). Medicare cost reduction in the US: A case study of hospital readmissions and value-based purchasing. International Journal of Healthcare Management, 14(1), 203–218.  


it is true that value-based healthcare is meant to be personalized medicine. Therefore, patients play an active role in VBH. Healthcare professionals consider patient tastes and preferences when providing value-based healthcare services. Different patients have unique healthcare needs. Thus, healthcare providers take time to understand their patients while providing VBH. VBH has the motto to “treat the right patient at the right time with the right treatment” (Reitblat et al., 2021). Diagnostic testing for cancer care has drastically improved for cancer patients with use of single testing and parallel testing. Cancer patients require quality healthcare services due to the nature of their illness, especially, at the advance stages of the disease (Zanotto et al., 2021).  Therefore, VBH guarantees healthcare professionals and patients about the provision of satisfactory healthcare services. The shift from volume-based to value-based model was delivered by a physician and was seen as the only truth to care and one-size fits all approach. Advanced registered nurses play an important role in implementing and using VBH.  


Reitblat, C., Bain, P. A., Porter, M. E., Bernstein, D. N., Feeley, T. W., Graefen, M., … & Gershman, B. (2021). Value-based healthcare in urology: a collaborative review. European Urology, 79(5), 571-585. 

Zanotto, B. S., da Silva Etges, A. P. B., Marcolino, M. A. Z., & Polanczyk, C. A. (2021). Value-based healthcare initiatives in practice: a systematic review. Journal of Healthcare Management, 66(5), 340. doi: 10.1097/JHM-D-20-00283 

The U.S. healthcare delivery system lacks a rational and integrated network of components designed to function coherently together. On the contrary, it is a diverse array of finance, insurance, distribution, and payment processes that need to be more coordinated. Each of these fundamental functional components embodies a combination of public (government) and private sources. The market-oriented economy of the United States entices a diverse range of private enterprises that seek to generate profits by facilitating the essential activities of healthcare delivery. Employers get health insurance for their employees from private entities, and employees avail of healthcare services provided by the private sector. The government funds public insurance for a substantial proportion of the nation’s low-income, elderly, disabled, and pediatric populations through Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). However, private businesses like health maintenance organizations (HMOs) facilitate insurance arrangements for many people with public insurance, and private physicians and hospitals offer healthcare services (DeNisco, 2024).  This has an impact on how the insurance company decides to reimburse providers for particular services.  However, if a patient is using government funds such as Medicare or Medicaid, there are certain items, such as DME, that are only covered once every 5–7 years.  Knowing what is covered helps providers properly care for their patients and assist them in obtaining resources to help.  For example, when I worked in home care, patients on Medicare or Medicaid could only obtain a walker or cane every 7 years.  This meant that if they were prescribed a walker on discharge from the hospital and recently obtained a cane, they would have to pay out of pocket or get one from another source.

DeNisco, S. M. (Ed.). (2024). Advanced practice nursing: Essential knowledge for the profession (5th ed.) Jones & Bartlett Learning. ISBN-13: 9781284264661

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