American Sentinel SIM410 Activity 1 National Health Coverage Plans, Reimbursements, & Quality Latest 2023

SIM410 Healthcare Policy and Regulation

Activity 1

National Health Coverage Plans, Reimbursements, and Quality

Baccalaureate education includes learning opportunities of healthcare policy, finance, and regulatory environments (AACN, 2008). 

Complete the Nursing Quality Indicators (NQI) virtual simulation activity to explore the impact of nursing designs on quality measures, including cost, systems, processes, and outcomes of various points of care. The goal of this activity is to think about basic quality and safety investigations that are used to create and measures outcomes of quality improvement processes.

Please Note: You can navigate to the NQI activity by clicking on ‘Sentinel Hospital’, entering the lobby, and clicking the brown icon: ‘Surgical Services.

Introduction & Healthcare Coverage and Vulnerable Populations

Describe the importance of healthcare coverage (insurance).  End with a clearly worded purpose statement for this project. Discuss two ways healthcare coverage is beneficial (helpful) for the vulnerable/ uninsured populations.

Diagnosis Related Groups

Describe the purpose of Diagnosis Related Groups (DRGs).  Explain the impact of DRGs on length of stay and payment of services.  Discuss how payments for DRGs are now impacted by quality indicators and measures.

Select a Major Healthcare Plan

(Label heading with the name of the plan Ex:  Preferred Provider Option Plan)  

Select one of the patients from the cases you reviewed in NQI.  Summarize two care options provided by the plan that facilitates access for your selected patient.  Summarize two care options that limit access to care for your selected patient.

Select a Second Major Healthcare Plan

(Label heading with the name of the plan Ex: Medicaid) 

Repeat this activity with the same patient.  Summarize two care options provided by the second plan that facilitates access for your selected patient.  Summarize two care options that limit access to care for your selected patient.

Impact of Nursing Interventions

Summarize at least four priority nursing interventions or considerations to promote self-care for your selected patient to provide high quality, safe healthcare considering nursing-sensitive indicators.  Provide a rationale for each of your selected nursing decisions.

Conclusion

Summarize the key points of your project.

**You will not discuss the deductibles or costs of the insurance plans as this is not the focus of this this assignment.

Following the simulated activity, you will examine the relationship between healthcare coverage (insurance), quality care, and reimbursements (payments) to health care organizations. Select two different major national (U.S.) insurance health plans.  You may choose Medicaid, Medicare, HMO, PPO, or private insurance plans.  You can choose your own personal insurance plan if you prefer.  Review healthcare coverage options offered by both plans that benefit (facilitate) and hinder (limit) access to care.  Examples of healthcare coverage (insurance) options that facilitate, or limit access include medication coverage, primary care physician office visits, specialists physician office visits, emergency care, lab or blood work and diagnostics, wellness care, prevention services or surgery (these are just a few examples). You will also explore the role of Diagnosis Related Groups (DRGs) and charity care within healthcare facilities (hospitals) and how charity care impacts the vulnerable or uninsured population. Finally, summarize nursing interventions or considerations for your selected patient to provide high quality, safe healthcare considering nursing-sensitive indicators in his/her unique scenario.

Textbook and other resources

Centers for Medicare and Medicaid

Additional Instructions:

All submissions should have a title page and reference page.

Utilize a minimum of two scholarly resources.

Adhere to grammar, spelling and punctuation criteria.

Adhere to APA compliance guidelines.

Adhere to the chosen Submission Option for Delivery of Activity guidelines.

Submission Options

Choose One:

Instructions:

Paper

4 to 6-page paper. Include title and reference pages.

Microsoft PowerPoint Presentation

8 to 10 slides. Add title and reference slides.

Follow Rules of 7.

Other media (Prezi, etc.) presentation

8 to 10 slides with speaker notes. Add title and reference slides.

Follow Rules of 7.

Video Presentation

5 to 8-minute video presentation.

Attach reference page or include in video.

Professional appearance and background.

Video submissions must include a script in Word format, submitted through Turnitin for an Originality Report.

Table

Table with appropriate columns and headers.

Include title and reference pages.

Graphs or other illustrations

Graphs or illustrations with appropriate labels. Include title and reference pages.

Poster

Poster utilizing any applicable poster template. Include visual graphics/images/other formats for visual appeal. Include appropriate title and references on poster.

Note: Title and reference pages/slides do not count towards the count requirements.

 

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