Explore the DNP-prepared nurse’s role, as a member of the interprofessional team, to design systems that optimize reimbursement with a goal to improve the quality of patient care. We will examine the influence of healthcare reimbursement on nursing practice, clinical outcomes, and cost issues.
Reflect upon your readings and professional experience regarding reimbursement issues and address the following.
Analyze how healthcare reimbursement influences your nursing practice.
Examine how the value-based insurance design (VBID) influences clinical outcomes and cost issues.
With the Affordable Care Act, the reimbursement model is shifting to provide incentives for innovating value-based programs, such as the Medicare Value-Based Insurance Design (V-BID) and Bundled Payment programs. The Value-Based Insurance Design is an approach that drives patients and providers to high value services while discouraging low-value services when the benefits do not justify the cost. The goal of V-BID is to decrease the cost of healthcare while increasing the effectiveness of health services. The V-BID approach structures health insurance in a way that incentivizes and drives patients and providers toward the most valuable services—those most beneficial relative to costs. V-BID has the potential to improve service utilization, quality, and outcomes.