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The Future of Nursing: Leading Change, Advancing Health
provided by these four initiatives. Nursing, in collaboration with other professions, should be a part of the design of these initiatives by shaping and leading solutions. Innovative solutions are most likely to emerge if researchers from the nursing field work in partnership with other professionals in medicine, business, technology, and law to create them.
Accountable Care Organizations
The ACO is a legally defined entity consisting of a group of primary care providers, a hospital, and perhaps some specialists who share in the risk as well as the rewards of providing quality care at a fixed reimbursement rate (Fisher et al., 2009; MedPAC, 2009). (The use of the phrase “primary care ACO professionals” in the ACA is inclusive of APRNs as well as physicians.) Payment for this set of services, as provided for in the ACA, will move beyond the traditional fee-for-service system and may include shared savings payments or capitated payments for all services. The goal of this payment structure is to encourage the ACO to improve the quality of the care it provides and increase care coordination while containing growth. ACOs that use APRNs and other nurses to the full extent of their education and training in such roles as health coaching, chronic disease management, transitional care, prevention activities, and quality improvement will most likely benefit from providing high-value and more accessible care that patients will find to be in their best interest.
The concept of a medical home was first developed by pediatricians in the late 1960s (AAP, 1967). The original impetus was to create a single place to house all of individual children’s medical records—particularly children with special health needs who often must see multiple clinicians (Sia et al., 2004). Over the years, however, the term “medical home” has evolved to refer to a specific type of primary care practice that coordinates and provides comprehensive care; promotes a strong relationship between patient and provider; measures, monitors, and improves the quality of care; and is not necessarily limited to children.
Medical homes play a prominent role in the ACA, but the law is not consistent in its terminology for them. In various places, the ACA refers to “medical homes,” “health homes,” and even the above-discussed PCMH that is recognized by NCQA. The ACA indicates that medical/health homes should be supported by community-based interprofessional teams or “health teams” that include physicians, nurses, and other health professionals.31
The medical/health home concept has been adopted and adapted in several ways. The latest phase of the broader nursing strategy at the VA, for example,
Patient Protection and Affordable Care Act, HR 3590 § 3502, 111th Congress.