Many consumer and health care advocacy initiatives are converging toward a mandate to provide public access to many types of information about managed care organization (MCO) performance, costs, and quality. In fact, employers in the many parts of the country who are the major purchasers of health insurance are now requiring MCOs to make “health plan performance data” available to subscribers to facilitate their choice of plans.

Discuss and provide the rationale for your opinion on providing data in areas such as patient outcomes, compliance with national standards for preventive and chronic care, and comparative costs to the public.

What obligation, if any, does an employer, and/or MCO have to educate subscribers in how to interpret performance data? At whose expense should such education be provided?

What are the possible benefits or disadvantages to making such performance data available to the public?

For this assignment, you will examine the importance of healthcare coverage (insurance).  You will also examine how reimbursements (payments) from healthcare plans are impacted by quality of care.  Start by describing the purpose and importance of Medicare and Medicaid programs.  Support your position by describing how you agree with or disagree with the purpose and intent of these plans. Next, you will review healthcare coverage options offered by both plans that benefit (facilitate) and hinder (limit) patient’s access to care.  Examples of healthcare coverage (insurance) options that facilitate or limit access include medication coverage, primary care physician office visits, specialist’s physician office visits, emergency care, lab or blood work and diagnostics, wellness care, prevention services, 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 explain how charity care impacts the vulnerable or uninsured population.

**You will not discuss the deductibles or costs of the insurance plans as this is not the focus of this this assignment.  Please do not use tables or seriation as you need to discuss the options. 

Textbook and other resources:

• Centers for Medicare and Medicaid 

All submissions must have a minimum of two scholarly references to support your work. 

Examples of work to show mastery:

• 4-5 page paper – APA format

A

What are the strengths and weakness of transformational leadership theory and leader-member theory (LMX)? How might your knowledge of the LMX theory help you to become a better leader?

B

How would you apply the transformational theory leader-member theory (LMX) to improve an organization’s performance? Discuss in the context of your own organization, an organization you have belonged to in the past, or another existing organization that would benefit from significant organizational improvement.

Please provide references

Write a 1000-1500-word APA paper addressing each of the following points. Be sure to completely answer all the questions for each bullet point. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least three (3) outside sources and the textbook using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.

Case Study: Mrs. Adams, a 68-year-old widow who was referred to case management upon discharge from the hospital based on her physician’s recommendation that she is not able to care for herself independently. Her diagnosis is diabetes, hypertension, and breast cancer. She is 5 days’ post-op from a right sided mastectomy.   Mrs. Adams apartment is located in a low-income area of the city where crime is prevalent.  Upon assessment by the Community Health Nurse, Mrs. Adams apartment was in disorder with minimal airflow or light. Her clothes appeared unchanged and she had no food in the apartment.  The small apartment also housed 3 cats and a small dog who Mrs. Adams considers family since the death of her husband 1 year ago. Mrs. Adams complains of pain and draining from her surgical site and a broken air conditioner. 

• Using Nightingale’s Environmental Theory, what actions would the nurse take upon the first assessment? What are the five essential components?
• What would be an appropriate plan of care be for Mrs. Adams? How would you prioritize the care plan?
• Apply Nightingale’s Environmental Theory to an area of your nursing practice?  What patient-population would benefit from this approach?  Support this practice change with at least one evidenced-based article.

Assignment Expectations:

Length: 1000 – 1500 words

Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.

References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of three (3) outside scholarly sources and the textbook are required for this assignment.