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.

please note the underlined info below.

Case Study: Contraception 

Scenario 3

Elaine Goodwin is a 38-year-old G5 P5 LC 6 presenting to your clinic today to discuss contraceptive options. She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, migraines, and IBS. Her surgical history is remarkable only for tonsils as a child. Her social history is negative for alcohol and tobacco; she reports daily marijuana use. She has no known drug allergies and takes only vitamin C. Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad had a history of skin cancer (basal cell). Elaine has one older sister with endometriosis who was told not to have more children because she had blood clots when she was pregnant with her second child. She also has one younger brother with no reported medical problems.  

• Height 5’ 7” Weight 148 (BMI 23.1)   BP 118/72 P 68  
• HEENT:  wnl  
• Neck: supple without adenopathy  
• Lungs/CV: wnl  
• Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge  
• Abd: soft, +BS, no tenderness  
• VVBSU: wnl,   
• Cervix: firm, smooth, parous, without CMT  
• Uterus: mid, mobile, non-tender, approximately 8 cm,  
• Adnexa: without masses or tenderness  

QUESTION:

What other information do you need?  

Elaine relates to you that she has used birth control pills before but “would keep messing them up.”  After that she switched to the patch, which she found worked well but discontinued use for reasons she does not remember. After that she used natural family planning but still conceived her last two children unexpectedly.  She has had three partners in last 12 months and has been with her current partner for the previous two months. She believes that he is “the one.”    

Elaine relates that her cycles come every 28-32 days, for a duration of 5-8 days, and on her heaviest day she must use a super tampon every hour and get up to change her pad 2-3 times at night. Her last gyn exam was one year ago and she shows you a copy of the results on her patient portal. The results for the pap were NILM, HPV negative, and her cultures for GC/CT were negative.  

In further questioning, you ask her about her sister’s blood clots and her father’s PE.  She shares that her father was 48 years old and “just died one day.” Her sister was on “shots” for her blood clots and then took a pill. She had some blood test done and they said she had something called heterozygous MTHFR and Factor V Leiden.  

She has heard about a pill where she will only get her period four times a year and feels now that she’s older she can remember to take the pill daily and plans on putting a reminder in her phone.  

QUESTIONS: 

1. What are your next steps/considerations?  
2. What teaching should you do?  
3. What other information do you need? 

Here are the instructions

Case Study Discussion: Gynecologic Health

Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, diagnostic approaches, as well as the development of treatment plans.

Photo Credit: Teodor Lazarev / Adobe Stock

For this Case Study Discussion, you will review a case study scenario to obtain information related to a comprehensive well-woman exam and determine differential diagnoses, diagnostics, and develop treatment and management plans.

To prepare:

• By Day 1 of this week, you will be assigned to a specific case study scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your case study assignment from your Instructor.
• Review the Learning Resources for this week and pay close attention to the media program related to the basic microscope skills. Also, consider re-reviewing the media programs found in Week 1 Learning Resources.
• Carefully review the clinical guideline resources specific to your assigned case study.
• Use the Focused SOAP Note Template found in the Learning Resources to support Discussion.

By Day 3

Based on the case study scenario provided, complete a comprehensive well-woman exam and critically analyze to focus attention on the diagnostic tests then,

Post your differential diagnosis. Include the additional questions you would ask the patient. Be sure to include an explanation of the tests you might recommend, ruling out any other issues or concerns and include your rationale. Be specific and provide examples. Use your Learning Resources and/or evidence from the literature to support your explanations.

Read a selection of your colleagues’ responses.