Assignment 09.2: Negotiating Contract

HA4070D – Regulatory Environment in Health Care

Assignment 09.2: Negotiating Contract

Directions

Complete the assignment beginning page 492 titled “Exercise: Negotiating a Managed Care Contract” in a one to two page paper. Submit the assignment to your instructor. For a general description of Marcus Welby Hospital see page 369 of the text. The assignment below makes some adaptations to the text to clarify expectations for your paper.

One of Marcus Welby Hospital ‘s (MWH) competitors established a successful IPA-model HMO two years ago. Fearing loss of patients, MWH is forming the Marcus Welby Managed Care Network (the Network). The objective is to sign up a number of physicians, mainly in primary care but also in common specialties, and then to market this network to these two sources: () large employers who provide health insurance to their workers on a self-insured basis; and 2) large regional or national insurance companies (such as Blue Cross) who then offer the network to their customers.

The Network is approaching each physician group individually and asking them to sign up nonexclusively, leaving them free to sign up with other networks or HMOs. The contract excerpts on pages 493 and following contain some common sticking points in these negotiations. Read each pairing of contract options and determine what is at stake. Then, assume the position of lawyer/negotiator for either (a) the Network or (b) a physician group who wants to sign up but is concerned about the details.

• Write in your paper what you would say in a meeting with a representative from the other side and

• Describe how you would hammer out a deal, either adopting one version or the other, or making any changes you want.

• You must therefore be able to write clearly about what the concerns of the other side would be.

• Cite when appropriate.

The Law of Health Care  Finance & Regulation–Vitalsource Bookself-username-crtshhill49@yahoo.com-Password-#magicMAN61

Identify applicable local, state, or federal health care policy or law that prescribes relevant performance benchmarks that your policy proposal addresses.

Record a slide presentation with audio voiceover, supported by 8-12-slides, for one of the stakeholder groups identified in your Assessment 2 Policy Proposal, which addresses current performance shortfalls, the reasons why new policy and practice guidelines are needed to eliminate those shortfalls, and how the group’s work will benefit from the changes.

Introduction

It is important that health care leaders be able to clearly articulate policy positions and recommendations and garner buy-in and support from stakeholder groups for policy and practice changes in their organizations. Unfortunately, effective communication is often lacking. Consequently, it is important for health care leaders, when leading change, to ensure that clear and open communication is ongoing and informative.

An important aspect of change leadership is the ability to address diverse groups of stakeholders and create buy-in and support for your ideas and proposals for change. This assessment provides you with an opportunity to demonstrate and hone these skills.

Record a slide presentation, with audio voiceover, for one of the stakeholder groups you identified in your Assessment 2 Policy Proposal. Inform the group of current performance shortfalls, introduce the proposed policy, explain why the policy is needed, and present policy-driven practice guidelines to resolve the performance issue. You must also obtain buy-in from the group by explaining the positive effects of the policy and practice guidelines on their work.

Note: Remember that you can submit all, or a portion of, your draft presentation to Smarthinking for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.

Requirements

The presentation requirements outlined below correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, be sure to note the requirements for presentation format and length and for supporting evidence.

  • Summarize your proposed organizational policy and practice guidelines.
    • Identify applicable local, state, or federal health care policy or law that prescribes relevant performance benchmarks that your policy proposal addresses.
    • Keep your audience in mind when creating this summary.
  • Interpret, for stakeholders, the relevant benchmark metrics that illustrate the need for the proposed policy and practice guidelines.
    • Make sure this is a brief review of the evaluation you completed in your Assessment 1 Dashboard Benchmark Evaluation.
    • Make sure you are interpreting the dashboard metrics in a way that is understandable and meaningful to the stakeholders to whom you are presenting.
  • Explain how your proposed policy and practice guidelines will affect how the stakeholder group does its work.
    • How might your proposal alter certain tasks or how the stakeholder group performs them?
    • How might your proposal affect the stakeholder group’s workload?
    • How might your proposal alter the responsibilities of the stakeholder group?
    • How might your proposal improve working conditions for the stakeholder group?
  • Explain how your proposed policy and practice guidelines will improve quality and outcomes for the stakeholder group.
    • How are your proposed changes going to improve the quality of the stakeholder group’s work?
    • How will these improvements enable the stakeholder group to be more successful?
    • What evidence supports your conclusions or presents alternative perspectives?
  • Present strategies for collaborating with the stakeholder group to implement your proposed policy and practice guidelines.
    • What role will the stakeholder group play in implementing your proposal?
    • Why is the stakeholder group and their collaboration important for successful implementation?
  • Deliver a persuasive, coherent, and effective audiovisual presentation.
    • Address the anticipated needs and concerns of your audience.
    • Stay focused on key policy provisions and the impact of practice guidelines on the group.
    • Adhere to presentation best practices.
    • Proofread your presentation slides to minimize errors that could distract the audience and make it more difficult for them to focus on the substance of your proposed policy and practice guidelines.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Presentation Format and Length

You may use Microsoft PowerPoint or other suitable presentation software to create your slides. If you elect to use an application other than PowerPoint, check with your faculty to avoid potential file compatibility issues.

If using PowerPoint to create your presentation slides, you may use the following presentation as a template.

Be sure your slide deck includes the following slides:

  • Title slide.
    • Presentation title.
    • Your name.
    • Date.
    • Course number and title.
  • References (at the end of your presentation). Apply current APA formatting to all citations and references.

Your slide deck should consist of 8–12 slides, not including a title and references slide.

Note: If you have technical difficulties in recording your audio, you may, in place of the audio, provide a complete script of what you intended to say in the notes section of each slide. If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@Capella.edu to request accommodations.

Supporting Evidence

Cite 3–5 sources of scholarly, professional, or policy evidence to support your analysis and recommendations.

Portfolio Prompt: You may choose to save your presentation to your ePortfolio.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

  • Competency 1: Analyze relevant health care laws, policies, and regulations; their application; and their effects on organizations, interprofessional teams, and professional practice.
    • Explain how a proposed policy and practice guidelines will affect how a stakeholder group does its work.
  • Competency 2: Lead the development and implementation of ethical and culturally sensitive policies that improve health outcomes for individuals, organizations, and populations.
    • Summarize a proposed organizational policy and practice guidelines.
    • Explain how a proposed policy and practice guidelines will improve quality and outcomes for a stakeholder group.
  • Competency 3: Evaluate relevant indicators of performance, such as benchmarks, research, and best practices, to inform health care laws and policies for patients, organizations, and populations.
    • Interpret, for stakeholders, the relevant benchmark metrics that illustrate the need for a proposed policy and practice guidelines.
  • Competency 4: Develop strategies to work collaboratively with policy makers, stakeholders, and colleagues to address environmental (governmental and regulatory) forces.
    • Present strategies for collaborating with a stakeholder group to implement a proposed policy and practice guidelines.
    • Deliver a persuasive, coherent, and effective audiovisual presentation.

Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

NOTE: 300 WORDS. Use 3 sources below.
Kindly read the instruction below.

Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

Hint:
Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities

RESOURCES:

1) Milstead, J. A., & Short, N. M. (2019). Health Policy and Politics: A nurse’s guide (6th ed.). Burlington, MA. Jones & Bartlett Learning

2) O’Rourke, N.C., Crawford, S.L., Morris, N. S.,, & Pulcini; J. (2017). Political efficacy & participation of nurse practitioner. Policy, Politics, & Nursing Practice, 18(3), 135-148

3) Publication Manual of the American Psychological Association (Paperback) 7th 20, Author: American Psychological Association.

what is best practice in code simulations for nurses?” could be used to research your topic use of simulation in nursing.

  1. Perform a bibliographic search and locate four sources from peer-reviewed journals using professional databases. Note: Articles must be no more than 5 years old.

Gastrointestinal Case Study

Reply to these post with 300-350 words for EACH post.

Post 1 

What lifestyle modifications do you recommend for CF?

    The lifestyle modifications that I would recommend for CF would include losing weight if he is overweight, raising the head of bed at night by adding pillows so his head is above his heart/stomach which can prevent acid from rising and will decrease the nighttime heart burn, avoiding eating late at night, avoiding large meals, to not lay down immediately after a meal, wearing loose comfortable clothing, and although he states he does not smoke anymore I would reiterate quitting smoking (Kahrilas, 2021). Other recommendations that I would make are specifically related to avoiding triggering foods. Triggering foods for heartburn and causing GERD flares are caffeine, chocolate, peppermint, spicy foods, and some fatty foods (Kahrilas, 2021). I would also encourage CF to keep a food journal which would allow him to pinpoint foods that bother him specifically.

Describe a rational drug choice for this patient. Be specific regarding what factors you would consider. Include pharmacokinetic and dynamic considerations for the pharmacological choices made. Also consider interactions and side effects.

    The rational drug choice for this patient would be a proton pump inhibitor (PPI). I would prescribe this because CF has already tried an H2 receptor antagonist and antacids with no relief so a PPI would be the next first line choice (Woo et al., 2020). Kahrilas (2020), states that PPI’s are the most effective medications for reducing stomach acid and H2 receptor antagonists can reduce stomach acid but are not usually effective in moderate to severe symptoms. PPI’s work by reducing gastric acid secretion in the stomach by blocking the mechanism of action of parietal cells (Woo et al., 2020). Parietal cells are cells found in the stomach wall and their role is to secrete acid. Gastric acid secretion is reduced by inhibiting the H+/K+/adenosine triphosphatase (ATPase) enzyme system found in the parietal cell (Woo et at., 2020). CF is appropriate for a PPI as it is approved for adults, he is male so there is no pregnancy risk as it is category B/C, and he is 48 so there is no concern for the use of it in an older adult (Woo et al., 2020). Before I started CF on a PPI I would run a liver panel and make sure that CF’s liver function was normal as PPI’s are metabolized in the liver and are contraindicated in patients with hepatic dysfunction (Woo et al., 2020). Hicklin (2017) found that blocking stomach acid can add to and affect liver damage, so ensuring that a patient’s liver is functioning at a normal level is incredibly important before starting them on a PPI. 

    I would explain to CF that there are possible adverse drug reactions that we would watch for. PPI’s can put the patient at risk for interactions with other medications due to interrupting the drug absorption so we would go over his mediation list (Woo et al., 2020). There is also a risk for vitamin deficiencies so ensuring that he is eating a healthy diet full of fruits and vegetables would be necessary (Woo et al, 2020). CF is also at risk for pneumonia and with long term use of a PPI, osteoporosis and hip fractures especially because he works a sedentary job so, when he is not at work making sure he gets enough exercise is crucial (Woo et al., 2020). As a future APRN anytime I start a patient on a new medication I want them to understand why they are on the medication, the benefits of taking it, but to also have an understanding of the side effects and adverse effects.  

What counseling points about this medication do you give CF?

   There are a few counseling points about this medication that I would explain to CF. First, I would explain that I would start CF on a daily dose of a PPI. I would start him on a daily dose and then if symptoms are not resolving or only slightly better than we can increase to twice daily (Woo et al., 2020). Secondly, I would explain that it is important for CF to take this medication daily before breakfast (Fass, 2021). This will help reduce acid before eating and if he takes a second dose it would be important to take this dose before dinner. I would then explain that it is important for CF to be medication compliant. Last, I would tell CF about possible side effects of PPI’s which can include diarrhea, nausea, vomiting, and rebound heart burn if CF stops the PPI abruptly (Ambizas, 2017). I would counsel CF to report these side effects to me if they occur. 

post 2

1. What lifestyle modifications do you recommend for CF?
Lifestyle modifications would include no food or drink before bed, continued smoking cessation, dietary changes and elevation of the bed (Woo & Robinson, 2020). Dietary changes should include stopping foods that can potentially aggravate reflux symptoms including caffeine, coffee, chocolate, spicy foods, highly acidic foods such as oranges and tomatoes, and foods with high fat content (Katz et al., 2013). The role of alcohol with GERD is still controversial with some reports suggesting alcohol weakens the esophageal motility and reduces pressure of lower esophageal sphincter while other studies finding no relation of alcohol and risk of reflux (Pan et al., 2019).  
2. Describe a rational drug choice for this patient.
The drug choice for this patient after lifestyle modification would be a proton pump inhibitor or a PPI. This patient has tried over the counter antacids with minimal effect and for this reason PPIs are the first line treatment that is recommended (Woo & Robinson, 2020). Symptom history of regurgitation and heartburn are the most reliable for making a diagnosis based on history alone (Katz et al., 2013). Signs and symptoms include burning substernal pain that radiates upward that can be increased after meals and laying down, sore throat, hoarseness, halitosis and halitosis (Woo & Robinson, 2020). The patient has a diagnosis of GERD by endoscopy and his symptoms correlate with this diagnosis. Proton pump inhibitors decrease the acid secretion by 100% by binding to the enzyme hydrogen, potassium ATPase (Woo & Robinson, 2020). Patients with hepatic impairment may need lower doses of PPI (Woo & Robinson, 2020). PPIs also interact with warfarin, phenytoin, diazepam, and clopidogrel (Woo & Robinson, 2020). Other side effects include diarrhea, stomach pain, headache and potential interference with food and minerals (H2 blockers & PPI, 2019). There are also long term effects to consider like reduced Calcium absorbtion, decreased Magnesium and rebound gastric secretions (H2blocker & PPI, 2019).  
3. What counseling points about this medication do you give CF?
CF would be counseled on how to take the drug and on the importance of assessing the symptoms after 4 weeks of therapy and if there is no improvement the patient need to know that they will be referred to a specialist (Woo & Robinson, 2020). CF will also be counseled about the importance of lifestyle modifications and the importance and side effects of the drug.

use APA format and 3 or more reference.

Your responses should be in a well-developed paragraph (300-350 words) to each peer. Integrating an evidence-based resource that is different than the one you used for the initial post.

Respectfully agree and disagree with your peers’ responses and explain your reasoning by Including your rationales in your explanation.

Article review for health class

read and review this article. The instructions are in the screenshot and make sure to follow the instructions , do not use any outside sources for this article review only the article that is provided below. Just search for the article on google. 

Article ‘We must fix us health and public health policy’ 

Culturally Competent Care for Native Americans

 Based on the readings, viewing the online materials & resources, and your own experience, what strategies would you recommend encouraging culturally competent care of Native Americans? 

Ritter, L.A., Graham, D.H. (2017). 

Chapter 8

My initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.  

  1. Discuss and compare the worldviews, pregnancy, mental health, and death and dying as they relate to Native Americans. 
  2. Conduct research and identify a model program for Native Americans. (CO2)

task 2

please give ansers under each qustion

Module 3 Discussion Post 2

  • Read the initial and secondary comments posted by your classmates and reflect upon them.
  • Directly respond to at least one classmate in a way that extends meaningful discussions, adds new information, and/or offers alternative perspectives.
  • Thank you for getting us started. You provided good information surrounding ancillary services and noted some struggles related to receiving services in rural areas. One development that has been incepted to close the gap in care is telemedicine. According to Durupt et al., (2016), “Telemedicine is a form of remote medical practice using information and communication technologies.” After interviewing several doctors telemedicine was found to be advantageous for the patient by providing faster access, eliminates the need for travel, and closes the gap in access for patients in need to see doctors where there is a shortage  (Durupt et al., (2016). While telemedicine has its benefits, physicians expressed concerns of losing the face-to-face contact or strained doctor-patient relationship, how will they be paid, and compromising the stages of consultation procedures i.e. visualizing the patients behavior and having a direct view, voicing that it will reduce the quality of diagnosis (Durupt et al., 2016). Have you used telemedicine? If so, what was your experience or your thoughts?

Dr. Sewell 

  • Durupt, M., Bouchy, O., Christophe, S., Kivits, J., & Boivin, J. (2016). Telemedicine in rural areas: General practitioners’ representations and experiences. Santé Publique (Vandoeuvre-Lès-Nancy, France), 28(4), 487-497.

Benchmark – Evidence-Based Practice Project: PICOT Paper

Refer to the PICOT you developed for your evidence-based practice project proposal. Write a 750-1,000-word paper that describes your PICOT.

1.  Describe the population’s demographics and health concerns.

2.  Describe the proposed evidence-based intervention and explain how your proposed intervention incorporates health policies and goals that support health care equity for the population of focus.

3.  Compare your intervention to previous practice or research.

4.  Explain what the expected outcome is for the intervention.

5.  Describe the time for implementing the intervention and evaluating the outcome.

6.  Explain how nursing science, social determinants of health, and epidemiologic, genomic, and genetic data are applied or synthesized to support population health management for the selected population.

7.  Create an Appendix for your paper and attach the PICOT. Be sure to review feedback from your previous submission and revise your PICOT accordingly.

8.  Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite at least four to six peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite.