Healthcare Delivery Models Overview

Current Law

The United States healthcare system has been experiencing intensive and widespread healthcare reforms aiming to reduce medical costs and improve care value. The most recent healthcare reform is the Affordable Care Act (ACA) which was introduced by President Obama and had comprehensive reforms in making sure that healthcare is affordable and accessible to all American citizens (McClellan & Japinga, 2018). The ACA experienced a remarkable shift in a number of aspects.

The legislation sought to increase healthcare coordination to reduce the costs of multiple prescriptions, repeating diagnostic tests, and hospitalizations. The law also sought to improve the quality of healthcare (Ho, 2018). Due to their experience, nurses make decent leaders, hence, they should be part of the healthcare restructuring. As the shift from provider-based patient care to patient-centered patient care happens, the nursing practice and its roles and responsibilities are undergoing drastic changes to conform to the new paradigm. Pay for performance, value-based purchasing, and shared savings are some of the main ideas supported by ACA (McClellan & Japinga, 2018). These approaches are aimed at the implementation of accessible, patient-centered, and affordable healthcare systems.

Therefore, the system is based on rewarding leaders according to the quality of their service as a measurable outcome. Furthermore, the nursing profession needs to improve patient-centered nursing, data quality analytics, and care coordination. Nurses should partner with relatives in the coordination of patient care for improved health outcomes (McClellan & Japinga, 2018). Due to the legislation, it is evident that nurses can assume new roles and responsibilities to make up for the drastic changes.

Pay for Performance

One of the critical aspects of healthcare reforms is the pay for performance (P4P) and quality measures. On the basis of P4P, the healthcare providers are rewarded or given penalties depending on their performance (McClellan & Japinga, 2018). Proper implementation of the program would reduce the unnecessary healthcare costs associated with hospitalizations and improve healthcare quality. However, there is little evidence on whether the quality measures and the P4P program enhance the outcome of the patients (Bond et al., 2019). At the same time, the P4P schedule has been shown to improve care modestly, though there is little evidence on the healthcare outcomes. Some studies have shown that P4P is consistent in improving patient care outcomes (Mathes et al., 2019). Evidence has shown that financial rewards offered to the hospitals that indicated improvements did not reduce the adverse consequences (Bond et al., 2019). Quality measures for improving the outcome of the patients are not clear.

Therefore, there is little or no conclusive evidence to show that P4P and quality measures improve healthcare outcomes. These quality measures affect the role of the nurses and their responsibility in the new healthcare arena (Mathes et al., 2019). Nurses play a critical role in demanding accessible, affordable, and high-quality health care. To achieve the above objective, nurses, from the managers to the bedside nurses, must understand how nursing care must be changed to fit into the quality measures of the current law. These changes will require nurses to have a new set of skills to enhance patient care.

Nursing Leadership Trends

The nursing profession is critical to transforming the healthcare sector as it makes drastic changes in repositioning. It is also in a position to help in the new healthcare delivery modes implementation. Since these unique healthcare delivery models focus on preventive measures and health promotion makes nurses develop the new nursing roles. The new position includes nurse-managed health centers, virtual healthcare nurses, patient navigators, health care coaches, and bundle care coordinators. All these roles are pivotal as the patient care extends from the acute care hospitals, and its complexity increases (Mathes et al., 2019). The nurse coordinator will ensure that a chronically ill patient’s care is coordinated for optimal and quality life. The bundled coordinator focuses on a clinical path that provides the best healthcare outcomes. The managed healthcare centers shift the management to the nurse practitioners, public health nurses, and midwives.

Nurses must be able to function to the full extent of their licensure and certification. With nurses coordinating the care of clients, the patient care is transiting away from the acute care centers to the community. Patients become assured of receiving the best and most evidence-based care that results in optimal outcomes. The future trends see a decrease in primary care physicians and specialty doctors. To accommodate the above changes will require both advanced practice nurses (APRNs) and the registered nurses (RNs) to access and maintain public healthcare coverage. Another trend is the development of patient-centered medical homes (Machon et al., 2019). Many hospitals are building these medical homes in rural areas to allow access to care. Many of these will be run and staffed by the PRNs and RNs. With these trends, the entry rates into a nursing career will increase, and the entire nursing education and the curriculum will undergo reforms.

Emerging Trends


Some of the trends in technology include computerized order entry, the use of bar codes, and electronic medical records that record nursing notes, progress notes, and test results. There has also been an increase in nursing informatics in healthcare. In the next five years, the data gathered in nursing informatics can help in the evidence-based studies in the nursing field, which improve patient care (Nagle et al., 2017). The use of nursing informatics in recent years has impacted change in communication and has further developed to enhance the quality and safety of patient care (Nagle et al., 2017). Future nursing education should incorporate basic training in computer technology and its role in clinical practice. Most healthcare settings have changed their record system to electronic, which means that nurses should be vigilant in getting adequate knowledge (Cohen & Boni, 2018). Information technology provides the nursing fraternity with a faster generation and distribution of new nursing knowledge.

Holistic Care

The healthcare reforms and the ACA have given rise to the demand for holistic and preventive healthcare services as patients become more informed. Holism emphasizes the need for the whole compared to the parts. Nurses need to have education and understanding of the holistic approach to patient care, such as social, psychological, emotional, and spiritual (Cohen & Boni, 2018). In the next few years, nurses will have to have more profound knowledge of alternative and complementary treatments and the interaction between holistic and traditional therapies. Thus, there is a level of responsibility that the nurses should have to meet the needs of the patients.


Bond, A. M., Volpp, K. G., Emanuel, E. J., Caldarella, K., Hodlofski, A., Sacks, L., Patel, P., Sokol, K., Vittore, S., Calgano, D., Nelson, C., Weng, K., Troxel, A., & Navathe, A. (2019). Real-time feedback in pay-for-performance: Does more information lead to improvement. Journal of General Internal Medicine, 34(9), 1737–1743.

Cohen, B. S., & Boni, R. (2018). Holistic nursing simulation: A concept analysis. Journal of Holistic Nursing: Official Journal of the American Holistic Nurses’ Association, 36(1), 68–78.

Ho, V. (2018). Refinement of the Affordable Care Act. Annual Review of Medicine, 69, 19–28.

Machon, M., Cundy, D., & Case, H. (2019). Innovation in nursing leadership: A skill that can be learned. Nursing Administration Quarterly, 43(3), 267–273.

Mathes, T., Pieper, D., Morche, J., Polus, S., Jaschinski, T., & Eikermann, M. (2019). Pay for performance for hospitals. The Cochrane Database of Systematic Reviews, 7(7).

McClellan, M., & Japinga, M. (2018). The Affordable Care Act: What’s next? Annual Review of Medicine, 69, 41–52.

Nagle, L. M., Sermeus, W., & Junger, A. (2017). Evolving role of the nursing informatics specialist. Studies in Health Technology and Informatics, 232, 212–221.