Study Guide: Health Care Reform
Health Care Reform: Overview
When it comes to healthcare in America, we seem to believe that more is better--but does more healthcare result in better health? As a nation, we spend more on healthcare per person than any European country, yet our health outcomes are worse. The PBS documentary, Money and Medicine was aired in 2012, and addresses one of the key issues of healthcare reform--the cost of health care. Watch the trailer below, or the entire episode here: http://video.pbs.org/video/2283573727/
(Links to an external site.)
http://youtu.be/a9oEtRwoVxs
(Links to an external site.)
The Affordable Care Act
The Patient Protection and Affordable Care Act (ACA), passed in 2010, is a collection of laws that were created to reform health insurance and healthcare.
The ACA significantly impacts nurses both personally and professionally. Bedside nurses are impacted by organizational changes that affect patient care, and may be providing information and resources to patients and caregivers about the ACA. However, as Hynds, Hatch and Samuels (2014) noted, nurses indicate they need more knowledge to understand the ACA policy implications of their practice.
Now, you can either read the 974 pages of the law itself, or you can watch this short, animated video produced by the Kaiser Family Foundation, and visit the helpful online resources below:
http://youtu.be/JZkk6ueZt-U
(Links to an external site.)
The YouToons Get Ready for Obamacare
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Affordable Care Act: Five Years Later
The Commonwealth Fund has developed several online, interactive resources to illustrate the impact of the Affordable Care Act in its first five years of implementation. Through personal stories, population and health systems data analysis, and graphics, the Commonwealth fund paints the picture of the impact of the ACA on individuals, businesses, providers and healthcare systems. Take some time to explore these resources in preparation for this week's discussion board. Link: The Affordable Care Act: A Look Back at the First Five Years.
(Links to an external site.)
Review the two interactive digital features: Coverage Reform
(Links to an external site.)
and Delivery Reform
(Links to an external site.)
.
Value-Based Purchasing--"Pay for Performance"
Increasingly, hospitals and healthcare providers are reimbursed not just for the amount of services provided (fee-for service), but for the results that are achieved for a particular patient population. As nurses, you may have observed policy changes that emphasize patient experience, prevention of hospital-acquired infections, and effective discharge planning ...
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
Essay On Health Care Reform
Essay on Quality Health Care
Essay On Healthcare System
Essay on Health Care
Essay on Careers in Healthcare
Essay On Health Care
Essay On Health Care
Health Insurance Essay
Essay about Health Care
Health Care Trends Essay examples
Essay On Health Care
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
Essay On Health Care Reform
Essay on Quality Health Care
Essay On Healthcare System
Essay on Health Care
Essay on Careers in Healthcare
Essay On Health Care
Essay On Health Care
Health Insurance Essay
Essay about Health Care
Health Care Trends Essay examples
Essay On Health Care
Unintended Consequences of Health Care ReformThe PPACA of .docxgibbonshay
Unintended Consequences of Health Care Reform
The PPACA of 2010 fostered new provisions for health care and the structure of health care delivery. The individual mandate to obtain insurance is one provocative provision. While this provision attempts to increase access to health care, it raises questions on how the existing system could sustain the potentially large influx of newly insured individuals.
Another provision calls for new models of health care provider organizations to ensure delivery efficiency and continuity of care. In this week’s media presentation, Dr. Kathleen White discusses the accountable care organization, which comprises a group of providers coordinating care across a variety of institutional settings. Yet becoming an accountable care organization may present a number of challenges.
This week’s Discussion builds on Week 1, continuing the examination of those societal and organizational contexts that influence health care reform. The unintended consequences of reform policy on the health care system are also considered.
To prepare:
Review this week’s media presentation and the other Learning Resources focusing on how reform may lead to improved quality, greater access, and reduced cost of care. Also think about the unintended consequences that may arise as a result.
Consider the information presented about the individual mandate and accountable care organizations. What are some questions or concerns you might have regarding the individual mandate? What are the pros and cons associated with becoming an accountable care organization?
With posting instructions in mind, select either the individual mandate or accountable care organizations as the focus of your Discussion this week.
By tomorrow Wednesday 03/07/18 BY 12pm, write a minimum of 550 words in APA format with a minimum of
THREE
scholarly references from the list of required readings below. Include the level one headers as numbered below:
Post
a cohesive response that addresses the following:
1) In the first line of your posting, identify the topic you have selected—either the individual mandate or accountable care organizations. With regard to this topic, describe one or more positive results that could be achieved, and one or more unintended consequence(s) that organizations or individuals may experience.
2) Briefly evaluate issues on the topic that may be a consideration for the organization you work in and the nursing profession ( I WORK I A HOSPITAL SETTING).
Required Readings
Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York, NY: McGraw-Hill Medical.
Chapter 5, “How Health Care is Organized – I: Primary, Secondary, and Tertiary Care”
Chapter 6, “How Health Care is Organized – II: Health Delivery Systems”
McClellan, M. (2010). Accountable care organizations in the era of health care reform. American Health & Drug Benefits, 3 ...
SOCW 6351 Wk 9 Discussion 1. Need Responses.Respond in one of t.docxrosemariebrayshaw
SOCW 6351 Wk 9 Discussion 1. Need Responses.
Respond in one of the following ways:
· Describe two factors that might make minority groups especially vulnerable in the Medicaid policy your colleague cited. Explain why these groups may not have a voice in the policy-making process.
· Offer examples of organized self-help and citizens’ groups as both support mechanisms and potentially powerful lobbies. Describe how these lobbying bodies can help in amending the policy your colleague described.
Support your response with specific references to the resources. Be sure to provide full APA citations for your references.
NA:
Top of Form
Medicaid is a medical assistance program developed specifically for low income individuals of any age, unlike Medicare, which is designed for those over 65 and have no income requirements (“Difference between Medicare and Medicaid”, n.d.). When health care policies are change, they affect programs such as Medicaid and Medicare. For example, when the ACA (Affordable Care Act) was implemented, it led to an increase of enrollment as it made the process easier and reached more individuals and it expanded Medicaid eligibility to low-income adults (Wachino, Artiga & Rudowitz, 2014).
In the state of Pennsylvania, a Medicaid policy that I would amend would be the Healthy PA policy, which was a Medicaid expansion that included drug and alcohol services (IRETA, 2015). The issue is the length of time it takes for someone to be admitted into a program. Whether it’s getting into an inpatient or outpatient program, the process needs to be expedited and more streamlined. Many who are suffering from substance abuse disorders struggle with finally getting themselves into a program and delaying the process could result in someone hesitating and deciding not to move forward with treatment that is crucial (IRETA, 2015).
In Pennsylvania, stakeholders include a steering committee, which is made up of hospitals, health care providers, consumers, foundations and academic institutions (“HIP”, 2019). This committee comes up with ways to improve population health and control health cost including Medicaid and Medicare. They developed a plan for heathcare delivery that will improve the quality of life for everyone, without limitations on income or background (“HIP”, 2019). This committee has 5 work groups that develop implementation plans for the goals that were developed by the committee and focus on specific aspects such as payment, price and quality transparency, population health, healthcare transformation and health information technology (“HIP”, 2019).
References:
HIP stakeholders. (2019). Retrieved from https://www.health.pa.gov/topics/Health-Innovation/Pages/Stakeholders.aspx
IRETA. (2015). Pennsylvania’s Medicaid expansion smooths the road to addiction treatment, but barriers remain. Retrieved from https://ireta.org/resources/pennsylvanias-medicaid-expansion-smooths-the-road-to-addiction-treatment-but-barriers-remain/
Wachino, V., A.
4 hours ago
Amy Miller
RE: Discussion - Week 7
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NURS 6050C: Policy and Advocacy for Improving Population Health
Main Question Post. The Patient Protection and Affordable Care Act of 2010 created several positive healthcare policies such as affordable health care, lifting the preexisting health condition clause from health insurance, requiring facilities to make healthcare charges public knowledge, and enforcing healthcare providers to become active in improving quality and health outcomes for patients (Library of Congress, n.d.). The act addressed a combination of the health care drivers of cost, quality, and access. According to a report released by the White House Press Secretary on April 17, 2014, “The Affordable Care Act is working. It is giving millions of middle class Americans the health care security they deserve, it is slowing the growth of health care costs and it has brought transparency and competition to the Health Insurance Marketplace.” (The White House, 2014). However, the price some healthcare providers had to pay a heavy financial - forcing some providers out of business. The negative side of the act is seldom portrayed in the news and media.
Section 3131(a) of the act required payment for home health services to be rebased over a period of four years (Centers for Medicare & Medicaid Services, 2013); resultant in a 2.8% reduction beginning in 2014 for four consecutive years totaling a reduction in payment of 11.6%. The reductions were placed along with mandates for quality reporting, new forms, and new processes resulting in increased administrative overhead costs while shouldering the burden of financial reductions.
Initiating a Change in Policy Process
Living in a rural community, I witness firsthand the lack of access to care as there are limited numbers of primary care providers. Couple the limited access to providers with the amount of paperwork and forms that must be signed by a physician and patients are not referred to home health services as often as one should be – the result is the patient presenting to the emergency room or a hospitalization to have one’s health care needs met. Currently, Medicare and Medicaid do not allow physician assistants or advanced practice registered nurses (APRNs) to sign the necessary orders and plan of care for home health services – only a “doctor of medicine, osteopathy, or podiatric medicine” may sign for services (Government Publishing Office, 2014, p. 693). I would like to use the knowledge gained as an APRN to legislate for this mandate to be changed and allow both physician assistants and APRNs to sign for coverage of home health services.
The Kingdon Model would be utilized for the legislation process by finding the three streams of problem, policy, and politics to coordinate with the above-mentioned issue (Milstead, 2019, p. 24). The problem would consist of the burdensome amount of paperwork imposed upon.
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Medical TourismMedical tourism is a much more common practice toAbramMartino96
Medical Tourism
Medical tourism is a much more common practice today for receiving affordable health care services. As the cost of health care continues to rise in the United States, increased numbers of potential patients are flocking to other countries to receive affordable health care services. While medical tourism might affect the financial posterity of your health care organization, it too might be a reflection of an industry's commitment to fostering increased access to affordable health care services. From your perspective as a current or future health care administration leader, is medical tourism a social good?
For this Discussion, reflect on the media pieces in this week's resources, which highlight medical tourism. Consider the potential benefits and consequences of medical tourism from both a consumer and a health care administration leader's perspective.
With these thoughts in mind:
Post an explanation of how the role of medical tourism might relate to social change. Be specific, and provide examples for both the consumer and the health care administration leader.
Discussion
Continue the Discussion and respond to your colleagues' posts (250 words or more), suggesting one challenge your colleague should consider in addressing medical tourism for his or her health care organization.
Colleague
As a healthcare administrator, I will have to consider the potential physical and mental risks first of medical tourism for consumers. I have looked for enough evidence-based research to help me to decide that this would be a choice that I would recommend. However, I did not find what I was looking for to say that I would without reservation and good judgment recommend a client to fly to India or Costa Rica for major surgery. I understand that the cost is so much less for various surgeries and companies and clients can save tons of money (ABC News (Producer), 2013).
I understand that this country’s expensive healthcare prices are driving patients and companies to participate in traveling outside of the country for medical procedures. “Organization for Economic Co-operation and Development (OECD) put the price of a knee replacement in the U.S. at $48,000. Travel to India and the same operation will cost $8500, more than 80% cheaper. A heart bypass that costs $113,000 in the U.S. can be bought for just $3250 in Mexico, while operations in Malaysia are typically 65-80% cheaper” (Lunt, Smith, Exworthy, Green, Horsfall, & Mannion, 2011). So, I see that the cost of healthcare is causing many Americans to file bankruptcy and America pays too much for a healthcare system that is not working. Also, companies who are not at the Fortune 500 status would like to find a way to save money on employee benefits.
Therefore, I would say my thoughts on getting on board with this would be when another country has a life-saving procedure that cannot be performed in this country for various reasonings like a personal moral view of a political party in charge ...
Market Power, Transactions Costs, and the Entryof Accountabl.docxinfantsuk
Market Power, Transactions Costs, and the Entry
of Accountable Care Organizations in Health Care
H. E. Frech III.1 • Christopher Whaley2 •
Benjamin R. Handel3 • Liora Bowers4 •
Carol J. Simon5 • Richard M. Scheffler6
Published online: 15 July 2015
� Springer Science+Business Media New York 2015
Abstract ACOs were promoted in the 2010 Patient Protection and Affordable
Care Act (ACA) to incentivize integrated care and cost control. Because they
involve vertical and horizontal collaboration, ACOs also have the potential to harm
competition. In this paper, we analyze ACO entry and formation patterns with the
use of a unique, proprietary database that includes public (Medicare) and private
ACOs. We estimate an empirical model that explains county-level ACO entry as a
function of: physician, hospital, and insurance market structure; demographics; and
other economic and regulatory factors. We find that physician concentration by
organization has little effect. In contrast, physician concentration by geographic
Earlier versions of this paper were presented at the International Industrial Organization Conference in
Boston, the International Health Economics Association meeting in Sydney, the Allied Social Science
meetings in Philadelphia, the ACO Workshop in Berkeley, and the Bates White Health Care and Life
Science Seminar in Washington, D.C. Thanks are due to the participants of those meetings, especially
Martha Starr, Dean Rice, and Martin Gaynor for helpful comments. Thanks are also due to Sandra
Decker, Abe Dunn, Robert Obstfeldt, Jim Rebitzer, Michael Morrisey, Jessica Foster, and Lee Mobley
for helpful comments on earlier versions and to the referees and editor of this journal for more recent
useful comments.
& H. E. Frech III.
[email protected]
Christopher Whaley
[email protected]
Benjamin R. Handel
[email protected]
Liora Bowers
[email protected]
Carol J. Simon
[email protected]
1
Department of Economics, University of California, Santa Barbara, Santa Barbara, CA 93106,
USA
123
Rev Ind Organ (2015) 47:167–193
DOI 10.1007/s11151-015-9467-y
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
site—which is a new measure of locational concentration of physicians—discour-
ages ACO entry. Hospital concentration generally has a negative effect. HMO
penetration is a strong predictor of ACO entry, while physician-hospital organiza-
tions have little effect. Small markets discourage entry, which suggests economies
of scale for ACOs. Predictors of public and private ACO entry are different. State
regulations of nursing and the corporate practice of medicine have little effect.
Keywords Health care competition � Antitrust � Entry � Integration � Accountable
care organizations � Transactions costs � Obama plan
JEL Classification L 14 � I11 � L44 � I18 � L41
1 Introduction and Overview
The US health car ...
· 7.4 Assignment Comparing Between-subjects and Within-subjects R.docxgerardkortney
· 7.4 Assignment: Comparing Between-subjects and Within-subjects Research
Design or locate a published study that illustrates application of between and within subjects design. Explain the merits of each and the limitations of each (between and within). Indicate which you believe is more informative of the results.
· Demonstrate understanding of the task and be able to address requirements using creativity and application of research design knowledge.
· Must demonstrate ability to analyze existing research to compare strengths and limitations of between-subjects and within-subjects analysis.
1
Course Learning Outcomes for Unit I
Upon completion of this unit, students should be able to:
1. Compare and contrast health services organizations within the healthcare system.
1.1 Explain the primary organizational components of the healthcare system and the
commonalities and differences among health services organizations.
Reading Assignment
Chapter 2:
Why and How Health Care Organizations Need to Change, pp. 13-34
Chapter 11:
Leading Change: First Steps in Employing Strategic Intelligence to Get Results, pp. 259-310
Unit Lesson
The Ideal Health System
Imagine you are now the Secretary of Health and Human Services; you have a magic wand and you can
create the perfect healthcare system. What components would it have? Would it include:
1. improving health outcomes for individuals, families and communities,
2. defending your population against threats to their health,
3. protecting your population against financial the consequences of bad health,
4. providing access to all with equality and no disparity, and
5. making it possible for people to make decisions in their own plans of care as well as have input into
the decisions that affect your country’s overall health system?
If you answered yes to these components, your definition matches the World Health Organization’s
Components of a Healthcare System (2010).
How This Course & Content Have Real-Word Application
We are witness to history and are living in one of the most active times in our country’s history for healthcare
reform. In 1966, the Medicare Act was signed into law by President Johnson, the most significant piece of
healthcare legislation in our country to that point. Fast forward from 1966 to 2010 and the passing of the
Affordable Care Act, which arguably is the second most impactful piece of legislation on U.S. health care
since the Medicare Act.
Medicare has grown significantly since 1966 and is now about 14% of our national budget, covering 47 million
Americans (Kaiser Family Foundation, 2015). Government health plans (Medicare, Medicaid, Tri-Care,
Veteran’s Administration) are growing and are on pace to insure more lives in the near future than lives
covered by commercial plans (Cigna, United, Blue Cross, etc.)
Speaking of this growth, Sylvia Burwell, Health & Human Secretary Director, announced that by 2018 the
Centers for Medicar.
In the coming years the United States will find themselves going through a number of changes within the Social Security Administration which will affect the Health Care Industry as we know it “Hospital size has long been an area of discussion and debate in the U.S. healthcare industry. Questions have consistently focused on cost management or efficiency in large versus small hospitals. A persistent question among researchers is whether efficiencies are associated with larger facilities through economies of scale, or if there are alternate scenarios that play a significant part in hospital cost and efficiency” (2009, JHM). Since the Affordable Health Care Act was established it made obtaining health care much more affordable and accessible, but at the same time there has to be some cut back.
DQ 3-2Integrated health care delivery systems (IDS) was develope.docxelinoraudley582231
DQ 3-2
Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system.
Excellence in care is attainable by incorporating allied healthcare professional, as high quality care is possible when coordination is unified and covers all areas of responsibilities. For an example-combining resources and coordination of care by involving physicians, dietitian, physical therapy or occupational therapy to work with patient diagnosed with obesity by promoting teamwork approach and ultimately delivering endurance in care and utilizing various resources.
Barriers to IDS can be a huge block in delivering quality care. Among many one limitation is physicians not participating in integrated healthcare system, which disconnect physicians from team based approached by deterring continuous quality improvement (essentialhospitals.org, n.d). This is because, system such as EHR or new innovative quality assurance programs are time consuming and overwhelming, thus decline in physicians support in IDS programs. By implementing user friendly system approach, enforcing focused based care and accepting the necessity of evidenced based practice can improve these barriers. Hence, increasing clinical expertise to produce better service and quality of care in integrated delivery system.
Essentialhospitls.org (n.d). Retrieved from: http://essentialhospitals.org/wp-content/uploads/2013/12/Integrated-Health-Care-Literature-Review-Webpost-8-22-13-CB.pdf
Dq 3-1
1.
In the US, there is not one type of health care system but rather a subset of systems, some of them catering to specific populations. These subsystems include managed care, military, and vulnerable populations. Managed care is a health care delivery system that seeks to achieve efficiency by integrating the basic functions of health care delivery, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid, military health care system is available free of charge to active duty military personnel and covers preventative and treatment services that are provided by salaried health care personnel and this system combines public health with medical services, and vulnerable population subsystem offers comprehensive medical and enabling services targeted to the needs of vulnerable populations and government health insurance programs provide.
NPV, IRR, Payback period,— PA1Correlates with CLA2 (NPV portion.docxpicklesvalery
NPV, IRR, Payback period,—> PA1
Correlates with CLA2 (NPV portion)
Real world examples
Which method is used more commonly?
Reference
**************
make 4 PPT slides. bullet points on the slides. speech notes on note area needed references
.
Now that you have had the opportunity to review various Cyber At.docxpicklesvalery
Now that you have had the opportunity to review various Cyber Attack Scenarios, it is now your turn to create one. As a Group you will identify a Scenario plagued with Cyber Threats. Each team will then be required to create a Threat Model (Logic Diagram) with various options. Selections will result in another option.
Below are some examples of possible Threat Modeling activities.
https://insights.sei.cmu.edu/sei_blog/2018/12/threat-modeling-12-available-methods.html
Each team will be required to present their Threat Model via Powerpoint and present to the class on Day 3. Each member of the team will be required to submit a copy of their teams powerpoint.
Subject :
Spring 2020 - Emerging Threats & Countermeas (ITS-834-25) - Full Term
Documentation :
https://www.cs.montana.edu/courses/csci476/topics/threat_modeling.pdf
Example :
https://www.helpsystems.com/blog/break-time-6-cybersecurity-games-youll-love
1. Targeted Attack: The Game
2. Cybersecurity Lab
3. Cyber Awareness Challenge
4. Keep Tradition Secure
What you need to do:
Write one page abstract
DO one page PPT
Write 2 pages main paper for this two topics( Library users and librarian & User credentials )
Draw a diagram if possible
.
Now that you have completed a series of assignments that have led yo.docxpicklesvalery
Now that you have completed a series of assignments that have led you into the active project planning and development stage for your project "
Work Overload in Healthcare System"
, briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it. What led to your current perspective and direction?
.
Now that you have completed your paper (ATTACHED), build and deliver.docxpicklesvalery
Now that you have completed your paper (ATTACHED), build and deliver a presentation that details your solution to the healthcare issue that serves as your topic.
In your presentation, you should:
Exhibit comprehensive research and understanding by referencing important points and insights from the perspectives of inquiry papers.
Present your issue and your argument for your solution
Demonstrate effective oral communication skills:
Exhibit competency in using virtual presentation tools and techniques.
Demonstrate planning, preparation, and practice.
Employ effective visual elements (multimedia).
.
Now that you have identified the revenue-related internal contro.docxpicklesvalery
Now that you have identified the revenue-related internal control that relates to the five assertions (existence, completeness, accuracy or valuation, rights and obligations, and presentation and disclosure), the test of controls will need to be identified for each assertion and internal control.
For this assignment, you will write and submit 400–500 words that set specific tests of internal controls for the 5 internal controls related to management assertions that you identified for the Unit 4
.
Now that you have read about Neandertals and modern Homo sapiens.docxpicklesvalery
Now that you have read about Neandertals and modern Homo sapiens, do you think that peoples' attitudes towards Neandertals in the past (and some today) was and is racist in nature? If you do, do you think the view is changing?
Answer the above question in an essay between 125 and 150 words.
.
Now that you have had an opportunity to explore ethics formally, cre.docxpicklesvalery
Now that you have had an opportunity to explore ethics formally, create a reflective assessment of your learning experience and the collaborations you engaged in throughout this session. You will submit
both
of the following:
A written reflection
For the written reflection, address Jane Doe's and respond to the following:
Articulate again your moral theory from week eight discussion (You can revise it if you wish). What two ethical theories best apply to it? Why those two?
week 8 discussion :’’The ethical philosophy chosen is utilitarianism. This philosophy is attributable to happiness if identified actions are right or harmful if the actions are considered to be wrong regardless of the prevailing conditions (Sen, 2019). It is meaningful to me since it is focused on contentment. Thus its moral obligation and importance is that it advocates for the satisfaction of the parties involved. The precedents of utilitarianism philosophy entail the following; that happiness of everyone counts uniformly, that actions are right if they result in pleasure otherwise wrong if they render unhappiness and that pleasure is the only thing that matters.
John Doe's involves a fiction scenario tailored at protecting the identity of witnesses in a case. Thus it is a slang name that informally represents the witnesses in a case to prevent them from manipulation by the defendant as their identity is rendered secretive (Smart, 2018). By application of the utilitarianism philosophy, a witness is considered to be happy (contented) if the identity is not revealed before the case for law during prosecution and hence we aspire to gain useful evidence. The morality of the theory revolves around its reliability as its only main obligation is to render witnesses pleasured. However, it might be termed immoral in situations where faithful information is required about every detail of the underlying case since no matter what; identity of the witnesses ought not to be revealed. Thus compromises its integrity.
Veil of ignorance constitutes the ethical reasoning whereby fair ruling is anticipated from a case by denying the parties involved any information that might bias them into suspecting who might benefit more from the ruling(Heen,2020). Thus in John Doe's case, when the identity of the witnesses is hidden, it is hard to identify possible relations of them with the plaintiff or defendant. This makes the judges seek justice independent of any information are sympathy to one of the parties at the expense of the other.’’
Apply to Jane Doe's case your personal moral philosophy as developed in week eight discussion and now. Use it to determine if what Jane Doe did was ethical or unethical per your own moral philosophy.
Consider if some of these examples are more grave instances of ethical transgressions than others. Explain.
Propose a course of social action and a solution by using the ethics of egoism, utilitarianism, the "veil of ignorance" method, deontological pr.
Novel Literary Exploration EssayWrite a Literary Exploration Ess.docxpicklesvalery
Novel Literary Exploration Essay
Write a Literary Exploration Essay for
Crow Lake
and additional texts on the following topic:
What is your opinion of the idea that the past can affect whom people become as adults?
.
Notifications My CommunityHomeBBA 3551-16P-5A19-S3, Inform.docxpicklesvalery
Notifications My CommunityHome
BBA 3551-16P-5A19-S3, Information Systems Management
Unit VIII
Unit VIII Introduction
During this term we have introduced many
different aspects of information systems
management. I hope you have learned lots of
new terms and concepts that will help you in
school and your career. In this unit we will
cover how systems are developed or created.
Organizations have a variety of tools,
methodologies, and processes that can be
used to assist in the development and
deployment of their information system.
Keep up the good work. Let me know if you
have any questions or issues.
Professor Bulloch
Unit VIII Study Guide
Click the link above to open the unit study
guide, which contains this unit's lesson and
reading assignment(s). This information is
necessary in order to complete this course.
Unit VIII Discussion Board
Weight: 2% of course grade
Grading Rubric
Comment Due: Saturday, 05/18/2019
11:59 PM (CST)
Response Due: Tuesday, 05/21/2019
11:59 PM (CST)
Go to Unit VIII Discussion Board »
Unit VIII Essay
Weight: 12% of course grade
Grading Rubric
Due: Tuesday, 05/21/2019 11:59 PM
(CST)
Instructions
Identify the components of an
information system (IS) using the five-
component framework, and provide a
brief summary of each.
Explain Porter’s five forces model.
Management IS (MIS) incorporate
software and hardware technologies to
provide useful information for decision-
making. Explain each of the following IS,
and use at least one example in each to
support your discussion:
a collaboration information system,
a database management system,
a content management system,
a knowledge management/expert
system,
a customer relationship
management system,
an enterprise resource planning
system,
a social media IS,
a business intelligence/decision
support system, and
an enterprise IS.
Identify and discuss one technical and
one human safeguard to protect against
IS security threats.
There are several processes that can be
used to develop IS and applications
such as systems development life cycle
(SDLC) and scrum (agile development).
Provide a brief description of SDLC and
scrum, and then discuss at least one
similarity and one difference between
SDLC and scrum
Sum up your paper by discussing the
importance of MIS.
In this final assignment, you will develop a
paper that reviews some of the main topics
covered in the course. Compose an essay
to address the elements listed below.
Your paper must be at least three pages in
length (not counting the title and reference
pages), and you must use at least two
resources. Be sure to cite all sources used
in APA format, and format your essay in
APA style.
Submit Unit VIII Essay »
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BBA 3551, Information Systems Management
Course Learning Outcomes for Unit VIII
Upon completion of this unit, students should be able to:
1. .
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The PPACA of 2010 fostered new provisions for health care and the structure of health care delivery. The individual mandate to obtain insurance is one provocative provision. While this provision attempts to increase access to health care, it raises questions on how the existing system could sustain the potentially large influx of newly insured individuals.
Another provision calls for new models of health care provider organizations to ensure delivery efficiency and continuity of care. In this week’s media presentation, Dr. Kathleen White discusses the accountable care organization, which comprises a group of providers coordinating care across a variety of institutional settings. Yet becoming an accountable care organization may present a number of challenges.
This week’s Discussion builds on Week 1, continuing the examination of those societal and organizational contexts that influence health care reform. The unintended consequences of reform policy on the health care system are also considered.
To prepare:
Review this week’s media presentation and the other Learning Resources focusing on how reform may lead to improved quality, greater access, and reduced cost of care. Also think about the unintended consequences that may arise as a result.
Consider the information presented about the individual mandate and accountable care organizations. What are some questions or concerns you might have regarding the individual mandate? What are the pros and cons associated with becoming an accountable care organization?
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THREE
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· Describe two factors that might make minority groups especially vulnerable in the Medicaid policy your colleague cited. Explain why these groups may not have a voice in the policy-making process.
· Offer examples of organized self-help and citizens’ groups as both support mechanisms and potentially powerful lobbies. Describe how these lobbying bodies can help in amending the policy your colleague described.
Support your response with specific references to the resources. Be sure to provide full APA citations for your references.
NA:
Top of Form
Medicaid is a medical assistance program developed specifically for low income individuals of any age, unlike Medicare, which is designed for those over 65 and have no income requirements (“Difference between Medicare and Medicaid”, n.d.). When health care policies are change, they affect programs such as Medicaid and Medicare. For example, when the ACA (Affordable Care Act) was implemented, it led to an increase of enrollment as it made the process easier and reached more individuals and it expanded Medicaid eligibility to low-income adults (Wachino, Artiga & Rudowitz, 2014).
In the state of Pennsylvania, a Medicaid policy that I would amend would be the Healthy PA policy, which was a Medicaid expansion that included drug and alcohol services (IRETA, 2015). The issue is the length of time it takes for someone to be admitted into a program. Whether it’s getting into an inpatient or outpatient program, the process needs to be expedited and more streamlined. Many who are suffering from substance abuse disorders struggle with finally getting themselves into a program and delaying the process could result in someone hesitating and deciding not to move forward with treatment that is crucial (IRETA, 2015).
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HIP stakeholders. (2019). Retrieved from https://www.health.pa.gov/topics/Health-Innovation/Pages/Stakeholders.aspx
IRETA. (2015). Pennsylvania’s Medicaid expansion smooths the road to addiction treatment, but barriers remain. Retrieved from https://ireta.org/resources/pennsylvanias-medicaid-expansion-smooths-the-road-to-addiction-treatment-but-barriers-remain/
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4 hours ago
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RE: Discussion - Week 7
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NURS 6050C: Policy and Advocacy for Improving Population Health
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Section 3131(a) of the act required payment for home health services to be rebased over a period of four years (Centers for Medicare & Medicaid Services, 2013); resultant in a 2.8% reduction beginning in 2014 for four consecutive years totaling a reduction in payment of 11.6%. The reductions were placed along with mandates for quality reporting, new forms, and new processes resulting in increased administrative overhead costs while shouldering the burden of financial reductions.
Initiating a Change in Policy Process
Living in a rural community, I witness firsthand the lack of access to care as there are limited numbers of primary care providers. Couple the limited access to providers with the amount of paperwork and forms that must be signed by a physician and patients are not referred to home health services as often as one should be – the result is the patient presenting to the emergency room or a hospitalization to have one’s health care needs met. Currently, Medicare and Medicaid do not allow physician assistants or advanced practice registered nurses (APRNs) to sign the necessary orders and plan of care for home health services – only a “doctor of medicine, osteopathy, or podiatric medicine” may sign for services (Government Publishing Office, 2014, p. 693). I would like to use the knowledge gained as an APRN to legislate for this mandate to be changed and allow both physician assistants and APRNs to sign for coverage of home health services.
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For this Discussion, reflect on the media pieces in this week's resources, which highlight medical tourism. Consider the potential benefits and consequences of medical tourism from both a consumer and a health care administration leader's perspective.
With these thoughts in mind:
Post an explanation of how the role of medical tourism might relate to social change. Be specific, and provide examples for both the consumer and the health care administration leader.
Discussion
Continue the Discussion and respond to your colleagues' posts (250 words or more), suggesting one challenge your colleague should consider in addressing medical tourism for his or her health care organization.
Colleague
As a healthcare administrator, I will have to consider the potential physical and mental risks first of medical tourism for consumers. I have looked for enough evidence-based research to help me to decide that this would be a choice that I would recommend. However, I did not find what I was looking for to say that I would without reservation and good judgment recommend a client to fly to India or Costa Rica for major surgery. I understand that the cost is so much less for various surgeries and companies and clients can save tons of money (ABC News (Producer), 2013).
I understand that this country’s expensive healthcare prices are driving patients and companies to participate in traveling outside of the country for medical procedures. “Organization for Economic Co-operation and Development (OECD) put the price of a knee replacement in the U.S. at $48,000. Travel to India and the same operation will cost $8500, more than 80% cheaper. A heart bypass that costs $113,000 in the U.S. can be bought for just $3250 in Mexico, while operations in Malaysia are typically 65-80% cheaper” (Lunt, Smith, Exworthy, Green, Horsfall, & Mannion, 2011). So, I see that the cost of healthcare is causing many Americans to file bankruptcy and America pays too much for a healthcare system that is not working. Also, companies who are not at the Fortune 500 status would like to find a way to save money on employee benefits.
Therefore, I would say my thoughts on getting on board with this would be when another country has a life-saving procedure that cannot be performed in this country for various reasonings like a personal moral view of a political party in charge ...
Market Power, Transactions Costs, and the Entryof Accountabl.docxinfantsuk
Market Power, Transactions Costs, and the Entry
of Accountable Care Organizations in Health Care
H. E. Frech III.1 • Christopher Whaley2 •
Benjamin R. Handel3 • Liora Bowers4 •
Carol J. Simon5 • Richard M. Scheffler6
Published online: 15 July 2015
� Springer Science+Business Media New York 2015
Abstract ACOs were promoted in the 2010 Patient Protection and Affordable
Care Act (ACA) to incentivize integrated care and cost control. Because they
involve vertical and horizontal collaboration, ACOs also have the potential to harm
competition. In this paper, we analyze ACO entry and formation patterns with the
use of a unique, proprietary database that includes public (Medicare) and private
ACOs. We estimate an empirical model that explains county-level ACO entry as a
function of: physician, hospital, and insurance market structure; demographics; and
other economic and regulatory factors. We find that physician concentration by
organization has little effect. In contrast, physician concentration by geographic
Earlier versions of this paper were presented at the International Industrial Organization Conference in
Boston, the International Health Economics Association meeting in Sydney, the Allied Social Science
meetings in Philadelphia, the ACO Workshop in Berkeley, and the Bates White Health Care and Life
Science Seminar in Washington, D.C. Thanks are due to the participants of those meetings, especially
Martha Starr, Dean Rice, and Martin Gaynor for helpful comments. Thanks are also due to Sandra
Decker, Abe Dunn, Robert Obstfeldt, Jim Rebitzer, Michael Morrisey, Jessica Foster, and Lee Mobley
for helpful comments on earlier versions and to the referees and editor of this journal for more recent
useful comments.
& H. E. Frech III.
[email protected]
Christopher Whaley
[email protected]
Benjamin R. Handel
[email protected]
Liora Bowers
[email protected]
Carol J. Simon
[email protected]
1
Department of Economics, University of California, Santa Barbara, Santa Barbara, CA 93106,
USA
123
Rev Ind Organ (2015) 47:167–193
DOI 10.1007/s11151-015-9467-y
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
site—which is a new measure of locational concentration of physicians—discour-
ages ACO entry. Hospital concentration generally has a negative effect. HMO
penetration is a strong predictor of ACO entry, while physician-hospital organiza-
tions have little effect. Small markets discourage entry, which suggests economies
of scale for ACOs. Predictors of public and private ACO entry are different. State
regulations of nursing and the corporate practice of medicine have little effect.
Keywords Health care competition � Antitrust � Entry � Integration � Accountable
care organizations � Transactions costs � Obama plan
JEL Classification L 14 � I11 � L44 � I18 � L41
1 Introduction and Overview
The US health car ...
· 7.4 Assignment Comparing Between-subjects and Within-subjects R.docxgerardkortney
· 7.4 Assignment: Comparing Between-subjects and Within-subjects Research
Design or locate a published study that illustrates application of between and within subjects design. Explain the merits of each and the limitations of each (between and within). Indicate which you believe is more informative of the results.
· Demonstrate understanding of the task and be able to address requirements using creativity and application of research design knowledge.
· Must demonstrate ability to analyze existing research to compare strengths and limitations of between-subjects and within-subjects analysis.
1
Course Learning Outcomes for Unit I
Upon completion of this unit, students should be able to:
1. Compare and contrast health services organizations within the healthcare system.
1.1 Explain the primary organizational components of the healthcare system and the
commonalities and differences among health services organizations.
Reading Assignment
Chapter 2:
Why and How Health Care Organizations Need to Change, pp. 13-34
Chapter 11:
Leading Change: First Steps in Employing Strategic Intelligence to Get Results, pp. 259-310
Unit Lesson
The Ideal Health System
Imagine you are now the Secretary of Health and Human Services; you have a magic wand and you can
create the perfect healthcare system. What components would it have? Would it include:
1. improving health outcomes for individuals, families and communities,
2. defending your population against threats to their health,
3. protecting your population against financial the consequences of bad health,
4. providing access to all with equality and no disparity, and
5. making it possible for people to make decisions in their own plans of care as well as have input into
the decisions that affect your country’s overall health system?
If you answered yes to these components, your definition matches the World Health Organization’s
Components of a Healthcare System (2010).
How This Course & Content Have Real-Word Application
We are witness to history and are living in one of the most active times in our country’s history for healthcare
reform. In 1966, the Medicare Act was signed into law by President Johnson, the most significant piece of
healthcare legislation in our country to that point. Fast forward from 1966 to 2010 and the passing of the
Affordable Care Act, which arguably is the second most impactful piece of legislation on U.S. health care
since the Medicare Act.
Medicare has grown significantly since 1966 and is now about 14% of our national budget, covering 47 million
Americans (Kaiser Family Foundation, 2015). Government health plans (Medicare, Medicaid, Tri-Care,
Veteran’s Administration) are growing and are on pace to insure more lives in the near future than lives
covered by commercial plans (Cigna, United, Blue Cross, etc.)
Speaking of this growth, Sylvia Burwell, Health & Human Secretary Director, announced that by 2018 the
Centers for Medicar.
In the coming years the United States will find themselves going through a number of changes within the Social Security Administration which will affect the Health Care Industry as we know it “Hospital size has long been an area of discussion and debate in the U.S. healthcare industry. Questions have consistently focused on cost management or efficiency in large versus small hospitals. A persistent question among researchers is whether efficiencies are associated with larger facilities through economies of scale, or if there are alternate scenarios that play a significant part in hospital cost and efficiency” (2009, JHM). Since the Affordable Health Care Act was established it made obtaining health care much more affordable and accessible, but at the same time there has to be some cut back.
DQ 3-2Integrated health care delivery systems (IDS) was develope.docxelinoraudley582231
DQ 3-2
Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system.
Excellence in care is attainable by incorporating allied healthcare professional, as high quality care is possible when coordination is unified and covers all areas of responsibilities. For an example-combining resources and coordination of care by involving physicians, dietitian, physical therapy or occupational therapy to work with patient diagnosed with obesity by promoting teamwork approach and ultimately delivering endurance in care and utilizing various resources.
Barriers to IDS can be a huge block in delivering quality care. Among many one limitation is physicians not participating in integrated healthcare system, which disconnect physicians from team based approached by deterring continuous quality improvement (essentialhospitals.org, n.d). This is because, system such as EHR or new innovative quality assurance programs are time consuming and overwhelming, thus decline in physicians support in IDS programs. By implementing user friendly system approach, enforcing focused based care and accepting the necessity of evidenced based practice can improve these barriers. Hence, increasing clinical expertise to produce better service and quality of care in integrated delivery system.
Essentialhospitls.org (n.d). Retrieved from: http://essentialhospitals.org/wp-content/uploads/2013/12/Integrated-Health-Care-Literature-Review-Webpost-8-22-13-CB.pdf
Dq 3-1
1.
In the US, there is not one type of health care system but rather a subset of systems, some of them catering to specific populations. These subsystems include managed care, military, and vulnerable populations. Managed care is a health care delivery system that seeks to achieve efficiency by integrating the basic functions of health care delivery, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid, military health care system is available free of charge to active duty military personnel and covers preventative and treatment services that are provided by salaried health care personnel and this system combines public health with medical services, and vulnerable population subsystem offers comprehensive medical and enabling services targeted to the needs of vulnerable populations and government health insurance programs provide.
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NPV, IRR, Payback period,—> PA1
Correlates with CLA2 (NPV portion)
Real world examples
Which method is used more commonly?
Reference
**************
make 4 PPT slides. bullet points on the slides. speech notes on note area needed references
.
Now that you have had the opportunity to review various Cyber At.docxpicklesvalery
Now that you have had the opportunity to review various Cyber Attack Scenarios, it is now your turn to create one. As a Group you will identify a Scenario plagued with Cyber Threats. Each team will then be required to create a Threat Model (Logic Diagram) with various options. Selections will result in another option.
Below are some examples of possible Threat Modeling activities.
https://insights.sei.cmu.edu/sei_blog/2018/12/threat-modeling-12-available-methods.html
Each team will be required to present their Threat Model via Powerpoint and present to the class on Day 3. Each member of the team will be required to submit a copy of their teams powerpoint.
Subject :
Spring 2020 - Emerging Threats & Countermeas (ITS-834-25) - Full Term
Documentation :
https://www.cs.montana.edu/courses/csci476/topics/threat_modeling.pdf
Example :
https://www.helpsystems.com/blog/break-time-6-cybersecurity-games-youll-love
1. Targeted Attack: The Game
2. Cybersecurity Lab
3. Cyber Awareness Challenge
4. Keep Tradition Secure
What you need to do:
Write one page abstract
DO one page PPT
Write 2 pages main paper for this two topics( Library users and librarian & User credentials )
Draw a diagram if possible
.
Now that you have completed a series of assignments that have led yo.docxpicklesvalery
Now that you have completed a series of assignments that have led you into the active project planning and development stage for your project "
Work Overload in Healthcare System"
, briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it. What led to your current perspective and direction?
.
Now that you have completed your paper (ATTACHED), build and deliver.docxpicklesvalery
Now that you have completed your paper (ATTACHED), build and deliver a presentation that details your solution to the healthcare issue that serves as your topic.
In your presentation, you should:
Exhibit comprehensive research and understanding by referencing important points and insights from the perspectives of inquiry papers.
Present your issue and your argument for your solution
Demonstrate effective oral communication skills:
Exhibit competency in using virtual presentation tools and techniques.
Demonstrate planning, preparation, and practice.
Employ effective visual elements (multimedia).
.
Now that you have identified the revenue-related internal contro.docxpicklesvalery
Now that you have identified the revenue-related internal control that relates to the five assertions (existence, completeness, accuracy or valuation, rights and obligations, and presentation and disclosure), the test of controls will need to be identified for each assertion and internal control.
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.
Now that you have read about Neandertals and modern Homo sapiens.docxpicklesvalery
Now that you have read about Neandertals and modern Homo sapiens, do you think that peoples' attitudes towards Neandertals in the past (and some today) was and is racist in nature? If you do, do you think the view is changing?
Answer the above question in an essay between 125 and 150 words.
.
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of the following:
A written reflection
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Articulate again your moral theory from week eight discussion (You can revise it if you wish). What two ethical theories best apply to it? Why those two?
week 8 discussion :’’The ethical philosophy chosen is utilitarianism. This philosophy is attributable to happiness if identified actions are right or harmful if the actions are considered to be wrong regardless of the prevailing conditions (Sen, 2019). It is meaningful to me since it is focused on contentment. Thus its moral obligation and importance is that it advocates for the satisfaction of the parties involved. The precedents of utilitarianism philosophy entail the following; that happiness of everyone counts uniformly, that actions are right if they result in pleasure otherwise wrong if they render unhappiness and that pleasure is the only thing that matters.
John Doe's involves a fiction scenario tailored at protecting the identity of witnesses in a case. Thus it is a slang name that informally represents the witnesses in a case to prevent them from manipulation by the defendant as their identity is rendered secretive (Smart, 2018). By application of the utilitarianism philosophy, a witness is considered to be happy (contented) if the identity is not revealed before the case for law during prosecution and hence we aspire to gain useful evidence. The morality of the theory revolves around its reliability as its only main obligation is to render witnesses pleasured. However, it might be termed immoral in situations where faithful information is required about every detail of the underlying case since no matter what; identity of the witnesses ought not to be revealed. Thus compromises its integrity.
Veil of ignorance constitutes the ethical reasoning whereby fair ruling is anticipated from a case by denying the parties involved any information that might bias them into suspecting who might benefit more from the ruling(Heen,2020). Thus in John Doe's case, when the identity of the witnesses is hidden, it is hard to identify possible relations of them with the plaintiff or defendant. This makes the judges seek justice independent of any information are sympathy to one of the parties at the expense of the other.’’
Apply to Jane Doe's case your personal moral philosophy as developed in week eight discussion and now. Use it to determine if what Jane Doe did was ethical or unethical per your own moral philosophy.
Consider if some of these examples are more grave instances of ethical transgressions than others. Explain.
Propose a course of social action and a solution by using the ethics of egoism, utilitarianism, the "veil of ignorance" method, deontological pr.
Novel Literary Exploration EssayWrite a Literary Exploration Ess.docxpicklesvalery
Novel Literary Exploration Essay
Write a Literary Exploration Essay for
Crow Lake
and additional texts on the following topic:
What is your opinion of the idea that the past can affect whom people become as adults?
.
Notifications My CommunityHomeBBA 3551-16P-5A19-S3, Inform.docxpicklesvalery
Notifications My CommunityHome
BBA 3551-16P-5A19-S3, Information Systems Management
Unit VIII
Unit VIII Introduction
During this term we have introduced many
different aspects of information systems
management. I hope you have learned lots of
new terms and concepts that will help you in
school and your career. In this unit we will
cover how systems are developed or created.
Organizations have a variety of tools,
methodologies, and processes that can be
used to assist in the development and
deployment of their information system.
Keep up the good work. Let me know if you
have any questions or issues.
Professor Bulloch
Unit VIII Study Guide
Click the link above to open the unit study
guide, which contains this unit's lesson and
reading assignment(s). This information is
necessary in order to complete this course.
Unit VIII Discussion Board
Weight: 2% of course grade
Grading Rubric
Comment Due: Saturday, 05/18/2019
11:59 PM (CST)
Response Due: Tuesday, 05/21/2019
11:59 PM (CST)
Go to Unit VIII Discussion Board »
Unit VIII Essay
Weight: 12% of course grade
Grading Rubric
Due: Tuesday, 05/21/2019 11:59 PM
(CST)
Instructions
Identify the components of an
information system (IS) using the five-
component framework, and provide a
brief summary of each.
Explain Porter’s five forces model.
Management IS (MIS) incorporate
software and hardware technologies to
provide useful information for decision-
making. Explain each of the following IS,
and use at least one example in each to
support your discussion:
a collaboration information system,
a database management system,
a content management system,
a knowledge management/expert
system,
a customer relationship
management system,
an enterprise resource planning
system,
a social media IS,
a business intelligence/decision
support system, and
an enterprise IS.
Identify and discuss one technical and
one human safeguard to protect against
IS security threats.
There are several processes that can be
used to develop IS and applications
such as systems development life cycle
(SDLC) and scrum (agile development).
Provide a brief description of SDLC and
scrum, and then discuss at least one
similarity and one difference between
SDLC and scrum
Sum up your paper by discussing the
importance of MIS.
In this final assignment, you will develop a
paper that reviews some of the main topics
covered in the course. Compose an essay
to address the elements listed below.
Your paper must be at least three pages in
length (not counting the title and reference
pages), and you must use at least two
resources. Be sure to cite all sources used
in APA format, and format your essay in
APA style.
Submit Unit VIII Essay »
�
›
� Logout�� Mary Katz
5/15/19, 12(27 PM
Page 1 of 1
BBA 3551, Information Systems Management
Course Learning Outcomes for Unit VIII
Upon completion of this unit, students should be able to:
1. .
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t.
NOTEPlease pay attention to the assignment instructionsZero.docxpicklesvalery
NOTE:
Please pay attention to the assignment instructions
Zero plagiarism
Five references
The Assignment: (1- to 2-page Comparison Grid; 1- to 2-page Legislation Testimony/Advocacy Statement)
Part 1: Legislation Comparison Grid
Based on the health-related bill (proposed, not enacted) you selected, complete the Legislation Comparison Grid Template. Be sure to address the following:
Determine the legislative intent of the bill you have reviewed.
Identify the proponents/opponents of the bill.
Identify the target populations addressed by the bill.
Where in the process is the bill currently? Is it in hearings or committees?
Is it receiving press coverage?
Part 2: Legislation Testimony/Advocacy Statement
Based on the health-related bill you selected, develop a 1- to 2-page Legislation Testimony/Advocacy Statement that addresses the following:
Advocate a position for the bill you selected and write testimony in support of your position.
Describe how you would address the opponent to your position. Be specific and provide examples.
Recommend at least one amendment to the bill in support of your position.
.
NOTE Everything in BOLD are things that I need to turn in for m.docxpicklesvalery
NOTE: Everything in
BOLD
are things that I need to turn in for my part.
Think of how many risks come into play when you decide to conduct a simple project, such as painting your living room. The following are some examples of risks:
What type of paint will you use (and can you afford high-quality paint)?
Who will move that brand new, big screen TV?
Who is going to paint?
Do you have the time, money, and resources?
Have you ever considered any of this, or do you simply cover up as much things as you can and start painting?
Risks exist regardless of whether people acknowledge it or not. Depending on the complexity of the project, the number and type of risk multiplies. Everyone has their own solution to each risk, but when working with a group within an organization, fragmentation such as this becomes counterproductive and a major risk in the end.
Scenario :
I have come with an Idea called ROSE which stands for Reserve on Site Easily, its a application that can be used on any phone. How it works is by lets say someone doesn't have a Wi-Fi connection or is not by Wi-Fi. What would happen is once by or near Wi-Fi their reservations will be saved and than will be sent to the hotel they would like to stay at, this will save a lot of time for not only them but the hotel as well. This will also save their spot until they have reached Wi-Fi, this will also be able to show what's available and what's not available when not on Wi-Fi.
Assignment:
Group Portion
As a group, you are to describe a project that all of you will participate in, and include the following:
Define the goal of the project
List the project's duration
Explain who are the stakeholders (those who participate)
*** Review benefits by the project implementation *** (My Portions)
Explain your need for resources
You need not go into in-depth details on the project.
Individual Portion
Each group member is to come up with 2 risks to this project. Each risk must include the following elements:
What technique(s) was used to identify the risk?
What type of risk is it, and does it have specific IT elements and considerations?
How was the risk assessed, and how does it rank with all of the risks identified by the group?
Is the risk qualitative or quantitative, and does it work with an EMV or Pareto analysis with all of the risks identified by the group?
What is the response to this risk, assuming it occurs during the project's lifecycle?
Provide at least 2 contingency plans for this risk (one primary and a second backup).
Group Portion
Combine the individual portion into a cohesive 6–8-page report that also includes the following:
A summary of the project (as discussed in the 1st group discussion)
How will the risks be monitored and controlled?
How will risks be communicated to all project participants?
*** What EVM comes from the risk management plan? *** (My Portion)
Are there any special tools utilized by the plan to manage all identified risks?
.
Note Be sure to focus only on the causes of the problem in this.docxpicklesvalery
Note: Be sure to focus only on the causes of the problem in this paper; do not consider effects or solutions.
A. Write a causal analysis essay (
suggested length of 3–7 pages
). In your essay, do the following:
1. Address an appropriate topic.
2. Provide an effective introduction.
3. Provide an appropriate thesis statement that previews
two
to
four
causes.
4. Explain the causes of the problem.
5. Provide evidence to support your claim.
6. Provide an effective conclusion.
B. Include
at least
two
academically credible sources in the body of your essay.
1. For your sources, include all in-text citations and references in APA format.
C. Demonstrate professional communication in the content and presentation of your submission.
.
Note I’ll provide my sources in the morning, and lmk if you hav.docxpicklesvalery
Note: I’ll provide my sources in the morning, and lmk if you have any questions since the instructions aren’t very detailed.
Objective
This research paper is an opportunity to demonstrate your understanding of issues and theories in critical Canadian Communication Studies. It is also an opportunity to demonstrate and practise scholarly research, critical thinking and good writing. Your paper will present an identifiable argument, a clear thesis and scholarly research.
Evaluation (20% of final grade)
Evaluation will be based on evidence that you have used
10 scholarly sources
to support and interpret your thesis. Use sources from your annotated bibliography. Include any number of additional popular sources (e.g., government documents, news item, film, web material) in addition to your 10 scholarly sources. The latter (in brackets above) are not scholarly sources.
Format
Margins: 2.5cm (one inch)
Length: 6-8 pages (not including title page or bibliography), double-spaced text
Font: 12-point, Times New Roman
APA format
Topic:
Fake news
is a recently-named genre in our contemporary media landscape. With reference to a specific example, argue for or against the idea that fake news harms democracy in Canada. Potential examples include disinformation tactics during an election campaign or deep fakes of notable people. Consider questions such as these: What is fake news? What are the implications for democracy in Canada and for the “marketplace of ideas” if we cannot distinguish fake news? Does objective and balanced journalism lose validity in the face of fake news?
.
Note Here, the company I mentioned was Qualcomm 1. Email is the.docxpicklesvalery
Note: Here, the company I mentioned was Qualcomm
1. Email is the most commonly used form of communication for businesses. To what degree does your company use email?
2. Imagine that this internship position is your long-term place of employment. What computer or technology equipment would you change and why?
.
Note Please follow instructions to the T.Topic of 3 page pape.docxpicklesvalery
Note: Please follow instructions to the T.
Topic of 3 page paper : a brief presentation on the corona virus on the U.S economy. I am asking for a 3 page summary presentation on the current status of the corona virus as it effects those working in government emergency management positions --focus on the emergency management operations centers (EOCs) in the state of Florida. This report paper will discuss the current involvement of the EOC in working with the businesses and other industries in the state of Florida that are dealing with the closing of businesses and other either forced closing of certain businesses and industries . Please provide information on what you are finding in your 3 page report are the effects of the corona virus on the closing of commerce and the potential repercussion of these forced shut downs by our government that will effect the economy. Make the paper a research type paper of interest to you and what you are concerned about as it may effect you and your job should a force closing be made that effects you.
PLEASE READ THIS ARTICLE BELOW AND USE THE SUBJECT MATTER IN THIS ARTICLE AS DIRECTION FOR YOUR PAPER
Example of a report as follows-- please do not copy an printed document/ article or other publication --make this your work and a report with your opinions and concerns.
Coronavirus triggers cancellations, closures and contingency planning across the country
With daily reports of the deadly coronavirus spreading (Links to an external site.) into communities across the country, schools (Links to an external site.), companies, religious organizations and local governments are grappling with whether to shut down facilities and cancel events or to proceed, cautiously, as planned.
Increasingly, organizations are opting to cancel large gatherings, encourage remote work or take other steps (Links to an external site.) reflecting an abundance of caution about the virus, according to interviews with officials in several states. Others are making contingency plans about more-significant steps they might take in the case of a wider outbreak.
Washington Gov. Jay Inslee (Links to an external site.) (D) said people should prepare for disruptions in their daily lives as a result of the novel coronavirus, which has killed nine people in the state.
“Folks should begin to think about avoiding large events and assemblies,” Inslee said Monday. “We are not making a request formally right now for events to be canceled, but people should be prepared for that possibility.”
While the virus has been deadliest in Washington state, it has spread across the United States, with more than a dozen states reporting infections. There have been several instances of people contracting the virus while inside the country.
The response effort so far has been fragmented, with conflicting messages about the level of threat and the need for significant lifestyle changes.
“The general rule is, use common sense,” said Health and Human Services Secret.
Note A full-sentence outline differs from bullet points because e.docxpicklesvalery
Note:
A full-sentence outline differs from bullet points because each section of the outline must be a complete sentence. Each part may only have one sentence in it. Capital letters are ideas that support the thesis.
Your outline must contain a minimum of 12 full sentences as follows.
The thesis statement of the paper (2 sentences minimum)
4 key points to support the thesis statement:
What is the issue and why is it significant? (2 full sentences minimum to clarify this point)
How would your first philosopher address your issue? (2 full sentences minimum to clarify this point)
How would your second philosopher address your issue? (2 full sentences minimum to clarify this point)
How would you apply your philosophers’ principles to your issue in modern society? (2 full sentences minimum to clarify this point)
Conclusion (2 sentences minimum)
Topic: Is the issue of racism painful in today's society?
Philosophers: John Locke & Thomas Hobbes
Resources
.
Notable photographers 1980 to presentAlmas, ErikAraki, No.docxpicklesvalery
Notable photographers: 1980 to present
Almas, Erik
Araki, Nobuyoshi
Balog, James
Bar-Am, Micha
Barbieri, Olivo
Clang, John
Clark, Larry
Consentino, Manuel
Crewdson, Gregory
Day, Corinne
Effendi, Rena
Flores, Ricky
Fontana, Franco
Galella, Ron
Geddes, Anne
Ghirri, Luigi
Goldberger, Sacha
Goldblatt, David
Goldin, Nan
Goldsworthy, Andy
Grannan, Katy
Gursky, Andreas
Herbert, Gerald
Higgins Jr., Chester
Hockney, David
Johansson, Erik
Johnson, Kremer
Jones, Charles
JR
Kander, Nadav
Kawauchi, Rinko
Kepule, Katrina
Kruger, Barbara
Kwon, Sue
Lanting Frans
Lassry, Elad
Lemoigne, Jean-Yves
Leone, Lisa
Luce, Kirsten
Manzano, Javier
Mapplethorpe, Robert
McGinley, Ryan
Modu, Chi
Mull, Carter
Neshat, Shirin
Nick Knight
Nilsson, Lennart
Opie, Catherine
Pao, Basil
Peters, Jennifer (and Michael Taylor)
.
Note 2 political actions that are in line with Socialism and explain.docxpicklesvalery
Note 2 political actions that are in line with Socialism and explain why and how they relate to the concepts attached to this ideology. List your sources.
2- Answer the questions below. List your source(s) for all your answers:
A) Why is Communism considered a dying ideology? Provide 2 arguments to support your answer.
B) Has Communism ever existed in practice? Use one example to support your answer.
800 words maximum
.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Study Guide Health Care ReformHealth Care Reform OverviewWhe.docx
1. Study Guide: Health Care Reform
Health Care Reform: Overview
When it comes to healthcare in America, we seem to believe
that more is better--but does more healthcare result in better
health? As a nation, we spend more on healthcare per person
than any European country, yet our health outcomes are worse.
The PBS documentary, Money and Medicine was aired in 2012,
and addresses one of the key issues of healthcare reform--the
cost of health care. Watch the trailer below, or the entire
episode here: http://video.pbs.org/video/2283573727/
(Links to an external site.)
http://youtu.be/a9oEtRwoVxs
(Links to an external site.)
The Affordable Care Act
The Patient Protection and Affordable Care Act (ACA), passed
in 2010, is a collection of laws that were created to reform
health insurance and healthcare.
The ACA significantly impacts nurses both personally and
professionally. Bedside nurses are impacted by organizational
changes that affect patient care, and may be providing
information and resources to patients and caregivers about the
ACA. However, as Hynds, Hatch and Samuels (2014) noted,
nurses indicate they need more knowledge to understand the
ACA policy implications of their practice.
Now, you can either read the 974 pages of the law itself, or you
can watch this short, animated video produced by the Kaiser
Family Foundation, and visit the helpful online resources
below:
http://youtu.be/JZkk6ueZt-U
(Links to an external site.)
2. The YouToons Get Ready for Obamacare
0:01 / 6:52
<div class="player-unavailable"><h1 class="message">An error
occurred.</h1><div class="submessage"><a
href="http://www.youtube.com/watch?v=JZkk6ueZt-U"
target="_blank">Try watching this video on
www.youtube.com</a>, or enable JavaScript if it is disabled in
your browser.</div></div> Minimize Video
Affordable Care Act: Five Years Later
The Commonwealth Fund has developed several online,
interactive resources to illustrate the impact of the Affordable
Care Act in its first five years of implementation. Through
personal stories, population and health systems data analysis,
and graphics, the Commonwealth fund paints the picture of the
impact of the ACA on individuals, businesses, providers and
healthcare systems. Take some time to explore these resources
in preparation for this week's discussion board. Link: The
Affordable Care Act: A Look Back at the First Five Years.
(Links to an external site.)
3. Review the two interactive digital features: Coverage Reform
(Links to an external site.)
and Delivery Reform
(Links to an external site.)
.
Value-Based Purchasing--"Pay for Performance"
Increasingly, hospitals and healthcare providers are reimbursed
not just for the amount of services provided (fee-for service),
but for the results that are achieved for a particular patient
population. As nurses, you may have observed policy changes
that emphasize patient experience, prevention of hospital-
acquired infections, and effective discharge planning to avoid
unplanned re-admissions. In hospitals, we hear a lot about
Hospital Consumer Assessment of Healthcare Providers and
Systems--more likely known for its acronym: HCAHPS. We also
hear the term "Core Measures," which refers to a national
standardized performance measurement system. Health system
performance reports are easily accessible to the public on the
Centers for Medicare and Medicaid Services (CMS) website,
where consumers can compare the performance of local
hospitals and providers.
Activity:
Visit the CMS Hospital Compare website:
http://www.medicare.gov/hospitalcompare/search.html
(Links to an external site.)
Look up the hospital where you work or live. Explore the
performance measures across the various categories, especially
"Survey of Patient Experiences" and "Timely and Effective
Care." Consider how your work is affected by these measures.
Accountable Care Organizations and Medical Homes
Hospitals and healthcare providers are reimbursed for Medicare
services based on their performance on key measures. In order
to improve results, providers have organized Accountable Care
Organizations and Medical Homes to provide a more
comprehensive, coordinated approach to achieve better health
4. and lower costs. Many organizations have established
partnerships to collectively be responsible for a group of
patients (Accountable Care Organizations) and provide a
"Medical Home" approach to improve patient care outcomes.
The Kaiser Family Foundation has created a brief video to
explain Accountable Care Organizations:
http://bcove.me/si8pqctw
(Links to an external site.)
The Cleveland Clinic video below describes such an approach:
http://youtu.be/_31k2gotfB8
(Links to an external site.)
Medicaid Expansion
Originally, the Affordable Care Act mandated expansion of
Medicaid to include a larger sector of the population--up to
138% of the Federal Poverty Level, with federal dollars funding
the vast majority of the related costs of coverage. However, the
Supreme Court ruled that the decision to expand Medicaid rests
with the states. Florida was one of the states which has not
expanded Medicaid (at least at this writing); the issue has
become a hot debate in the 2015 legislative session. The
following articles from the Kaiser Family Foundation provide a
little background to learn more about Medicaid expansion and
the experience of states who have expanded coverage:
Video: Expanding Affordable Care through Medicaid
(Links to an external site.)
How Well Does Your State Perform?
The Commonwealth Fund's Scorecard on State Health System
Performance (2014) assessed states on 42 indicators of health
care access, quality, costs and outcomes from 2007 to 2012.
This interactive tool (link below) will show the gains that your
state could achieve by improving its performance to the level of
5. better-performing states, as well as the losses that would result
if your state failed to sustain its performance. Take a look--
how does your state perform?
Commonwealth Fund Scorecard on State Health System
Performance Interactive Tool
(Links to an external site.)
What does the Affordable Care Act mean for Nursing?
You will respond to this question in this week's discussion
forum, based on an article by Brenda Luther and Sara
Hart: What does the Affordable Care Act mean for nursing?,
and the articles and resources you used to develop your Health
Care Reform paper. The American Nurse's Association has
developed an excellent summary of how the ACA impacts
nursing: http://nursingworld.org/MainMenuCategories/Policy-
Advocacy/HealthSystemReform/AffordableCareAct.pdf
(Links to an external site.)
Additional Resources:
Here are several excellent resources to increase your knowledge
about the ACA, in preparation for this week's Discussion Board
on Healthcare Reform.
1. U.S. Department of Health and Human Services:
http://www.hhs.gov/healthcare/
(Links to an external site.)
2. Kaiser Family Foundation: Health Reform:
http://kff.org/health-reform/
(Links to an external site.)
(Links to an external site.)
3. The Facts on Medicare Spending and
Financing: http://kff.org/medicare/fact-sheet/medicare-
spending-and-financing-fact-sheet/
(Links to an external site.)
4. Read Article: Summary of the ACA: http://kff.org/health-
reform/fact-sheet/summary-of-the-affordable-care-act/
9. Nurses are ethically bound to engage in efforts of improving
health and healthcare delivery and, even more important, nurses
recently have been called out as key leaders in the reform of
healthcare delivery, including many components of the Patient
Protection and Affordable Care Act. The Patient Protection and
Affordable Care Act, its history, and what healthcare will look
like during and after implementa- tion are addressed in this
article. A discussion of the role and value of nurses in
healthcare reform accompanies knowledge-building and action-
oriented resources available to nurses and clients.
As nurses, we are watching and experiencing healthcare reform
as both professionals and citizens. The nursing profession is
now placed in a unique position to facilitate development
of patient coordination including identification of key points in
client care to manage wellness and illness as well as systematic
measurement of health outcomes. In this article, we present a
review of the Patient Protection and Affordable Care Act
(ACA).
When President Obama signed the Patient Protection and
Affordable Care Act on March 23, 2010, a collection of laws
was created that, as a whole, put in place com- prehensive
healthcare and health insurance reform. The development of
these laws began much earlier with legislation and regulation
designed to create a patient’s a bill of rights, encourage the use
of evidence-based best practices, and increase access to
affordable healthcare. The resulting ACA legislation focused on
building change into our existing system and is the most signifi-
cant reform of how we pay for and deliver healthcare since the
1965 adoption of Medicare and Medicaid (Jost, 2014). This
legislation represents a complex series of changes.
The major goals of the ACA are to build on our cur- rent system
10. by (1) expanding Medicaid, (2) preserving
surance they have personally selected and are person- ally
paying for (Congressional Budget Office, 2014). It is predicted
that new and younger people entering the healthcare market will
drive the costs of healthcare down. Recent analysis by the
Congressional Budget Office now predicts that the costs of
implementing the ACA are even lower than previously reported
(Stein & Young, 2014). Still, to date, many of the benefits of
the ACA remain largely unseen.
The costs of delivering healthcare in our country have become a
major concern, with the overall costs of now at 23% of the
federal budget and 20% of most household budgets (Centers for
Medicare and Medicaid Services, 2014; Hartman, Martin,
Benson, & Catlin, 2013). Healthcare costs have risen to a point
that 32% of people with insurance have difficulty paying their
medi- cals bills, must pay healthcare over time, or are unable to
pay at all (Pollitz & Cox, 2014). The No. 1 cause of personal
bankruptcy for middle-class, insured, working
U.S. citizens is healthcare costs (Himmelstein, Thorne, Warren,
& Woolhandler, 2009). By addressing the cost of healthcare, as
well as issues of access to healthcare, better health and
financial stability are possible for indi- viduals, businesses, and
government.
Historically, U.S. healthcare has been complicated by the
inherent competition set up between systems of payers,
providers, users, and regulators. Effective healthcare and good
and affordable health for any pop- ulation result from high-
quality, affordable, and acces- sible care (Lamb, 2014). These
three points are fre- quently represented by disparate and
disconnected industries, often industries that are competing
with each other rather than working together to maintain good
health for their clients. The “triple aim” of health reform, and
of the ACA, is to (1) improve the patient experience with higher
quality care, (2) increase access to care, and (3) control
healthcare costs (Institute of
11. both employer/job-based coverage and Medicare, and
(3) promoting state control of insurance markets. The ACA has
had early success in implementing these re- forms and
preserving the structure of care (Jost, 2014). Thirty-four percent
of new enrollees are under 34 years of age; during the first
enrollment period, more than 8 million people have obtained
coverage through the ACA Health Insurance MarketPlace, and
even many more private pay nonelderly people are covered with
in-
Brenda Luther, PhD, RN, Assistant Professor, Director Care
Management Programs, College of Nursing, University of Utah,
Salt Lake City.
Sara Hart, PhD, RN, Assistant Professor, College of Nursing,
University of Utah, Salt Lake City, and Gold Humanism Scholar
from the Harvard Macy Institute.
The authors and planners have disclosed no conflicts of interest,
finan- cial or otherwise.
DOI: 10.1097/NOR.0000000000000096
Medicine, 2011). The ACA has attempted to deal with more
than just payment and cost of healthcare by im- proving the
quality of care delivered and access to pre- ventive care and
early intervention.
Competition between disconnected organizations is
demonstrated in our traditional fee-for-service health- care
system. When more services are provided, more rev- enue is
generated. But more care does not necessarily result in higher
quality care or better health outcomes. Services must represent
appropriate interventions and expected outcome based on the
client’s goals of care. While quality is inherently measured and
valued in healthcare, it has not often been paid for or
incentivized. The economic risks of healthcare costs have
12. traditionally fallen most heavily on third party payers (insurers
and the state and federal governments), not the providers.
The ACA and the New Roles for Nurses
The ACA promotes healthcare that is designed within co-
ordinated, orchestrated, and value-based care models. Value-
based care incentivizes healthcare providers to keep population
groups healthy by focusing on outcomes of care rather than
volume of service of care. Value-based care incentivizes
healthcare organizations to meet benchmark health outcomes for
their clients. This also creates healthcare systems that are
focused on wellness, prevention, minimizing repetition, and
unnecessary costs. Nurses are key players in this component of
health- care reform. Uniquely situated on the front lines of pa-
tient care, as well as within healthcare payer and supplier
agencies, nurses have the expertise and obligation to in- fluence
practice and policy (Institute of Medicine, 2011). Nurses
promote health, navigate chronic illness, and pre- vent the
development of secondary conditions, all of which align with
the triple aims of healthcare reform.
As hospitals, insurance providers, and provider groups align to
be a part of value-based payment systems, the roles of nurses
become integral to promoting these changes. Care managers,
care coordinators, and infor- matics experts—nurses—are vital
leadership for directing care process changes, quality and
evidence-based inter- ventions, and measurement of care
outcomes (Lamb,
2014). Nurses have a demonstrated history of leadership in
team-based care processes. Nurses have patient- centered care
as a core professional standard and compe- tency. Nurses are
pivotal to care quality and patient satis- faction, as well as
efficacious use of resources to provide patient-centered and
evidence-based care.
What Are the Health Insurance MarketPlaces?
13. Health Insurance MarketPlaces are centralized sources for state-
level information on the options and costs for indi- viduals and
small businesses when purchasing affordable healthcare
coverage. Individuals use the MarketPlace to determine whether
they qualify for insurance premium subsidies (subsidies are cost
sharing reductions or govern- ment-sponsored programs based
on income). People liv- ing between 130% and 400% of the
Federal Poverty Level typically qualify for subsidized policies
(Sommers, Graves, Swartz, & Rosenbaum, 2014). States were
given the option to develop their own State MarketPlace or to
use a state- based but federally developed MarketPlace. In
October 2013, the Federal MarketPlace launched with many
tech- nical challenges. Yet most stat-developed MarketPlaces
were up and functioning with little problems. As of May 2014,
more than 8 million new, subsidized enrollees were processed
through the MarketPlace and, unexpectedly, more than 12
million private, self-pay clients found afford- able healthcare
they could purchase (Stein & Young, 2014). People will
continue to access the online MarketPlace individually but in-
person navigators are also available to help individuals
understand their options and the enrollment process. Open
enrollment via the MarketPlaces officially closed March 31,
2014. Until the next open enrollment period, the MarketPlace
remains open for enrollment for individuals and families experi-
encing qualifying events such as job loss and changes to family
composition.
Sources for Educating Ourselves and Our Clients
As nurses, we are always challenged to teach clients about the
healthcare delivery system and the ACA has
T
ABLE
14. 1.
D
EFINITIONS
Cost-sharing reduction A discount given for insurance
through the MarketPlace exchanges based on income and health
plan type Deductible The amount the consumer owes for
services before the health plan will begin to pay
Federal poverty level Levels of personal income used to
determine a client’s eligibility for Medicaid, Children’s Health
Insurance Program, and Subsidized Coverage of ACA
Fee-for-service Paying providers for each service they perform
rather than the quality of services provided Job-based coverage
Insurance coverage offered to employees and often their
dependents
MarketPlace A resource to learn about coverage options,
compare plans, and enroll. Some are run by the state and others
by the federal government
Navigator Trained individual or organization to help consumers
and small businesses look for healthcare coverage. Services are
free to consumers
Qualified health plan An insurance plan certified to provide
the essential benefits and established limits on costs such as
deductibles, copay, out-of-pocket
Value-based care Linking provider payments for services to
the quality of care they provide
T
ABLE
2.
L
INKS FOR
C
LIENT
15. Q
UESTIONSwww.healthcare.gov Need to get ready to enroll?
Or, find a
local navigator?
Why should a client be covered?
What are different types of health insurance?
www.dol.gov Consumer Information on the Affordable Care
Act
significantly increased the need for these efforts. Many clients
are confused with their options and the pro- cesses for obtaining
and accessing health coverage. For example, new users may be
surprised that the plans they selected are low cost in monthly
premiums and una- ware those will typically translate to higher
deductibles, even though the deductibles are typically below
policies outside of those offered at the MarketPlace (Jost,
2014). Nurses may find themselves overwhelmed by the educa-
tion and information needs of their clients. Below are three
tables: a list of definitions (see Table 1) and lists of resources
for client questions (see Table 2) and valuable resources for you
as a nurse (see Table 3).
Are There New Services Offered Under the ACA?
There are new requirements for the healthcare benefits offered
in any Qualified Health Plan. Enrollment in a Qualified Health
Plan is required by the Individual Mandate of the ACA. No
longer can policies be offered that do not provide “Essential
Benefits” such as preven- tive care or comprehensive care or
maternity benefits, for example (see Table 4). Previous to the
ACA individ- ual insurance policies often lacked these basic
levels of coverage. Coverage of the essential health benefits, as
mandated under the ACA laws and regulations, ex- panded
effective and affordable, quality healthcare cov- erage for
millions of Americans, but some have pre- dicted this may also
drive up costs of insurance premiums. This controversy
continues to play out in the reform debate, but what is also
16. being discovered is how
many people were purchasing ineffective, low-cost/low- benefit
policies that actually did not save them money when they
needed coverage for essential services.
Interesting components of these essential services are worthy of
discussion. For instance, the additional requirement of mental
health and behavioral health, in- cluding counseling and
psychotherapy, has resulted in many primary care organizations
developing integrated physical and mental health services for
their clients. Those with chronic illness now have access to
ongoing therapy services to help them achieve optimal function.
New wellness and prevention and behavioral health ser- vices
are quickly being expanded into the traditional service lines of
primary care, medical homes, family practice, and outpatient
services.
Key Elements of an Accountability Care Organization
Accountable care organizations (ACOs), a Medicare Pilot
Program under the ACA, is a way of organizing care delivery
that establishes a system of value-based payment contracts for
large populations of the insured. The ACO model allows
Medicare, and other payors of healthcare, to contract with
providers for services based upon benchmark health outcomes
for their clients. Though still a fee-for-service model, the ACO
payment structure is based on financial incentives to improve
benchmarks. For example, an ACO may negotiate that a
majority of their clients will have controlled blood pres- sure
levels. If the ACO attains the agreed-upon bench- mark for their
population of their clients, the ACO will share in the savings
achieved rather than the insurer keeping all those savings.
Incentivized, benchmarked, value-based outcomes system is the
heart of creating an ACO framework as a method of healthcare
reform.
To set and measure benchmarks for quality and cost, we must
first reach agreement on accurate measures of quality. This
17. requires available informatics systems ca- pable of tracking and
reporting outcomes data in an ACO. This highlights the
importance of new health in- formation technology requirements
rolled out in the ACA. Many clinical groups and providers did
not have
T
ABLE
3.
V
ALUABLE
L
INKS FOR
H
EALTHCARE
R
EFORM
R
ESOURCES
American Nurses Association: “professional organization
representing the interests of the nation’s 3.1 million registered
nurses”
Centers for Medicare and Medicaid Services: governmental
website with client and provider Medicare and Medicaid
information
http://www.nursingworld.org/http://www.cms.gov/
Institute of Medicine: “an independent, non-profit organization
working outside of government to provide unbiased and
authoritative advice ftor decision makers and the public”
18. Kaiser Family Foundation: an independent, non-profit
foundation focusing on providing research and knowledge about
major healthcare issues
http://www.iom.edu/
http://kff.org/
http://kff.org/health-reform/faq/health-reform- frequently-
asked-questions/
National Council of Nonprofits: a resource and advocate for
nonprofit agencies http://www.councilofnonprofits.org/public-
policy/federal-policy-issues/health-care- reform
U.S. Department of Labor: information related to employment-
based health plan coverage related to the ACA
http://www.dol.gov/ebsa/healthreform/
T
ABLE
4.
E
SSENTIAL
H
EALTH
P
19. LANS
B
ENEFITS
M
UST
I
NCLUDEAmbulatory services Emergency services
Hospitalizations
Maternity and newborn care
Mental health and substance use disorder services including
behavioral health treatment
Prescription drugs
Rehabilitation and habilitation services Laboratory services
Preventative and wellness services
adequate systems for ACO participation; thus, the ACA also
offered provider networks funding to upgrade and implement
information systems.
An ideal model for healthcare delivery reform ad- dresses four
key concepts integral to the sustainability:
(1) access, (2) care coordination, (3) healthcare infor- mation
technology, and (4) payment reform (Patient- Centered Primary
Care Collaborative, 2011). Table 5 briefly presents these
concepts based on what we know from trends, data, and
evidence (Patient-Centered Primary Care Collaborative, 2011).
Nursing and Integrated Care Teams and ACOs
For nurses, being a part of an ACO means being a part of
integrated, interdisciplinary teams collecting meas- urements of
health outcomes, being aware of how those outcomes are cared
for in their system, and assuring the interventions provided to
clients are effective, effica- cious, and evidence-based.
Important to nursing and healthcare science is that we focus on
20. preventing illness and promoting wellness in our care teams by
using evi- dence-based strategies (Grady, 2014). Integrated
teams of care providers will play a major role in applying evi-
dence-based practice to the populations we care for.
Now as new services become available to our clients, such as
behavioral and mental health, care teams are challenged to
integrate services across disciplines. Coverage of obesity
counseling for orthopaedic clients can be paid for under the
ACA, coverage for substance abuse, smoking cessation, or other
services not previ-
ously covered services, are now being provided. This pushes us
as nurses to care for our clients in more holis- tically ways,
rather than providing only sick care spe- cialty services as we
may have in the past. As the client moves between all types of
care services offered, care managers will be monitoring health
outcomes and con- necting to services. For example, a nurse in
an outpa- tient orthopaedic clinic or a clinician at a behavioral
health counseling session could also be monitoring and
coordinating efforts to address a client’s hypertension.
Integrated clinics specializing in personalized health- care are
showing up in our communities. Integrated care means that
nurses may be working in an internal medi- cine clinic as a care
manager, navigating patients through bundled care services and
assuring the care bundle devel- oped by their organization are
being completed for each client. An integrated, personalized
care structure may mean that all the diabetic clients of the
clinic’s population have a group of ideal outcomes to be
accomplished such as controlled A1C levels less than 8%, blood
pressure lev- els less than 140/90 mm Hg, low-density
lipoprotein level less than 100, microalbumin check yearly, and
eye exami- nation yearly. A variety of clinicians are needed to
achieve the goals of this care bundle. To support measuring the
outcomes of a bundle, systems need informatics, track- ing,
assessment, and a team of coordinated care provid- ers. Care
managers will be monitoring all of the clients, but they may be
21. supervising medical assistants calling clients for check-ins or
scheduling appointments; thus, leaving their time for one-on-
one sessions reviewing needed teaching or scheduling a
healthcare advocate to make home visits to assess a client’s
falls risk.
Healthcare providers are becoming connected in new ways. One
example may be that the pharmacy would note that a client has
not picked up a refill of a medica- tion, and alert the care
management team to initiate a call to the client to see what they
can do to help the client stay on their medications. Another
form of connection would be a care manager alerting a primary
care pro- vider when their clients are within the goals of health
outcomes and prompt the primary care providers about what
could be discussed or revised for the client to im- prove these
goals. Gone are the days when one care pro- vider can be
expected to track, remember, and measure all of the outcomes
that are now known as basic care for diagnoses or conditions.
Teams are needed to provide quality, evidence-based best
practices, examine evi- dence, make system changes, and
ultimately interface with the client to bring quality healthcare to
their lives.
T
ABLE
5.
K
EY
E
LEMENTS OF AN
A
FFORDABILITY
C
ARE
22. O
RGANIZATION
Access Addressing access to primary care providers means to
have off-hours or same-day access as improving those decreases
emergency department use and improves patient and clinician
satisfaction.
Care coordination Care coordination improves exchanging
information between systems and improving accountability of
systems to each other and to their clients.
Health information technology
Healthcare information technology offers healthcare providers
immense outcomes tracking as well as innovative clinician–
provider communication and ultimately improves patient self-
management.
Note.
Data
from
Patient-Center
Primary
Care
Collaborative,
2011.
Retrieved
23. from
http://www.pcpcc.org/sites/default/files/media/
better_best_guide_full_2011.pdfPayment reform Quality is
rewarded over quality in a new value-based, shared outcomes
setting. Many valuable but unreimbursed services can be
provided included such as e-visits and phone visits; RN,
pharmacy, health educators, and coaches.
The examples described previously highlight where nurses are
uniquely situated to affect patient outcomes within the work of
an ACO. Nurses possess a theoretical base of biophysical,
psychosocial, and developmental knowledge. Nurses, in these
roles, must expand their skills to effectively support behavior
change in clients to achieve quality health outcomes, skills such
as motiva- tional interviewing, understanding the stages of
change, knowing the challenges of an individual’s personal de-
velopment, and being an expert in interprofessional
communication are essential. All are skills that nurses have and
can continue to develop.
Conclusion
The ACA of 2010 enacted a large group of laws that brought
change to processes, systems, payers, and users of healthcare.
This is not the first time that reform of our private, market-
based healthcare system has been attempted. Presidents Teddy
and Franklin Roosevelt, Harry Truman, John F. Kennedy,
Richard Nixon, and Bill Clinton all ventured into lobbying and
legislation for reforming healthcare delivery. These leaders, and
others, settled for incremental changes to the system and no
comprehensive reform occurred; this left us with fractured,
disconnected, and competing systems paying and providing
healthcare to our nation. This magnitude of collaboration and
broad inclusion of stakeholders of the ACA is creating forward
thinking health planning and something that will most likely be
seen as uniquely American.
24. REFERENCES
Congressional Budget Office. (2014). Updated estimates of the
effects of the insurance coverage provisions of the Affordable
Care Act, April 2014. Retrieved from www.
cbo.gov/publication/45231
Centers for Medicare and Medicaid Services. (2014). Retrieved
from http://www.cms.gov/Research-Statistics-
Data-and-Systems/Statistics-Trends-and-Reports/
NationalHealthExpendData/Downloads/tables.pdf
Grady, P. (2014). Charting future directions in nursing re-
search: NINR’s innovative questions initiative. Journal of
Nursing Scholarship, 46(3), 143–143. doi:10.1111/ jnu.12078
Hartman, M., Martin, A., Benson, J., & Catlin, A. (2013).
National health spending in 2011: Overall growth re- mains low,
but some payers and services show signs of acceleration. Health
Affairs, 32(1), 87–99. doi:10.1377/ hlthaff.2012.1206
Himmelstein, D. U., Thorne, D., Warren, E., & Woolhandler,
S. (2009). Medical bankruptcy in the United States, 2007:
results of a national study. American Journal of Medicine,
122(8), 741–746. doi:10.1016/j.amjmed.2009.04.012
Institute of Medicine. (2011). The future of nursing: Leading,
changing, advancing health. Washington, DC: The National
Academies Press. Retrieved from www.iom.
edu/Reports/2010/The-Future-of-Nursing-Leading- Change-
Advancing-Health.aspx
Jost, T. (2014). Implementing health reform: Four years later.
Health Affairs, 33(1), 7–10. doi:10.1377/ hlthaff.2013.1355
Lamb, G. (2014). Care coordination: the game changer.
Silver Springs, MA: American Nurses Association.
Patient-Centered Primary Care Collaborative. (2011). Better to
best: Value-driven elements of the patient cen- tered medical
home and accountable care organizations. Retrieved from
http://www.pcpcc.org/sites/default/
files/media/better_best_guide_full_2011.pdf
25. Pollitz, K., & Cox, C. (2014). Medical debt among people with
health insurance. Retrieved from http://kff.org/ private-
insurance/report/medical-debt-among-people- with-health-
insurance/
Sommers, B. D., Graves, J. A., Swartz, K., & Rosenbaum, S.
(2014). Medicaid and marketplace eligibility changes will occur
often in all states; policy options can ease impact. Health
Affairs, 33(4), 700–707. doi:10.1377/ hlthaff.2013.1023
Stein, S., & Young, J. (2014). CBO: Obamacare will cost less
than projected, cover 12 million uninsured peo- ple this year.
Huffington Post. Retrieved from http://
www.huffingtonpost.com/2014/04/14/cbo-obamac- are-
report_n_5146896.html
For 74 additional continuing nursing education articles on
professional issues, go to nursingcenter.com/ce.
NUR 3805 Dimensions of Professional Nursing Practice
Health Care Reform Paper
Purpose: The Patient Protection and Affordable Care Act (ACA)
was a sweeping health reform statute signed into law by
President Obama in March of 2010. The ACA is the most
significant government expansion and regulatory overhaul of
the health system since the advent of Medicare and Medicaid.
The intent of the law is to expand insurance coverage, control
health care costs, and to improve healthcare delivery systems.
Even as the ACA rolls out, much of the population (including
26. nurses) lack understanding of the ACA, and question the value
of the law in achieving its intended results. This assignment
gives students the opportunity to explore how healthcare is
organized and financed, and discuss how the Affordable Care
Act affects population health, patient care quality and safety,
and the practice of nursing.
Prepare: Complete the “Health Care Reform” study guide, watch
videos and read the articles provided in the module.
Content: For the Health Care Reform PAPER, select ONE of
the following questions that addresses/explores one aspect of
the ACA. Write a brief (2-3 page) paper in APA format that
provides a clear description that answers the question, AND
reflect on why this information is important to you in your
practice as a nurse, as a family member and/or as member of
your community.
Choose ONE topic/question:
1. Describe the Affordable Care Act (ACA), including the major
goals and features of the law. How does the ACA differ from
government-run healthcare in other countries?
2. What are the Health Insurance Marketplaces, and how do
consumers enroll in health insurance? How do the exchanges
work?
3. Describe the Medicare program, including eligibility, and
program elements (Parts A, B, C, D). Describe Medicare
expenditures for the most recent year.
4. Describe the Medicaid program, including eligibility by age
and income. Explain Medicaid Expansion programs proposed
under the ACA, and the current status of expansion programs in
the United States.
5. One of the goals of the ACA is to decrease the number of
uninsured people. How well has this goal been achieved? What
population groups have been impacted the most by this
increased coverage?
27. 6. Define the concept of Hospital Value-based Purchasing (also
known as pay-for-performance or performance-based
reimbursement. Provide examples of how hospitals are affected
by value-based purchasing policies.
7. Define Medical Homes and Accountable Care Organizations.
How can these approaches improve population health, improve
the quality of healthcare and lower costs?
Format: Apply APA format and style guidelines to write a 2- to
3-page paper, which should include a minimum of three
references, one or more of which is an article from a peer-
reviewed journal. No abstract is required for this paper.
Discussion:
See Discussion assignment instructions; students will post one
substantive post and one substantive peer response to the
following question: What does the Affordable Care Act mean
for nursing? Base your initial post on information described in
your Health Care Reform paper, supplemented by the Luther
and Hart article (and/or more resources)! Grading will be
evaluated by the Discussion Board Grading Rubric.
Health Care Reform Paper Grading Rubric
Criteria
Ratings
Explain concepts introduced in question, including and citing
reliable sources (government organizations, reliable
foundations, peer-reviewed journal articles).
Narrative demonstrates understanding of concepts and programs
described; information cited from reliable sources =50
Description of concepts lacks accuracy or clarity or extensive
use of quotations = 35
Minimal description of concepts introduced in question; sources
are not adequately cited and/or are not reliable =10
Why this information is important to you
Thoughtful reflections of why healthcare program or reform is
28. important to you as a nurse, as a family member and/or as
member of your community = 30
Little reflection on what was presented in the paper or extensive
use of quotations = 15
Minimal or missing reflection = 0
APA and Scholarly Writing
Follows APA style and format with rare and minor exceptions;
scholarly and objective writing = 20
APA and writing have a few mistakes OR body of paper exceeds
3 pages by one additional page = 10
More than a few APA errors; OR body of paper exceeds 4 pages
= 0
Possible Points = 100