27 Jan Respond?to ?two?of your colleagues by suggesting additional opportunities or recommendations for overcoming the challenges described by your colleagues. Se
Respond to two of your colleagues by suggesting additional opportunities or recommendations for overcoming the challenges described by your colleagues.
See attachment for peer responses
Peer 1
Week 9; Discussion
The role of the RN/APRN in policy evaluation
Medicaid is a state and federally funded program that provides healthcare to low-income individuals and families. Evaluating the effectiveness of Medicaid programs at the community, state, or federal level is a complex and multifaceted task that requires the use of a variety of criteria and methodologies. These evaluations are crucial in informing policy decisions and improving the program to ensure that it meets the healthcare needs of the population it serves. Several criteria and methodologies are commonly used in these evaluations, including access to care, quality of care, cost-effectiveness, and health outcomes.
Access to care is a critical criterion in evaluating the effectiveness of Medicaid programs. This involves assessing the extent to which the program provides affordable and timely access to healthcare services for eligible individuals and families. Measures such as the percentage of the population enrolled in the program, wait times for appointments, and geographic distribution of healthcare providers are often used to evaluate access to care.
Quality of care is another important criterion in evaluating Medicaid programs. This involves assessing the extent to which the program delivers high-quality healthcare services that meet established standards of care. Measures such as adherence to clinical guidelines, patient satisfaction, and health outcomes are commonly used to evaluate quality of care.
Cost-effectiveness is a key consideration in evaluating the effectiveness of Medicaid programs. This involves assessing the extent to which the program efficiently allocates resources to achieve desired health outcomes. Measures such as per capita spending, utilization of healthcare services, and return on investment are often used to evaluate cost-effectiveness.
Health outcomes are a fundamental criterion in evaluating the effectiveness of Medicaid programs. This involves assessing the impact of the program on the health status of the population it serves. Measures such as mortality rates, disease prevalence, and health disparities are commonly used to evaluate health outcomes.
In summary, evaluations of Medicaid programs at the community, state, or federal level use a variety of criteria and methodologies to measure effectiveness. These evaluations are essential for informing policy decisions and improving the program to ensure that it effectively meets the healthcare needs of the population it serves. By considering criteria such as access to care, quality of care, cost-effectiveness, and health outcomes, and employing a combination of quantitative and qualitative methodologies, policymakers and stakeholders can gain a comprehensive understanding of the effectiveness of Medicaid programs and make informed decisions to enhance their impact on public health.
Social Determinants
Social determinants of health have a significant impact on the effectiveness of the Medicaid program and influence the issues it addresses, including economic stability, access to quality education, healthcare accessibility and quality, neighborhood and built environment concerns, social and community context, as well as food insecurity. These factors underscore the need for a holistic approach to healthcare within Medicaid programs in order to enhance overall effectiveness. Additionally, addressing social determinants of health can help reduce health disparities, improve health outcomes, and promote equity within the Medicaid population.
Zimbroff et al.(2020) discuss how the social determinants of health play a crucial role in shaping the effectiveness of Medicaid programs. Research indicates that these determinants, including housing stabilityfood security, and accessibility, significantly impact the outcomes of Medicaid initiatives. For example, adding social supports to home-based primary and palliative care in the Medicaid program has led to additional savings and benefits, demonstrating the influence of social determinants on healthcare outcomes (Zimbroff et al., 2020). Furthermore, the impact of disability and social determinants of health on condition-specific readmissions beyond Medicare risk adjustments has been studied, revealing the varying impact of social determinants across hospital populations (Meddings et al., 2016). Furthermore, addressing social risk factors has been shown to have an impact on performance and penalties in the hospital readmissions reduction program. This highlights the need to take into account social determinants in healthcare quality assessments (Maddox et al., 2019). State Medicaid programs have also prioritized addressing social determinants of health to drive higher utilization, reduce disparities, and improve health outcomes (Chisolm et al., 2019). Additionally, integrated home- and community-based services have been found to improve community survival among Medicare beneficiaries, mitigating the effects of social determinants such as accessibility and housing stability (Valluru et al., 2019).
Overall, the incorporation of social determinants of health into the evaluation of Medicaid programs is essential for understanding their effectiveness, ensuring cost-effectiveness, and identifying opportunities for improvement in access to care and health outcomes.
References
Chisolm, D. J., Brook, D., Applegate, M., & Kelleher, K. J. (2019). Social determinants of health priorities of state medicaid programs. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-3977-5
Meddings, J., Reichert, H., Smith, S. N., Iwashyna, T. J., Langa, K. M., Hofer, T. P., … & McMahon, L. F. (2016). The impact of disability and social determinants of health on condition-specific readmissions beyond medicare risk adjustments: a cohort study. Journal of General Internal Medicine, 32(1), 71-80. https://doi.org/10.1007/s11606-016-3869-x
Maddox, K. E. J., Reidhead, M., Hu, J., Kind, A., Zaslavsky, A. M., Nagasako, E. M., … & Nerenz, D. R. (2019). Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program. Health Services Research, 54(2), 327-336. https://doi.org/10.1111/1475-6773.13133
Valluru, G., Yudin, J., Patterson, C. L., Kubisiak, J., Boling, P. A., Taler, G., … & Kinosian, B. (2019). Integrated home‐ and community‐based services improve community survival among independence at home medicare beneficiaries without increasing medicaid costs. Journal of the American Geriatrics Society, 67(7), 1495-1501. https://doi.org/10.1111/jgs.15968
Zimbroff, R. M., Ritchie, C. S., Leff, B., & Sheehan, O. C. (2020). Home‐based primary and palliative care in the medicaid program: systematic review of the literature. Journal of the American Geriatrics Society, 69(1), 245-254. https://doi.org/10.1111/jgs.16837
Peer 2
Healthcare Program
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federally funded healthcare program. This program is in place to serve the needs of low-income women who are currently pregnant, post-partum, and/or breastfeeding, as well as children up to age five in need of nutritious food supplements (USDA, 2022). WIC was created to support the health and wellness of mothers in need and their children and has expanded availability in 50 states, DC, and US territories since its inception (USDA, 2023).
Effectiveness
According to the USDA, in the 2022 fiscal year, WIC was able to serve around 6.3 million participants each year, which included about 39% of all infants present in the United States at the time (USDA, 2023). Because the program is niche and only available to low-income pregnant/postpartum women and children, the statistics of their reach are quite impressive when limiting factors of financial resources, pregnancy status, age, and sex are considered. Families are also eligible for additional programs such as Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and Medicaid while enrolled in WIC to better support them.
Social Determinants
According to the CDC, some social determinants that may affect user enrollment in this plan could be a lack of education about the programs, financial resources to get to and from eligibility appointments, low health literacy, and choosing not to engage in community wellness programs (CDC, 2022).
Role of the RN/APRN
The nursing role in this program could be directly involved with the program itself or as a third party. With direct involvement, nurses can help shape the revisions on parameters within the program, including health eligibility requirements and expanding participants' nutritional needs programs based on new data. As a third-party participant in a care coordinator position, clinic nurse, midwife, etc., nurses can educate low-income mothers on the program offers and provide them with information on how to apply.
Centers for Disease Control and Prevention. (2022). Social determinants of health at CDC. Retrieved on January 22, 2024, from https://www.cdc.gov/about/sdoh/index.html#:~:text=Social%20determinants%20of%20health%20(SDOH,the%20conditions%20of%20daily%20lifeLinks to an external site. .
USDA. (2022). About WIC. Retrieved on January 22, 2024, from https://www.fns.usda.gov/wic/about-wicLinks to an external site.
USDA. (2023). WIC program. Retrieved on January 22, 2024, from https://www.ers.usda.gov/topics/food-nutrition-assistance/wic-program/Links to an external site.
