NURS 6050 Healthcare Program/Policy Evaluation Analysis Paper

Patient protection and Affordable Health Care Act, also popularly known as ‘Obama Care’ is a health policy that was signed into law by President Barrack Obama on 23^rd March, 2010. At the moment, the policy stands out as the most extensive in the United States’ healthcare system since the approval of Medicare and Medicaid in 1965.

The impacts of the policy have been vast and wide. The most significant element of the policy is that it provides subsidies which makes healthcare insurance affordable (Blumenthal et Al., 2015). Another aspect of the policy is that it emphasizes on preventive care by improving legislations that govern how the care itself is delivered.

The success of the ACA policy can only be effectively measured by considering how much it reduces the number of uninsured people and if it improves the quality of care, whose availability will be at a low cost. Its success will also be quantified by reviewing the federal and state budget

s which will take several tears to be noticeable. Basically, it can be said that the policy has been successful at availing affordable care to millions of Americans. This is because, following its introduction, more than 20million people have been able to access healthcare insurance with more medical coverage. In addition, those where poorly insured get a chance to access quality medical insurance at a relatively low cost.

Before the implementation of ACA, may people were uninsured due to the loopholes in the public insurance system, and inaccessibility to affordable health insurance. The ACA policy has demonstrated the largest gains in coverage in the history of United States’ healthcare. The policy extended medical coverage to low income earners and provided subsidies to the people below 400% of poverty. For instance, after it was signed in 2010, the number of uninsured elderly people reduced from 44 million in 2013 to 27 million in 2016.

Evaluation of a healthcare policy involves a thorough activity of gathering, examining, and the use of evidence based data to come up with answers to some fundamental questions arising from the policy. Policy evaluations may be of various types such as process and outcome evaluations, cost-benefit and cost-effectiveness evaluations, and formative and summative evaluations. In terms of cost-benefit and cost-effectiveness, the ACA demands for all insurance companies to scrap off annual and lifetime limits and cover all costs to reduce the unnecessary catastrophic costs for individuals (French et Al., 2016).

Healthcare providers continue to utilize several strategies to adapt and remain compliant to the requirements of the ACA policy. However, as the policy continues to take root, it yields to unintended consequences. These include continuity of care whereby different organizations are unable to offer consistent care, which often arises from transferring patients from system to system (Dubois, 2015).Another consequence is the outpatient treatment. The policy advocates for 60% outpatient care and 40% in patient, which is a disadvantage since most patients view hospitals as safer places of in case of adverse reactions, a sense of security that they may not have with outpatient facilities.

The main stakeholders in the ACA policy are patients, insurance companies, healthcare providers, and the government (Weiner et Al., 2017). The patients benefit most from ACA because it minimizes the rise in healthcare costs making it accessible even to low income earners.

The policy has certainly met its original intent by a considerable percentage. A lot of reforms are evident in the healthcare sector courtesy of the ACA policy. For instance, the number of uninsured people has relatively reduced from 44 million in 2013 to 27 million in 2016

I would recommend implementation of some of the provisions of the ACA policy like improving communication when dealing with low literacy patients. This assist in improving patient care, and satisfaction thus promoting a good public reputation for the institution.

As a nurse, I would compare the financial input and outcomes in the organizations utilizing the ACA provisions. I would also look at the labor costs to establish if the healthcare facilities incur positive or negative financial impacts. Secondly, I would also have a look at the patient outcomes before and after implementation of ACA policy provisions.

The ACA policy has generally improved the health sector of the United States in terms of accessibility and affordability. Health facilities are encouraged to continue implementing the provisions of the policy to improve patient care ad satisfaction.

The Affordable Care Act is a comprehensive healthcare reform policy that offers subsidies for individuals to lower healthcare insurance costs and whose goal is to ensure more people have health insurance coverage and improve the quality of healthcare for US citizens. The policy implementation was intended to improve US citizens’ health insurance coverage and the corresponding access to quality healthcare services.

The outcome of the policy was an increased number of insured individuals with access to healthcare services. The program was a success because over 20milion US citizens are now insured under the policy, decreasing the socioeconomic healthcare disparity (Griffith, Evans, & Bor, 2017).

The policy does not discriminate, and thus, any individual can access health insurance with lower premiums. Insurance has increased access to healthcare services because individuals are no longer prevented from accessing healthcare services by funds (Courtemanche et al., 2018). It has thus saved many lives.

The policy has also led to healthcare systems reform to reduce healthcare costs and improve services quality. The policy has standardized care and collaborates with other policies such as Medicaid and Medicare to ensure the healthcare organizations maintain high-quality health standards.

In addition, the Act has minimized racial and ethnic healthcare disparities. Statistics show a decrease by 51% of the gap between uninsured whites and African Americans in states that have adopted the Act (Collins, Gunja, & Doty, 2017). The gap between the uninsured rates among the Hispanic and non-Hispanic whites has decreased by 45% in states that adopted the Act (Lipton, Decker &Sommers, 2019). A decrease in the disparities is a success in ensuring a healthy community.

Generally, the outcomes of the policy outcomes are far-reaching and widely recognizable. It has achieved its intended goals and set objectives despite the opposition it received right from the beginning of its implementation.

The success of the program was evaluated using hospital data and data from healthcare insurance firms. Hospitals provided data on the number of patients accessing healthcare services using the act provisions. The health insurance forms provided data on the prevalence of new insurance users and the healthcare spending for the policy’s work period. Relevant population characteristics such as age, race, and gender were vital data sources.

Society data also provided statistics on the insured and uninsured individuals. The data collected was compared to the data from previous years when the Act was not functional. Analysis of the data helped denote areas that changed, and the differences provided the information necessary to determine the policy’s success.

The healthcare program targeted all vulnerable US citizens. According to ACA statistics, the policy program reached about 20 million uninsured people in society, and they secured healthcare insurance coverage with the benefits of subsidized premiums (Levy, Ying, & Bagley, 2020). In addition, more than 38 states have adopted, implemented, and continue to enjoy the benefits of the healthcare policy. The majority of the beneficiaries are the geriatrics, the poor, and the physically disadvantaged. However, the ACA does not discriminate, and any citizen can enjoy the benefits of decreased health insurance premiums.

Program evaluations are based on the structure, process, and outcomes measured against the expected results. The program evaluation utilized outcome key process indicators, and it was evaluated after implementation and adoption into the population health policies. The report encompasses the program’s evaluation in the last ten years.

There were three primary sources of data for the project evaluation. The first society was society and where data about the insured and uninsured individuals were readily available. The second source of data was the healthcare institutions’ electronic health records.

The records provided data on the changes in healthcare access and the number of patients who accessed healthcare services through services provided by the affordable care act. The third crucial source was data from insurance firms. Data necessary was on the rate and number of enrolled clients in the healthcare firms. The data from these firms is essential to determine which part of the insurance coverage among the US citizens uninsured population is remaining.

The health policy implementation had both positive and negative impacts. The first positive impact was a decrease of the uninsured in society to 15% (Lantz & Rousenbaum, 2020). This ACT requires all employees to be insured and also enhances individuals’ access to health insurance at affordable rates, which drove the insurance coverage of millions of American citizens. ACA has also reformed healthcare systems by improving the quality of care they provide and minimizing healthcare costs.

Thus, individuals receive quality care at a standardized price. Another benefit was increased access to healthcare services to disadvantaged in society (those who could not pay the premiums before ACA). Insured patients and their families increased their hospital visitation rates following a reduction in healthcare costs. Funds are a significant issue affecting healthcare access and the healthcare-seeking behavior among US citizens (Griffith, Evans, & Bor, 2017).

Some unintended consequences are that the low prices compensation of the health insurance firms drives out private health institutions, which reduces competition in the healthcare sector. Driving out private institutions can dilute healthcare quality due to a lack of competition in the healthcare sector.

Another unintended consequence was access to a limited number of healthcare services offered by the complying healthcare institutions.

The stakeholders were the state and federal governments, healthcare organizations, insurance firms, employers, political leaders, and the general public. Federal and state governments familiarize the public with the policy and issues directives regarding it. Political leaders were integral in influencing people to comply with the Act.

Employers should provide employee details and ensure their employees are insured. Insurance firms were expected to comply with the laws, standardize insurance rates, and make the services available to all citizens.he general public primary role was to cooperate with health insurance coverage requirements.

The stakeholders contribute differently to the success of the program and also share the benefits in varying degrees. The program’s primary beneficiaries were the general public—however, the state and federal governments’ major beneficiaries of the results and reporting on the policy. The data collected will be integral in future healthcare planning. It shall also help them make decisions on the implementation of the policy by weighing the costs and the benefits policy and determining the way forwards.

ACA successfully ensured that a majority of US citizens are insured and have access to quality healthcare services. During the first year of its implementation, The number of uninsured in society dropped significantly. The number of uninsured citizens has significantly decreased, and the citizens have more access to healthcare services; thus, the policy successfully achieved its original intentions.

I would recommend continuing this policy program. Some citizens continue to suffer due to poor access to healthcare services. Most of them cannot pay for the pre-existing premiums. By subsiding the costs of healthcare services, these people can access healthcare services, improving the health of the communities.

People with fund restrictions often refrain from seeking healthcare and only seek healthcare services at the advanced stages of their disease, which leads to higher healthcare costs and poor patient outcomes. ACA will contribute to healthier communities with decreased disease complications. The Act is also indiscriminate, and anyone can access it hence equality in healthcare services.

As a nurse advocate, participating in collecting data for the evaluation of policies is integral. The nurse can be an active research team member in data collection to ensure accurate, timely, and consistent data collection and prevent collecting unreliable data that leads to poor conclusions and interventions (Abbasinia, Ahmadi, & Kazemnejad, 2020).

As a nurse, I can also advocate for the protection of patient privacy during data collection to ensure the human dignity and ethics of research are duly met during the research studies and data collection. A nurse advocate would thus prevent the exploitation of patients during data collection for evaluating a program (Abbasinia et al., 2020).

Nurses are good sources for the implementation of a program/policy. They are the professionals closest to the patient and thus contain important information about interventions that produce a change in patient status and those that do not. Thus nurses can provide reliable information as research subjects during project evaluation aiding in the success of the project evaluation.

The US affordable care act was an essential program in improving the quality of life for US citizens by ensuring better access to healthcare insurance and healthcare equity (Lantz & Rosenbaum, 2020). The policy achieved its objectives and expected outcomes, and thus it was a success.

However, it also led to some undesirable effects, such as factoring out some healthcare organizations, especially in the private sector, and thus reducing competition which has led to diluted quality healthcare services. However, the policy has been integral to the healthcare of US citizens.

The program aims to offer diabetes self-management support system through a 24/7 call center support. The call center will focus on providing personalized diabetes care support to home-based diabetes patients who want medical help. The program evaluation process is an ongoing one, so that the users and purchasers of the program can routinely receive information to allow them to evaluate the program’s performance and operation especially whether it accords benefits to the diabetic patients.

As such, the support process measures highlighted herein will examine the extent to which the call-center staff perform the tasks to which they are assigned i.e. how well they are offering support to diabetic patients who make calls for enquiries, medication and nutrition guidelines.  

Because it is a call-center program, the success measures will majorly focus on ‘reach’. Therefore, the program will be considered successful based on: at least 70 percent of the enrolled population receive self-management support services, number of education sessions provided per patient by telephone or in person, duration of telephone calls, frequency of telephone calls, and the support content delivered through the telephone calls. The program will also be considered successful if the average number of people who could not be reached are low. 

An evaluation of the diabetes telecare program revealed that 600 out of 650 eligible enrollees received at least two nurse calls. This translated to an average of 11.2 calls made per patient with calls lasting for an average duration of 7 minutes. Furthermore, the number of educational postings mailed reached an average of 6 emails per patient par day. This was alongside an average of 3 calls made per high severity patients per day

The program evaluation was a continuous process that occurred at any given point the success metrics could be ascertained. Furthermore, the overall success of the program was evaluated yearly, by comparing year over year metrics. This was done through a survey questionnaire to evaluate the enrollees’ diabetes self-care efficacy and knowledge.

The evaluation metrics were derived from documentations of the support processes including call-logs, enrollment registers and collaboratively agreed patient goals. Furthermore, the evaluation was conducted during patient education, during the completion of action plans, and during patient referrals.

Patient self-efficacy and knowledge was measured by the patient’s adherence to specific behaviors such as exercise, stress management, and diet, as well as their abilities to overcome the obstacles to these desired behaviors. The self-care support program, through a survey questionnaire, also measured the patient’s ability to monitor blood-glucose levels, ability to reduce the risk of complications and ability to take medicine. 

The evaluation also considered measures of provider guideline and behavior conformance. This entailed the provider’s mediation subscription, referrals, and diagnosis documentation. More importantly, the evaluation program relied on measures of disease control such as self-reported symptom severity, blood glucose level measures and blood glucose control measures to evaluate the program’s ability to facilitate diabetes self-care

Both the program’s users and builders were important stakeholders in the program evaluation. These two parties would always benefit from an ongoing program evaluation by being able to evaluate the program’s performance and operation and most importantly, whether it helps the enrollees to control diabetes. 

Similarly, partners and sponsors of the program would benefit from the program evaluation because it helps identify whether the program achieves the purpose for which they invested in it. Establishing and maintaining a diabetes call-center self-management program is an expensive and time-consuming process. As such, the program financiers and other partners would like to know whether the program is really achieving its purpose.

The original intent of the program was to enable diabetes patients receive support remotely through telephone calls and emails whenever they needed help or had questions. The call center managed to help on a variety of issues including what to do in case of a seizure, how to test blood sugar levels, and when to visit physician for help.

Similarly, based on the program evaluation, it emerged that patients received assistance on insulin dose adjustments, had their prescription issues remotely resolved, and had their insurance authorization issues addressed. The call center, through emails, also answered questions from patients who did not require immediate response.

The other indicator that the program met its original intent was the number of emergency cases that were resolved through the call center. For instance, a few patients received ambulance services when they had very low sugar levels that they could not stabilize through self-care. others also had their glucagon supply immediately replenished by just a phone call. Also, in one scenario, a patient’s insulin dosage error was resolved through a simple phone call.

Diabetes is a complicated medical condition that requires consistent help from both medical and non-medical caregivers. Establishing a self-management call center is a creative way of connecting diabetes patients and their family caregivers to medical professionals who can give immediate guidance and assistance regardless of the patient’s location.

Therefore, a diabetes call-center program is recommendable to all diabetes patients. It provides a peace of mind to family caregivers who might want to confirm their care giving actions and to avoid any mediation errors that may risk the patient’s lives. It also provides an opportunity for clinicians to closely monitor patients’ progress. More importantly, self-management call centers provide a cheap way of managing chronic illnesses because it eliminates unnecessary hospital admission.

One can also be involved in the program evaluation process by joining professional bodies that support transparency and accountability in medical program evaluation processes.