Ethical and policy factors in care coordination

Tyler Roberts

NURS-FPX4050: Coordinating Patient-Centered Care

January, 2024

Good evening, and thank you for allowing me to be here. My name is Tyler Roberts and I am a registered nurse compliance auditor with Superior Healthplan. This evening we are going to be talking about ”Ethical and Policy Factors in Care Coordination”. Prior to becoming a compliance auditor, I worked as a home health nurse, a hospice nurse and spent 4 years as a service coordinator with Superior Healthplan. To say I have seen in all related to care coordination would be understatement. So, let get right into it. I don’t want to take up too much of your time.

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agenda

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Care coordination

Government policies

Policy Provisions

Ethical Questioning

Healthy People 2030

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I’ll will begin by explaining what care coordination is and why it’s so important to the nursing profession. Next, I’ll talk about how mental health patients are directly impacted by government policy. We will talk about the policy’s provisions and how the mentally ill are specifically affected by them. We will cover ethical considerations surrounding patient care coordination. We will discuss the laws that govern the treatment of these patients, namely the Mental Health Parity and Addiction Equity Act, the Health Insurance Portability and Accountability Act, and the Affordable Care Act. We will wrap up by talking about Healthy People 2030 and how it pertains to the mental health community

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What is care coordination

Care coordination is crucial for providing excellent healthcare in the nursing profession. Incorporating diverse facets of patient care, considering their individual requirements, and guaranteeing smooth transitions between different healthcare environments. Because they are frequently the first point of contact for patients and provide information, support, and direction across the treatment continuum, nurses are essential to this process. Nurses play a critical role in improving patient outcomes and the overall efficiency of the healthcare system by skillfully coordinating treatment (ANA, n.d.)

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Government policies in care coordination

HIPPA

Confidentiality and privacy

Patient protections

Sensitive nature of information

The US has requirements for securing sensitive patient data, including mental health data, under the Health Insurance Portability and Accountability Act (HIPAA). HIPAA regulations protect the privacy and security of mental health patients’ health information in the same manner that they do for any other medical condition (Guerrini et al., 2019). HIPAA offers private healthcare while safeguarding the records of mentally ill individuals. This is particularly crucial because the mentally ill population places a high value on privacy and delicate subjects. Furthermore, before any information is shared within a multidisciplinary healthcare team, healthcare providers must obtain written consent.

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Government policies in care coordination

ACA

Increase quality and affordability.

Provide care to specific groups

The Affordable Care Act may have a significant impact on patient-centered care, influencing both the general experiences and results of patients. The goals of the 2010 Affordable Care Act (ACA) were to expand Medicaid, improve the quality and cost of health insurance, and advance a number of changes to the way that healthcare is delivered. Medicare and Medicaid are federal programs that offer health insurance to certain populations, such as low-income individuals and seniors. This makes it easier for our mentally ill population to pay for and obtain care (ACA, n.d.).

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Government policies in care coordination

Equity Act (MHPAE Mental Health Parity and Addiction)

Make mental health accessible

Makes mental health affordable

The Mental Health Parity and Education Act (MHPAEA), which was passed in 2008, forbids health insurance issuers and group health plans that offer benefits for mental health or substance use disorders to place less favorable benefit limitations on those benefits than on medical and surgical benefits. This covers restrictions on items like treatment visit caps, deductibles, and co-pays (Presskreischer et. al., 2022).

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ANA health provision

Provide compassion and respect

Be committed to patient and family

Advocates for patients

Promotes decision based on patient obligations

Same duties to self and others

There are health provisions offered by the American Nurse Association. Patients with mental illnesses are impacted by these provisions at all stages of care. Utilizing the policies and procedures to enable patients to obtain mental healthcare and be able to pay for it is one of the national level provisions. In addition, patients receive care from nurses who uphold the nine principles established by the American Nurse Association and who have an ethical mindset. Medicaid is accessible at the state level, yet certain states are making it difficult to obtain. Texas and the federal government contended that the Affordable Care Act was rendered null and unconstitutional in whole or in part by the 2017 Tax Cuts and Jobs Act, which decreased the individual mandate—also known as the shared responsibility payment—to $0 for people who chose not to acquire health insurance. Twenty-one states, led by California, joined the US House of Representatives in upholding the Act. This ruling may radically disrupt the current access to protections and care for millions of people (Kaplan, 2021).

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ANA health provision

Maintains an ethical environment

Enhances the profession through research

Collaborates with other healthcare professionals

Maintain values

Patients receiving care from their providers is included in local provisions. The provider must abide by HIPPA for in order for their data to be shared. A reduction in hospital readmissions, better patient outcomes, and higher-quality healthcare overall can result from effective care coordination. It’s critical to take into account the distinct features of the community, the policy provisions, and the larger socioeconomic backdrop when evaluating the precise consequences of healthcare policy provisions on a local community. Furthermore, it is imperative to have continuous assessment and feedback systems in place to guarantee that regulations adapt to the changing requirements of the community. These rules offer a thorough framework for moral nursing practice, directing nurses in their dealings with patients, coworkers, and the larger medical community.

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ethics

Beneficence

Nonmaleficence

Autonomy

Justice

We must recognize the significance of the ethical precepts of beneficence, non-maleficence, autonomy, and justice in our role as nurses. To be benevolent, one must behave in their patients’ best interests, which include giving them care that will likely enhance their health and honoring their decisions regarding the care they receive (Varkey, B. 2021). The concept of non-maleficence entails not causing harm to patients, and when this idea clashes with beneficence, requiring cautious assessment to weigh the advantages and disadvantages (Varkey, B. 2021). An essential component of patient-centered care is autonomy, which upholds the patient’s right to make decisions regarding their treatment. Justice also entails treating patients equally and fairly, making sure that everyone receives the right care regardless of their background. Providing nursing care that is both ethical and effective requires striking a balance between these ideas (Varkey, B. 2021).

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Healthy people 2030

Healthy People 2030 goals include patients with disorders and addictions to receive care

Increased depression screening for teens and adults

Healthy People 2030 is a set of objectives set forth by the U.S. government to guide national health promotion and disease prevention efforts over a decade. With an emphasis on the prevention, screening, assessment, and treatment of mental diseases and behavioral issues, Healthy People 2030 has established goals to enhance mental health. With a goal of enhancing the health and quality of life for those impacted, the project acknowledges that about 50% of Americans will receive a mental health diagnosis at some point in their lives. Additionally, the goals address the need for better treatment access and the disproportionate impact that mental diseases have on communities (Health People 2030, n.d.). ​

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To sum up, care coordination is an essential component of nursing that is necessary to maximize patient outcomes in all types of healthcare settings. This presentation emphasized the significance of ethical standards in patient care coordination while highlighting the effects of government policies on mental health treatment. We examined important laws governing mental health treatment, such as HIPAA, and ACA, emphasizing the role that Healthy People 2030 will play in improving mental health services. Care coordination has the potential to realize the goals of a more efficient healthcare system by working together and according to ethical principles.

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references

Please see speaker notes

Affordable Care Act (n.d.)
https://www.healthcare.gov/glossary/affordable-care-act/

American Nurses Association. (n.d.). ANA Enterprise.
https://www.nursingworld.org

Guerrini, C. J., Botkin, J. R., & McGuire, A. L. (2019). Clarify the HIPAA right of access to individuals’ research data. Nature Biotechnology, 37(8), 850–852.
https://doi.org/10.1038/s41587-019-0190-3

Kaplan, L. (2021). 2020 Supreme Court challenge to the Affordable Care Act and potential implications. The Nurse Practitioner, 46(3), 10-11.
https://doi.org/10.1097/01.NPR.0000733688.08184.8e

Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2030. U.S. Department of Health and Human Services. Retrieved [Date you accessed the site], from
https://health.gov/healthypeople

Presskreischer, R., Barry, C. L., Lawrence, A. K., McCourt, A., Mojtabai, R., & McGinty, E. E. (2022). Factors affecting state-level enforcement of the federal mental health parity and addiction equity act: A cross-case analysis of four states. Journal of Health Politics, Policy and Law, 48(1), 1–34.
https://doi.org/10.1215/03616878-10171062

Varkey, B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical

Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

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