Nursing Care Management: Influence on Bundled Payments.

Area of Science:

• Healthcare Management
• Nursing Leadership
• Health Services Research

Background:

• Fragmented and uncoordinated care is a major contributor to U.S. healthcare costs, with a small percentage of patients accounting for a disproportionately large share of expenses.
• Care management interventions significantly influence healthcare spending and patient outcomes.
• The Affordable Care Act emphasizes cost reduction and improved patient experience, necessitating efficient care coordination.

Observation:

• A literature search identified best practices for care coordination across acute, transitional, and post-acute phases for elective surgical procedures.
• A model for nurse-led care coordination was developed and demonstrated through a case study.
• Care coordination aims to enhance patient and caregiver engagement and improve communication across care settings.

Findings:

• Nurse-led care coordination in presurgical, inpatient, and post-acute settings requires systemic changes and administrative backing.
• This model provides nursing care management leaders with a framework for coordinating elective surgical patients' care across various settings.
• Effective care coordination is crucial for reducing redundancy and costs while enhancing the patient experience.

Implications:

• Nursing leaders must adapt care management processes, particularly care coordination, in response to evolving bundled payment structures.
• Implementing a comprehensive care coordination model can lead to significant cost savings and improved patient outcomes.
• This approach supports the goals of the Affordable Care Act by streamlining care and reducing waste.