discussion post and two replies- masters level

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Instructions—- Initial thread must be at least 500 words and demonstrate course-related knowledge. Each reply must be at least 250 words. Each thread and each reply must be supported with at least 2 citations in current APA format .

****initial post

  1. Describe the principles of practice redesign.
  2. Compare and contrast preventative care and chronic care models.
  3. Discuss how payment models will adapt in the face of a shift in the population health paradigm.

respond to classmate #1 in at least 250 words

Describe the principles of practice redesign.

According to Nash, Fabius, Skoufalos, Clarke, and Horowitz (2016) practice redesign is a process to improve patient care while delivering effective healthcare. Within practice redesign there are components that help to make up a successful model to deliver exceptional care (Nash, Fabius, Skoufalos, Clarke, & Horowitz, 2016). The first component is access, which addresses if a patient is able to receive care within an appropriate time frame (Nash et al., 2016). Successful access allows a patient to contact their health care provider during an acute illness, to manage a chronic disease, or just being able to call a provider about a question they may have (Nash et al., 2016). The second component is clinical decision support, this surrounds the use of electronic health records to improve provider decision making (Nash et al., 2016). The third component is risk stratification, this is a technique that prioritizes who does or could possibly have a greater need for care over another person with a similar diagnosis (Nash et al., 2016). The fourth component is patient engagement, this is how ready a person is to take responsibility of their own health (Nash et al., 2016). The next component is building and tracking relationships, this allows providers to see the whole picture of their patients’ health care journey (Nash et al., 2016). Building and tracking allows health care providers the opportunity to provide a comprehensive health care experience for the patient (Nash et al., 2016). The last component is measuring and moving over time, this is where improvement work and evidence-based practice comes into play (Nash et al., 2016). A goal of better health care has the ability to be met when using a system-thinking approach (Nash et al., 2016). According to a study from Coker, Moreno, Shekelle, Schuster, and Chung (2014) it was important for parents to be able to spend a longer amount of time with providers during well visits. No parent wants to spend an excessive amount of time in an exam room, but they do want all of their needs meet (Coker, Moreno, Shekelle, Schuster, & Chung, 2014). Longer well-care child visits were a result of a practice redesign for this particular practice; providers listened to the needs of their patients and improved their current practice (Coker, Moreno, Shekelle, Schuster, & Chung, 2014).

Compare and contrast preventive care and chronic care models.

Chronic care model focuses on the needs of patients that suffer from chronic health conditions (Nash et al., 2016). The major focus is on patient provider relationships and education on how to effectively manage the chronic health condition (Nash et al., 2016). This model promotes better health for people with chronic disease conditions (Nash et al., 2016).

Preventive care focuses on preventing illness or health conditions from occurring. Education and care is concentrated on detection and prevention (Nash et al., 2016). The goal is for patients to remain in an optimal health condition, or stay well (Nash et al., 2016).

The idea behind the chronic care model is different than that of the preventive care model; in chronic care the patient has already been diagnosed with a health condition and it is important for them to figure out how best to manage the condition and promote optimal health at the same time (Nash et al., 2016). Preventive care wants to prevent the health conditions that utilize the chronic care model from ever occurring (Nash et al., 2016). Unfortunately within the United States we have many people who are living and or affected with a chronic health condition. In an article from Davy, Bleasel, Liu, Tchan, Ponniah, and Brown (2015) it was noted that “of the 57 million deaths in 2008, 36 million (63%) were a direct result of chronic disease”. It was concluded from their study that there was a positive correlation between the use of the chronic care model and improvements in health outcomes for people with chronic health conditions (Davy et al., 2015).

Discuss how payment models will adapt in the face of a shift in the population health paradigm.

Health care is no different than most things, the expectation is quality care at the lowest price possible. As health care priorities change so do payments for services, more people want more service for their dollar. Nash et al. (2016) discusses two different payment methods that are emerging in health care. The first is ambulatory episodic-based payment, this type of payment bundles the cost of many services into one (Nash et al., 2016). Ambulatory episodic-care has the potential to hold providers accountable with the care they are delivering (Press, Rajkumar, & Conway, 2016). According to an article episodic-care payment can be a win-win for patients; they will receive efficient and high-quality care at a lower cost (Coker et al., 2014). The other payment model is accountable care organizations, this program partners with Medicare (Nash et al., 2016). ACOs require the health care teams to work as a whole to provide quality care to their patient (Nash et al., 2016). ACOs have the ability to be reimbursed, by Medicare, when quality preventive and chronic care is met (Nash et al., 2016). The expectation is that ACOs will be able to reduce unnecessary visits and improve quality patient outcomes; this was found to be true from an article by Kaufman, Spivack, Stearns, Song, and O’Brien (2017). Although there was some evidence that showed no improvement, it was determined that farther studies need to be conducted (Kaufman, Spivack, Stearns, Song, & O’Brien, 2017). It appears that ACOs has the potential to have an impact on the population health paradigm (Kaufman et al., 2017).

Christian Worldview

Isaiah 43:18-18 tells us “remember not the former things, nor consider the things of old. Behold, I am doing a new thing; now it springs forth, do you not perceive it? I will make a way in the wilderness and rivers in the dessert”. Health care is not looking back, it is moving forward and progressing to make quality outcomes for patients. Just as everyone around needs to not dwell in the past, but figure how to move forward. People will see that change is not always easy, but it can create a better culture.


Coker, T. R., Moreno, C., Shekelle, P. G., Schuster, M. A., & Chung, P. J. (2014, July). Well-child care clinical practice redesign for serving low-income children. Pediatrics, 134(1), 229-239. Retrieved from http://pediatrics.aappublications.org/content/134/…

Davy, C., Bleasel, J., Liu, H., Tchan, M., Ponniah, S., & Brown, A. (2015, May 10). Effectiveness of chronic care models: Opportunities for improving healthcare practice and health outcomes: A systematic review. BMC Health Services Research, 15(194). https://doi.org/doi.org/10.1186/s12913-015-0854-8

Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2017, December 12). Impact of accountable care organizations on utilization, care, and outcomes: A systematic review. Medical Care Research and Review, 1-36. https://doi.org/doi-org.ezproxy.liberty.edu/10.117…

Nash, D. B., Fabius, R. J., Skoufalos, A., Clarke, J. L., & Horowitz, M. R. (2016). Population health creating a culture of wellness (2nd ed.). Burlington, MA: Jones and Bartlett Learning.

Press, M. J., Rajkumar, R., & Conway, P. H. (2016, January 12). Medicare’s new bundled payments: Design, strategy, and evolution. Journal of American Medical Association, 315(2), 131-132. https://doi.org/doi:10.1001/jama.2015.18161

classmate #2-

Principles of practice redesign.

Practice redesign is necessary to meet the goal of the Triple Aim: better care for lower costs and better patient experiences. The principles of practice redesign are access, clinical decision support, risk stratification, patient engagement, building, and tracking relationships and measuring and improving over time. “Access to the right care at the right time is the most foundational concept for practice redesign” (Nash, B., Fabius, R., Skoufalos, A., Clarke, J., Horowitz, M., 2016, pg. 279) and three types of access: acute access, maintenance access and personal access. These three types of access describe the how and why patients generally seek out medical care; through urgent care or ER, routine or primary care, and telephone consults or advice nurse lines.

Clinical decision support involves the adoption of the electronic health record nationwide. This will allow providers to make pertinent medical decisions that would improve care and control costs. Risk stratification is determining what patients have a greater need for care throughout their healthcare journey. Patient engagement is the willingness and understanding of the patient to get involved in their health. This requires a strong patient-provider relationship to be successful. God requires us to be good stewards of all that he gives us. This includes our bodies because it is the temple of God. We are responsible for how we care for our bodies. Building and tracking relationships is a real concern when attempting to care for a patient across different healthcare systems. Soldiers moving from one duty station to another have experienced issues with a provider accessing their own or their family member’s electronic medical record if a soldier was from a different region previously. Retired soldiers often face difficulty with the lack of communication between providers at the Department of Veteran Affairs (VA) and military treatment facilities causing repeat prescriptions, studies, labs, and exams. Measuring and improving over time is the best way to optimize evidence-based performance and improve patient outcomes.

Preventative care versus chronic care models

Preventative care and chronic care models are both needed to address the patient’s need at their wellness or management level. They both require a willing, compliant patient engagement in order to succeed. Preventative care seeks to help people live longer, healthier lives by intervening when a trigger has been identified. Chronic care “focuses on a population health strategy aimed at maintaining or improving health for a chronic condition” (Nash et al., 2016), whereas preventative care is proactive in surveying the population to identify possible health concerns before they become chronic issues. Preventative care is less expensive than chronic care.

Payment model shift

As healthcare moves toward population health paradigm, payment models will have to shift toward a value-driven payment model rather than a volume-based, fee-for-service model. Population health requires evidence-based, quality, and cost-effective care (Triple-Aim). Ambulatory episodic and accountable care organizations have established elements of population health management such as an interdisciplinary approach, good communication between patient and provider, preventative services and unique payment bundling options that can reduce cost significantly.


Baan, C., Drewes, H., Heijink, R., Steenkamer, B., Struijs, J., (2017). Defining population health management: A scoping review of Literature. Population Health Management. 20 (1). pgs. 74-84.

doi: 10.1089/pop.2015.0149

Nash, D., Fabius, R., Skoufalos, A., Clarke, J., & Horowitz, M., (2016). Population health: Creating a culture of wellness- with Access. (2nd ed.) Burlington, MA: Jones & Bartlett Learning.

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