Unintended Consequences of Health Care Reform The PPACA of 2010 fostered new provisions for health care and the structure of health care delivery. The individual mandate to obtain insurance is one provocative provision. While this provision attempts to increase access to health care, it raises questions on how the existing system could sustain the potentially large influx of newly insured individuals. Another provision calls for new models of health care provider organizations to ensure delivery efficiency and continuity of care. In this week’s media presentation, Dr. Kathleen White discusses the accountable care organization, which comprises a group of providers coordinating care across a variety of institutional settings. Yet becoming an accountable care organization may present a number of challenges. This week’s Discussion builds on Week 1, continuing the examination of those societal and organizational contexts that influence health care reform. The unintended consequences of reform policy on the health care system are also considered. To prepare: Review      this week’s media presentation and the other Learning Resources focusing      on how reform may lead to improved quality, greater access, and reduced      cost of care. Also think about the unintended consequences that may arise      as a result. Consider      the information presented about the individual mandate and accountable      care organizations. What are some questions or concerns you might have      regarding the individual mandate? What are the pros and cons associated      with becoming an accountable care organization? With      posting instructions in mind, select either the individual mandate or      accountable care organizations as the focus of your Discussion this week. By tomorrow Wednesday 03/07/18 BY 12pm, write a minimum of 550 words in APA format with a minimum of THREE scholarly references from the list of required readings below. Include the level one headers as numbered below: Post a cohesive response that addresses the following: 1) In the first line of your posting, identify the topic you have selected—either the individual mandate or accountable care organizations. With regard to this topic, describe one or more positive results that could be achieved, and one or more unintended consequence(s) that organizations or individuals may experience. 2) Briefly evaluate issues on the topic that may be a consideration for the organization you work in and the nursing profession ( I WORK I A HOSPITAL SETTING). Required Readings Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York, NY: McGraw-Hill Medical. Chapter 5, “How Health Care is Organized – I: Primary, Secondary, and Tertiary Care” Chapter 6, “How Health Care is Organized – II: Health Delivery Systems” McClellan, M. (2010). Accountable care organizations in the era of health care reform. American Health & Drug Benefits, 3 ...

1. Unintended Consequences of Health Care Reform
The PPACA of 2010 fostered new provisions for health care and
the structure of health care delivery. The individual mandate to
obtain insurance is one provocative provision. While this
provision attempts to increase access to health care, it raises
questions on how the existing system could sustain the
potentially large influx of newly insured individuals.
Another provision calls for new models of health care provider
organizations to ensure delivery efficiency and continuity of
care. In this week’s media presentation, Dr. Kathleen White
discusses the accountable care organization, which comprises a
group of providers coordinating care across a variety of
institutional settings. Yet becoming an accountable care
organization may present a number of challenges.
This week’s Discussion builds on Week 1, continuing the
examination of those societal and organizational contexts that
influence health care reform. The unintended consequences of
reform policy on the health care system are also considered.
To prepare:
Review this week’s media presentation and the other
Learning Resources focusing on how reform may lead to
improved quality, greater access, and reduced cost of care.
Also think about the unintended consequences that may arise
as a result.

2. Consider the information presented about the individual
mandate and accountable care organizations. What are some
questions or concerns you might have regarding the
individual mandate? What are the pros and cons associated
with becoming an accountable care organization?
With posting instructions in mind, select either the
individual mandate or accountable care organizations as the
focus of your Discussion this week.
By tomorrow Wednesday 03/07/18 BY 12pm, write a minimum
of 550 words in APA format with a minimum of
THREE
scholarly references from the list of required readings below.
Include the level one headers as numbered below:
Post
a cohesive response that addresses the following:
1) In the first line of your posting, identify the topic you have
selected—either the individual mandate or accountable care
organizations. With regard to this topic, describe one or more
positive results that could be achieved, and one or more
unintended consequence(s) that organizations or individuals
may experience.
2) Briefly evaluate issues on the topic that may be a
consideration for the organization you work in and the nursing
profession ( I WORK I A HOSPITAL SETTING).
Required Readings

3. Bodenheimer, T., & Grumbach, K. (2016). Understanding health
policy: A clinical approach (7th ed.). New York, NY: McGraw-
Hill Medical.
Chapter 5, “How Health Care is Organized – I: Primary,
Secondary, and Tertiary Care”
Chapter 6, “How Health Care is Organized – II: Health Delivery
Systems”
McClellan, M. (2010). Accountable care organizations in the era
of health care reform. American Health & Drug Benefits, 3(4),
242–244.
The PPACA of 2010 encourages the formation of accountable
care organizations (ACOs) to improve the quality and efficiency
of health care delivery. An ACO is a group of health care
providers who coordinate care for their Medicare patients and
share the financial incentives of health care improvement gains.
Moore, K. D., & Coddington, D. C. (2010). Accountable care:
The journey begins. Health Care Financial Management, 64(8),
57–63.
This article provides information on the importance of health
care provider organizations taking steps to become accountable
care organizations (ACOs) and provides examples of systems
that have historically functioned in this capacity. The authors

4. also provide steps for developing and transitioning to an ACO
structure.
Institute of Medicine. (2010). The future of nursing: Leading
change, advancing health. Retrieved from
http://www.nationalacademies.org/hmd/Reports/2010/The-
Future-of-Nursing-Leading-Change-Advancing-Health.aspx
This report discusses how nurses can and should play a
fundamental role in meeting the challenges of increased demand
for health care brought about by the implementation of the 2010
Affordable Care Act. In addition, it stresses the need for nurses
to be partners with other health professionals and assume
leadership roles in redesigning health care in the United States.
Institute of Medicine. (2010). Report brief: The future of
nursing: Leading change, advancing health
. Retrieved from
http://www.nationalacademies.org/hmd/~/media/Files/Report%2
0Files/2010/The-Future-of-
Nursing/Future%20of%20Nursing%202010%20Recommendation
s.pdf
This report brief highlights the four key recommendations from
the Robert Wood Johnson and Institute of Medicine the Future
of Nursing: Leading Change, Advancing Health report. The
recommendations focus on nursing practice, education and
training, partnerships with other healthcare professionals, and
workforce planning and policymaking.

5. HealthCare.gov. (n.d.). Understanding the Affordable Care Act.
Retrieved from http://www.hhs.gov/healthcare/rights/index.html
This website introduces the Affordable Care Act and presents
the timeline for implementation of the various provisions of the
Act.
HealthCare.gov. (n.d.). Understanding the Affordable Care Act:
About the law. Retrieved from
http://www.hhs.gov/healthcare/rights/law/index.html
Read the full Affordable Care Act law at this website. An
overview of the law is also provided along with an outline of
how the Affordable Care Act helps reduce health insurance
costs.
Required Media
Laureate Education, Inc. (Executive Producer). (2011).
Healthcare policy and advocacy: Reforming health care
delivery: Accountable care organizations. Baltimore: Author
.
Note: The approximate length of this media piece is 7 minutes.
In this media presentation, Dr. Kathleen White explains the
structure of accountable care organizations (ACO) and discusses
the benefits and challenges of becoming an ACO.

6. Optional Resources
APRN Joint Dialogue Group Report. (2008). Consensus model
for APRN regulation: Licensure, accreditation, certification &
education.
Retrieved from http://www.aacn.nche.edu/education-
resources/APRNReport.pdf
Fisher, E. S., & Shortell, S. M. (2010). Accountable care
organizations: Accountable for what, to whom, and how. JAMA:
Journal of the American Medical Association, 304(15), 1715–
1716.
Fisher, E. S., Staiger, D. O., Bynum, J. W., & Gottlieb, D. J.
(2007). Creating accountable care organizations: The extended
hospital medical staff. JHealth Affairs, 26, w44-w57.
doi:10.1377/hlthaff.26.1.w44–57
McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., &
Fisher, E. S. (2010). A national strategy to put accountable care
into practice. Health Affairs, 29(5), 982–990.
Kaiser Health News. (2011). Accountable care organization
proposed regulations: Resources. Kaiser Family Foundation.
Retrieved from
http://www.kaiserhealthnews.org/Stories/2011/March/31/ACO-
Documents-In-The-News.aspx