The document discusses several approaches to improving healthcare delivery and reducing costs through more coordinated, patient-centered care. It describes how medical homes provide comprehensive primary care through interdisciplinary teams to manage chronic conditions and reduce emergency visits. The document also discusses how standardized clinical pathways and communication between specialists can improve patient outcomes. Finally, it explains how patient-centered care that involves shared decision-making with providers can increase patient engagement, knowledge, and adherence to treatment plans.

1. Comment 1Many provisions are being done to the affordable care act
most of which are trying to demonstrate reducing the cost, which is not
proving to be enough. Another approach that is becoming prima
QUESTIONOCT 04, 2018Comment 1Many provisions are being done to the affordable care
act most of which are trying to demonstrate reducing the cost, which is not proving to be
enough. Another approach that is becoming primaComment 1Many provisions are being
done to the affordable care act most of which are trying to demonstrate reducing the cost,
which is not proving to be enough. Another approach that is becoming primary is focusing
on the overall quality, and coordination of the patients care. By focusing on the overall
quality of care, this includes everyone who is involved in the care of the patient.
Medical/Health homes are homes that provide patients with a central primary care practice
or provider. The homes allow providers to focus on preventative care and chronic care
management. This program will also help reduce dependence on specialist and emergency
care. The Patient Protection and Affordable Care Act authorizes who how contracts directly
with the state to establish community-based interdisciplinary and interprofessional teams
in supporting the patients’ primary care. The interdisciplinary and interprofessional teams
may then decided if medical specialist, nurses, pharmacists, nutritionists, dieticians, social
work, behavioral health and mental health providers are necessary for care.I believe that
this can be beneficial to patients and healthcare in the fact that it reduces that amount of
emergent and acute care issues. If a patient is coming into one provider for preventative
care check with hope to detect symptoms early and treat with a primary doctor avoiding the
need to see a specialist reducing the cost to the patient and the healthcare provider. The
Patient Protection and Affordable Care Act determines who is eligible for an
interdisciplinary team so not everyone will be at the mercy of the team also reducing the
cost. The quality of care should remain at the same level the Medical/Health Homes just
won’t be utilizing as many providers if the patient does not require them. Not to mention
patient will have access to Medical/Health 24/7 interviewees reported that 24/7 access to a
care provider is also an essential element of the medical home equation even if only through
telephonic or electronic means, helps reduce reliance on emergency rooms and resultant
preventable hospitalizations (ANA, 2010).According to Nester (2016), succeeding in the
current care environment can only be possible if inter-professional teams will come
together and work as a unit. As such, the inter-disciplinary or interprofessional Practice
Model as emphasized in the Institute of Medicine report can be termed as

2. innovative.Comment 2One innovative health care delivery model which incorporates an
interdisciplinary care delivery team is a systematic approach to the flow of care. First a
patient presents with certain symptoms or complaints related to his or her health. There
might be positive screenings from tests they have already received related to their
symptoms. Following a diagnostic workup, a tentative diagnosis regarding their concern
can be made. Following this diagnosis, it might be necessary to send the patient to a
medical/surgical bed or ICU. They might require medical or surgical intensive care, or
simply be sent home. Each stream follows a different set of procedures and personnel
responsible for determining the correct path for each patient. This is advantageous to
patient outcomes because it ensures that they receive the optimal treatment for their
ailments. Standardizing the process and keeping it organizational will greatly benefit
patient outcomes and ensure that there is no delay in care. “Each of these steps potentially
involves a myriad of options, each of which is directed by a different specialist. This can
sometimes result in care that is not clinically appropriate” (Osarogiagbon et. al, 2016, p.
984). All members of the interdisciplinary team need to communicate with one another,
rather than just making care decisions based on individual assertions and collecting data
together. This can cause disjunction in critical information, delay treatment, and have
adverse effects in patient outcomes. Comment 3As science has advanced to allow for more
treatment options and cures for patients, providers have found themselves providing a
more distanced type of care. With the distance of care, patient and families have been left
less educated of their health status and reason for treatments leaving the patients to not feel
as secure or in control of their health (Barry & Edgman-Levitan, 2012). In the Institute of
Medicine report called Crossing the Quality Chasm, the IOM attempted to introduce an
approach to assist in the reform of health care by explaining patient-centered care (Barry &
Edgman-Levitan, 2012). The IOM described patient-centered care as care that is respectful
of and responsive to individual patient preferences, needs and values (Barry & Edgman-
Levitan, 2012). This care model calls clinicians to work as partners and coaches in a
patient’s health care journey rather than as a dictator (Barry & Edgman-Levitan, 2012).
Such a care model asks patients and their families to become allies with the health care
team in designing, implementing and evaluating medical options (Barry & Edgman-Levitan,
2012). Treatment and interventions must be presented to the patient as an option as they
always have a choice, especially when options are deemed to have consequences.As
clinicians relinquish their authority role of decision making and move towards a shared-
decision making approach they are more equipped to view the experience through the
patient’s eyes (Barry & Edgman-Levitan, 2012). This will allow providers to be more
responsive to patient’s needs and treat their patients better. Also, clinicians are able to
embrace the ethical principles of autonomy and beneficence with this type of model
(Reuben & Tinetti, 2012). Patient centered and shared decision care benefits patients by
increasing their knowledge of their disease, allow decisions to be aligned with their values,
reduced internal conflict and more inclined for positive outcomes when patients are
actively engaged (Barry & Edgman-Levitan, 2012). One of the largest barriers to goal-
oriented and shared-decision modeled patient care is that medicine is deeply rooted in a

3. disease-outcome–based rather than asking what patients want; the culture values managing
each disease as well as possible according to guidelines (Reuben & Tinetti, 2012).