Evolving practice of nursing

How do you feel about accountable care organizations (ACO), medical homes, and nurse-managed health clinics? I'm working on gathering opinions of how nurses feel about the future of nursing in regards to these patient care models. Any thoughts would be greatly appreciated! Here is a little background in case you are not familiar:

Accountable Care Organizations

"Accountable Care Organizations (ACOs) are groups of health care providers that work as a team to coordinate care for a group of patients, with the goals of providing high-quality, patient-centered care and reducing costs" (National Alliance for Quality Care, 2013). ACO's focus on better healthcare via efforts to improve quality and reduce costs across the care continuum. They are designed to encourage the cultural change necessary to achieve the 'Triple Aim' which includes better health for the population, higher quality care, and lower costs of care. Additionally, they strive to provide smooth, continuous, high-quality care instead of the fragmented care in Medicare's current fee-for-service model. Nurses have an integral role to play "acting as care coordinators, communicators, quality improvement managers and providers of advanced levels of care" (National Alliance for Quality Care, 2013).

Medical Homes

Patient-centered medical homes (PCMHs) are primary care practices in which patients receive coordinated, interdisciplinary and interprofessional care. A personal health care provider maintains a continuous patient relationship and manages a team that takes responsibility for the continuum of care. The team often consists of physicians, APRNs and other nurses who all strive to provide integrated patient-centered care. PCMH utilizes strategies such as team approach, collaboration with other providers, care coordination, self-management and health information technology. Care is arranged to meet the patient's short and long-term healthcare goals, throughout every stage of life, settings, and care levels. An APRN may lead PCMH in certain states that authorize nurse-led practices. Nurses are pivotal in coordinating care and especially during transitions in care. Nurses bring the concept of holistic patient care to PCMHs that physicians often lack. This type of care delivery model allows patients to be at the center of their health care coordination with accessible primary care (Case Di Leonardi, 2015).

Nurse-Managed Health Clinics

Nurse-managed health clinics (NMHCs) are accessible service sites that deliver community-based primary and/or wellness care regardless of a patient's ability to pay. They provide primary health care experience with underserved populations. Nurses provide the majority of care; a team of advanced practice nurses, RNs and other health care professionals in collaboration with physicians in jurisdictions where required. The dominant theme for NMHCs is that nurses control their own practice and provide the care. "NMHCs serve as critical access points to keep patients out of the emergency room, saving the healthcare system millions of dollars annually" (American Association of Colleges of Nursing, 2013). NMHCs provide clinical placements for undergraduate and graduate nursing students necessary to increase the enrollment in nursing education programs, helping to eliminate shortages in the supply of nurses (Sutter-Barrett, Sutter-Dalrymple, & Dickman, 2015). This exposure enhances the chance that the students will select to practice in underserved areas. NMHCs give students the unique opportunity to integrate classroom learning with community-based care.

American Association of Colleges of Nursing. (2013, May 16). Nurse‐managed health clinics: Increasing access to primary care and educating the healthcare workforce. Retrieved from American Association of Colleges of Nursing: http://www.aacn.nche.edu/government-affairs/FY13NMHCs.pdf

Case Di Leonardi, B. (2015, January 16). The role of the nurse in transforming healthcare. Retrieved from RN.com: The Future of Nursing Report: The Role of the Nurse in Transforming Healthcare

National Alliance for Quality Care. (2013, May 1). The role of nurses in accountable care organizaitons. Retrieved from National Alliance for Quality Care: http://www.naqc.org/main/resources/nursesrole-accountablecareorg.pdf

Sutter-Barrett, R., Sutter-Dalrymple, C., & Dickman, K. (2015). Bridge care nurse-managed clincis fill the gap in health care. Journal for Nurse Practitioners, 11(2), 262-265. doi:10.1016/j.nurpra.2014.11.012