In the cover story of the October, 2016 edition of "The Journal of Healthcare Financial Management Association" Tim Barry and Clive Fields MD addressed the health insurance industry's move to value-based care and billing reimbursement. The journal article begins with the following statement "The tipping point. The point of no return. A critical juncture." This refers to the healthcare industry's current standard of care and reimbursement based on a value-care, pay-for-performance model. The article continues: "This means healthcare providers need to revamp their current patient care model to include patient health education for disease prevention as a cornerstone of patient-centered care. By 2018, 50% of all Medicare payments will be tied to value-based alternative payment models, recognizing not only the volume of care delivered, but also the clinical outcomes such care generates. Commercial carriers have followed suit."
The impact on nurses, is especially significant. For the first time, the U.S. insurance industry has endorsed a holistic approach to healthcare and disease prevention as the preferred model of medical care delivery. This is forcing healthcare providers to move beyond the current acute care, symptom-based approach to including disease prevention and patient education for self-care. Now that the healthcare industry is embracing how to deliver patient-driven health care for reducing costs, the demand and utilization of modalities which support this model are rapidly growing.
Patient health education is at the heart of the patient-centered care model and no other health professional is better poised to fill this role than the nurse. This is important because (1) Patient health education is contained within the nursing scope of practice, (2) Physicians have limited time with their patients, and (3) Nurses spend more time with patients often being the first or last to have contact with patients during a medical office visit.
The HFMA journal article goes on to clarify this evolving model of healthcare: "Delivering care within a value-based model involves much more than changing contracts and compensation. It requires a pro-active clinical focus in which patients at high risk for disease progression are identified for early intervention and patient education services expanded...with three key objectives: making patients healthier, providing high-quality care, and reducing the cost of care."
Since 1980, the National Institute of Whole Health has been conducting hospital-based research on a holistic patient-health education model which includes Behavioral Engagement with Pure Presence, a health behavior change model. The most recent studies on the NIWH model include a Central Michigan University (CMU) group of patients and four physician practices and a Blue Cross Blue Shield-funded Michigan State University (MSU) physician practice study, utilizing the Consultation and Relational Empathy (CARE) Measure Survey with pre- and post-intervention. The study demonstrated a 27.5 - 35% improvement in both patient satisfaction and physician satisfaction using the NIWH Whole Health Education Behavioral Engagement model. The study was conducted by two medical researchers from Central Michigan University and Michigan State University respectively.
Table 1. Participant Pre-Intervention and Post-Intervention Survey
Excellent Response Scores
Excellent Responses (%)
For nurses who want to work with patients as health and wellness educators and advocates, now is the perfect time to get the necessary training to enter this exciting specialty which provides licensed nurses the qualification for professional liability, an NPI number and expertly prepared billing manual to have patient health education services billed and paid for.