The Power of Alignment: Pioneering New Collaborations During Transformational Change.

Both health care reform and the Triple Aim call for enhanced patient experience, improved health outcomes, and reduced costs. To achieve these goals, we must collaborate across health care and community organizations, across fields of expertise, and across the continuum of care. As collaboration is one of nursing's core competencies, nurses are ideally positioned to lead the drive toward the Triple Aim. This article outlines 3 key areas of collaboration and describes successful interventions that the Visiting Nurse Service of New York has developed in these areas: as community organizers, partnering with health, grassroots, and government agencies; as transitional integrators, partnering with acute-care facilities to reduce rehospitalizations; and across populations, partnering in new ways to help patients manage chronic and complex health issues in the context of their families and communities.

Excellence and evidence in staffing: a data-driven model for excellence in staffing (2nd edition).

The Patient Protection and Affordable Care Act (PPACA, 2010) and the Institute of Medicine's (IOM, 2011) Future of Nursing report have prompted changes in the U.S. health care system. This has also stimulated a new direction of thinking for the profession of nursing. New payment and priority structures, where value is placed ahead of volume in care, will start to define our health system in new and unknown ways for years. One thing we all know for sure: we cannot afford the same inefficient models and systems of care of yesterday any longer. The Data-Driven Model for Excellence in Staffing was created as the organizing framework to lead the development of best practices for nurse staffing across the continuum through research and innovation. Regardless of the setting, nurses must integrate multiple concepts with the value of professional nursing to create new care and staffing models. Traditional models demonstrate that nurses are a commodity. If the profession is to make any significant changes in nurse staffing, it is through the articulation of the value of our professional practice within the overall health care environment. This position paper is organized around the concepts from the Data-Driven Model for Excellence in Staffing. The main concepts are: Core Concept 1: Users and Patients of Health Care, Core Concept 2: Providers of Health Care, Core Concept 3: Environment of Care, Core Concept 4: Delivery of Care, Core Concept 5: Quality, Safety, and Outcomes of Care. This position paper provides a comprehensive view of those concepts and components, why those concepts and components are important in this new era of nurse staffing, and a 3-year challenge that will push the nursing profession forward in all settings across the care continuum. There are decades of research supporting various changes to nurse staffing. Yet little has been done to move that research into practice and operations. While the primary goal of this position paper is to generate research and innovative thinking about nurse staffing across all health care settings, a second goal is to stimulate additional publications. This includes a goal of at least 20 articles in Nursing Economic$ on best practices in staffing and care models from across the continuum over the next 3 years.

Early intervention services for persons with HIV/AIDS and hepatitis C: a community health center perspective.

Visiting Nurse Association of Central Jersey has been involved in care for patients with HIV/AIDS since 1991. In that year, the organization received funding as the lead agency for a Title II grant to establish an HIV/AIDS Consortium consisting of over 20 organizations, including other home care agencies, hospitals, county boards of social service, and other community providers. The Consortium collaborated to establish a thorough network of services: housing, transportation, medical treatment, medication access, support, resource identification, and education for both the infected and affected. As the linkages became stronger, the quantity and quality of services increased so that patients were receiving state-of-the-art health care while wrapped in a blanket of comprehensive supportive services.

Medicare home health payment reform may jeopardize access for clinically complex and socially vulnerable patients.

The Affordable Care Act directed Medicare to update its home health prospective payment system to reflect more recent data on costs and use of services-an exercise known as rebasing. As a result, the Centers for Medicare and Medicaid Services will reduce home health payments 3.5 percent per year in the period 2014-17. To determine the impact that these reductions could have on beneficiaries using home health care, we examined the Medicare reimbursement margins and the use of services in a national sample of 96,621 episodes of care provided by twenty-six not-for-profit home health agencies in 2011. We found that patients with clinically complex conditions and social vulnerability factors, such as living alone, had substantially higher service delivery costs than other home health patients. Thus, the socially vulnerable patients with complex conditions represent less profit-lower-to-negative Medicare margins-for home health agencies. This financial disincentive could reduce such patients' access to care as Medicare payments decline. Policy makers should consider the unique characteristics of these patients and ensure their continued access to Medicare's home health services when planning rebasing and future adjustments to the prospective payment system.