| Course | NR 717 Concepts in Population Health Outcomes & Health Policy |
|---|---|
| Week | 5 |
| Paper type | Health care financing analysis |
| Length | About 1,100 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NR 717 Week 5
Who Pays for the Postpartum Blood Pressure Check? A Financing Analysis of Payment Mechanisms and the Behavior They Produce at Riverbend Health
Student Name
College of Nursing, Chamberlain University
NR 717: Concepts in Population Health Outcomes & Health Policy
Instructor Name
Month Day, Year
Who Pays for the Postpartum Blood Pressure Check? A Financing Analysis of Payment Mechanisms and the Behavior They Produce at Riverbend Health
Payer Mix Before Anything Else
Of 4,180 delivery hospitalizations at Riverbend Health last year, Medicaid financed 2,341, or 56.0%; commercial insurance 1,588, or 38.0%; and 251, or 6.0%, were self-pay or other. Medicaid in this state is delivered almost entirely through managed care: three plans enroll the system's Medicaid patients, and the two largest account for 81% of its Medicaid deliveries. Any analysis of who pays for postpartum care at Riverbend is therefore mostly an analysis of how the state pays those plans and how the plans pay the system and its obstetric practices.
The Mechanisms, Described Plainly
Three payment mechanisms sit on top of one another.
The state pays each plan a fixed monthly amount per enrolled member, capitation, and in this state also a one-time maternity case payment for each delivery. Capitation rewards the plan for keeping total spending below what it receives, so the plan has a reason to prevent costly events such as readmissions.
The plans pay the hospitals per admission, using diagnosis-related groups, and per visit for emergency care. A delivery admission produces one payment; a readmission for postpartum preeclampsia produces another. Per-admission payment rewards shorter stays within an admission, but it pays for each new admission in full.
The plans pay the obstetric practices a global obstetric fee that bundles prenatal visits, the delivery and routine postpartum care through six weeks. A bundled fee rewards doing the bundled work efficiently, but anything added inside the bundle, such as an extra blood pressure check at day seven, earns nothing further. The plans' claim edits routinely deny a separate visit inside the global period when it is billed with a pregnancy-related diagnosis, which is how a postpartum blood pressure check is usually coded.
Who Absorbs the Difference
When a patient with postpartum hypertension is readmitted, the plan pays about $9,450. The hospital's cost for that admission, from its cost accounting system, averages $8,100, so the hospital is paid about $1,350 more than the admission costs it. The hospital's charge for the same stay is about $38,600, a list price almost nobody pays and which tells the reader nothing about either cost or payment (Penner, 2017). For an emergency visit sent home, the plan pays $780 against a cost of about $610.
So the plan absorbs the expense of every avoidable readmission and emergency visit; the hospital earns a small margin on each; and the obstetric practice, which is best placed to prevent them, absorbs the unpaid cost of any early follow-up it chooses to provide. The patient, covered by Medicaid, pays nothing at the point of care but bears the cost in transport, time and, in the worst cases, harm.
Table 1
Who Bears the Cost of a Readmission for Postpartum Hypertension
| Party | What it receives | What it bears | Net effect of an avoidable readmission |
|---|---|---|---|
| Medicaid managed care plan | Capitation and a delivery case payment | Payment for each readmission and emergency visit | Loses about $9,450 |
| Hospital system | Per-admission and per-visit payments | Cost of delivering the care | Gains about $1,350 |
| Obstetric practice | Global fee for prenatal, delivery and postpartum care | Cost of any extra visit inside the bundle | No change |
| Patient | Coverage with no cost sharing | Travel, time and clinical risk | Bears the harm |
Note. Note. Payment and cost figures are Riverbend averages for the baseline year. Charges are excluded because no party pays them in full.
Incentives Traced to Behavior
The table predicts what the parties do, and the records bear it out. The plan has a financial interest in preventing readmissions but does not deliver care, so its main tool is a care management call program that reaches patients after discharge but cannot take a blood pressure. The hospital system has no financial reason to fund remote monitoring, since the events it would prevent are modestly profitable. The obstetric practices schedule the six-week visit the global fee pays for and fit early checks in where they can, which is why only 196 of 502 patients with a hypertensive disorder had one in the recommended window. Nobody in this chain is behaving badly; each party is responding sensibly to the way it is paid.
The Effect of Extended Coverage
The state's adoption of twelve-month postpartum Medicaid coverage, under federal guidance issued in 2021 (Centers for Medicare & Medicaid Services, 2021), changes who is covered but not how anyone is paid. Before extension, only 73.0% of Medicaid-financed patients at Riverbend were still enrolled six months after delivery, a pattern of coverage loss seen nationally (Daw et al., 2017). Extension keeps patients enrolled, and in states that expanded Medicaid, postpartum coverage and outpatient visits rose (Gordon et al., 2020). But coverage alone does not create a paid slot for a day-seven blood pressure check inside a global fee. It widens the population a plan is responsible for without changing the practice's incentive to see them early. In financial terms, extension raises the plans' exposure, since they now carry more members through the months when postpartum complications occur, which strengthens their reason to fund prevention even though the delivery system's incentives are unchanged.
Cost, Charge and Reimbursement Kept Apart
Throughout this analysis, cost means what the system spends to deliver care, from its cost accounting; charge means its list price; and reimbursement or payment means what a plan actually pays. Confusing them changes the argument: by charges, an avoidable readmission looks like a $38,600 loss to the system; by payment and cost, it is a $1,350 gain. Only the second is accurate, and only the second explains why the hospital system has not acted on its own.
The Bedside Contradiction
A nurse on the practice's telephone line who hears that a patient has a home reading of 168/112 on day five faces a choice the payment system has already made. The clinic has no paid slot for a blood pressure check inside the global period, and the next scheduled visit is weeks away, so the safest instruction is to go to the emergency department. That visit is paid; the clinic visit that might have prevented it is not. The nurse knows the emergency visit is the expensive answer and gives it anyway, because the cheaper one does not exist in the payment rules.
References
Centers for Medicare & Medicaid Services. (2021). Improving maternal health and extending postpartum coverage in Medicaid and the Children's Health Insurance Program (CHIP) (State Health Official Letter No. 21-007). U.S. Department of Health and Human Services. https://www.medicaid.gov/federal-policy-guidance/downloads/sho21007.pdf
Daw, J. R., Hatfield, L. A., Swartz, K., & Sommers, B. D. (2017). Women in the United States experience high rates of coverage churn in months before and after childbirth. Health Affairs, 36(4), 598-606. https://doi.org/10.1377/hlthaff.2016.1241
Gordon, S. H., Sommers, B. D., Wilson, I. B., & Trivedi, A. N. (2020). Effects of Medicaid expansion on postpartum coverage and outpatient utilization. Health Affairs, 39(1), 77-84. https://doi.org/10.1377/hlthaff.2019.00547
Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing.
The Chamberlain NR 717 Week 5 instructions
Start with payer mix, because it tells you whose rules matter. Describe each payment mechanism plainly, saying what it pays for and what it rewards: fee for service rewards volume, capitation rewards keeping members out of costly care, bundles shift risk to whoever accepts them and per-admission payment rewards short stays but pays for each admission. Say who absorbs the difference when care costs more or less than the payment assumes, preferably in a table by party. Trace each incentive to an observed behavior in your setting. Keep cost, charge and reimbursement apart and define each, since the argument changes when the word does. Assess any reform by where it puts risk, not by its stated intention. Close with the contradiction a clinician sees at the bedside, which is the part of the analysis only a nurse can supply.
Inside the NR 717 Week 5 example
The sample gives the payer mix and notes that two managed care plans account for 81% of Medicaid deliveries. Three mechanisms are described in turn: state capitation with a maternity case payment, per-admission payment to the hospital and the global obstetric fee, whose claim edits deny a separate early blood pressure visit. A section compares a $38,600 charge, an $8,100 cost and a $9,450 payment for one readmission, and a table shows each party's gain or loss. Incentives are traced to behavior, including a plan care management call that cannot take a blood pressure. Twelve-month postpartum coverage is assessed as widening the plan's exposure without changing the practice's incentive. A short section defines the three money terms, and the paper ends with the day-five telephone call.
NR 717 Week 5 rubric: what full points look like
The costliest paper explains a payment system accurately and never says what it makes anyone do, which is a textbook summary rather than analysis. Next is cost, charge and reimbursement used interchangeably, because the argument changes meaning every time the word does. Marks are also lost for a payer mix with no source, for risk described as shared with no account of who absorbs it and for incentives claimed with no behavior attached. Endorsing a reform on its stated intent rather than on where it puts risk costs points too. Analyses score well when each party's gain or loss is shown, when incentives are traced to observed behavior and when the bedside consequence is described.
NR 717 Week 5 help: mistakes that cost points
Payment systems are usually taught as definitions, which makes it hard to see what they cause. Share your population, its payers and what you know about how each is paid, and we can help you describe each mechanism by what it rewards, build a table of who gains and loses from a given event, trace incentives to behavior in your setting and keep cost, charge and payment distinct. We can also help you write the bedside contradiction. The payer details and the clinical account come from your own setting.
Get a NR 717 Week 5 example written to your instructions
Send the Week 5 instructions with the element list your classroom publishes and the population or payment arrangement you are analyzing, and a custom example is written to those requirements and returned inside 24 to 48 hours. The first one is free. Which reform you end up defending is your own call.
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NR 717 Week 5 questions, answered
Do I need real financial figures for this paper?
Published rates, fee schedules, cost reports and payer summaries are usually sufficient and are what most sections expect. Internal figures from an employer are rarely appropriate and are frequently confidential, so the safer paper rests on public sources. Where you apply a national average to a local population, say that you have, since the substitution is only reasonable while it remains visible.
Is one payment method better than the others?
Each is good at something and produces a distinct failure, which is why the assignment asks about a specific population rather than in the abstract. Volume based payment underserves prevention, while population based payment can underserve the genuinely sick. Naming the failure mode that matters for your population is the analytical move, and a paper declaring one arrangement simply superior reads as unexamined.
How does this differ from a policy analysis?
A policy analysis asks whether a rule is fair, adequate or workable. This asks how the money moves, who is exposed when it runs short, and what that does to the care that gets delivered. The two draw on similar sources and reach different findings, and the doctoral version is the one able to say what a payment arrangement changes about practice itself.
Where can I find a free NR 717 Week 5 sample paper?
The full financing analysis of postpartum blood pressure care under Medicaid managed care is available on this page.
Why does the hospital in the NR 717 Week 5 sample not fund early checks itself?
Each avoidable readmission earns it about $1,350 more than the stay costs, so preventing them would lower its revenue slightly.