NR 717 Week 7 Advocacy Plan Example

Advocacy Plan: Four Ways to Pay for Postpartum Blood Pressure Monitoring at Riverbend Health, and Why the Managed Care Contract Is the One to Pursue

Student Name

College of Nursing, Chamberlain University

NR 717: Concepts in Population Health Outcomes & Health Policy

Instructor Name

Month Day, Year

Advocacy Plan: Four Ways to Pay for Postpartum Blood Pressure Monitoring at Riverbend Health, and Why the Managed Care Contract Is the One to Pursue

The Change Being Pursued

The change is remote blood pressure monitoring for each Riverbend patient whose delivery admission ends with a diagnosis of a hypertensive disorder of pregnancy: a home cuff, twice-daily text reporting for six weeks and same-day nurse review, at about $160 per patient. Last year 502 patients would have qualified, and only 39.0% had a blood pressure check in the recommended 7 to 10 days. The clinical case has been made in earlier work and is not repeated here. The question this plan answers is who pays, and how to get that party to agree before the next contract year begins.

Four Pockets, One Chosen

The same change can be funded in four ways, each with a different decision maker, timescale and chance of surviving a lean year.

Table 1

Four Ways to Fund Postpartum Remote Monitoring

Note. Note. Lakeview Community Health Plan covers about 49% of Riverbend's Medicaid deliveries.

The managed care contract is chosen because it puts the cost where the savings fall. Lakeview pays about $122,600 a year for avoidable hypertension readmissions and emergency visits among its members delivering at Riverbend, and the pilot would cost it about $23,500. The hospital's own budget is the wrong pocket, because the hospital earns about $1,350 on each readmission it would prevent. A grant would fund a start, but programs paid by grants tend to end when the grant does. A state mandate would be the most durable route but would take at least two legislative sessions.

A Change Somebody Can Approve

The specific request is a contract amendment: a per-member payment of $160 to Riverbend for each Lakeview member enrolled in monitoring, for twelve months from 1 July 2027, with monthly reporting. Two people at Lakeview can approve it, the chief medical officer and the vice president of finance, without board action, because it falls within the medical management budget they control.

Allies, Named by Role

Four allies matter. Lakeview's director of quality needs better results on the postpartum care measure the state now requires plans to report. Riverbend's director of women's services runs the units that would deliver the program. The state perinatal quality collaborative publishes the benchmark that shows Riverbend below the median, which gives both organizations a reason to act. And a member of Riverbend's patient and family advisory council who was readmitted with postpartum preeclampsia has offered to speak.

Opposition, Read by What It Stands to Lose

Lakeview's actuarial team will resist a new per-member cost that appears in this year's figures before any savings do; the response is the break-even point, three prevented readmissions, and a twelve-month review. Riverbend's hospital finance office stands to lose about $13,500 a year in readmission margin if the program works; the response is that the amount is small and the program builds a contract relationship worth more. The obstetric practices stand to gain work without payment, since same-day referrals fall inside the global fee; the response is to ask Lakeview to pay those referral visits separately in the same amendment.

Where the Clinical Testimony Goes

Clinical testimony is spent only where it can change a decision. The patient advisor and the DNP student will present to Lakeview's quality committee, which advises the chief medical officer, at its April meeting. They will not testify at the legislature this year, because the legislature is not the decision maker for this route. Testimony at the committee will be short: one patient's account and one nurse's description of the day-five telephone call that ends in an emergency visit. Both will be de-identified and cleared with the patient in writing beforehand. The nurse's account carries a specific weight: a doctoral nurse who has made that call can tell the committee what happens when the program is not funded, in terms no claims report contains. That is the standing the plan spends, and it is spent once, in the room where the decision is shaped, rather than in letters to people who cannot act on them.

The Calendar That Governs

The calendar is Lakeview's contract cycle, not the academic term. Contract amendments for 1 July must be agreed in a term sheet by 1 April, and Lakeview's quality committee sits monthly, on second Tuesdays.

Table 2

Advocacy Timeline Set by the Contract Cycle

Note. Note. Dates follow Lakeview's published contracting and committee schedule.

Policy windows tend to open when a problem is widely recognized, a workable solution is ready and the people who decide are receptive, all at once (Kingdon, 2011). Twelve-month postpartum coverage, adopted under federal guidance (Centers for Medicare & Medicaid Services, 2021), has made Lakeview responsible for these members for a full year, and its contract renewal is the window when the problem and the solution can meet.

Movement Short of Approval

If Lakeview declines the full amendment, three smaller outcomes would still count as progress: a data-sharing agreement that lets Riverbend see Lakeview's emergency visit claims for its patients, a smaller pilot covering cuffs only, or a commitment to revisit the request at the six-month point of the contract year. Any of these keeps the decision maker engaged, and research on evidence-based policy suggests that sustained relationships between those who hold the evidence and those who decide improve the chance that evidence is used (Brownson et al., 2009).

References

Brownson, R. C., Chriqui, J. F., & Stamatakis, K. A. (2009). Understanding evidence-based public health policy. American Journal of Public Health, 99(9), 1576-1583. https://doi.org/10.2105/AJPH.2008.156224

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

Kingdon, J. W. (2011). Agendas, alternatives, and public policies (Updated 2nd ed.). Longman.