NUR 621 Economics and Quality
NUR 621 Economics and Quality
Chronic disease is a major problem impacting the US and global economy significantly. Chronic diseases are the leading cause of morbidity and mortality in the US. They affect more than half the population, and at least 6 in 10 Americans (estimated 129 million people) live with at least one chronic disease, which has significant health and economic impacts (Hacker, 2024). Chronic diseases are responsible for 7 out of every 10 deaths in the US, and in 2021, non-communicable diseases, which include chronic diseases, accounted for 75% (43million deaths) of all non-pandemic-related deaths. The major chronic illnesses include heart disease, cancer, diabetes, asthma, kidney disease, depression, and hypertension. The burden is high in older adults, a concerning phenomenon considering that the US population is aging. Aging increases the risk for chronic diseases, and older adults are more vulnerable to severe illness from infections and these chronic diseases (The National Council on Aging, 2025). Chronic disease is a national menace and an issue of global concern. This paper discusses the economic impact of chronic disease, interventions to make an impact on chronic disease in my professional setting, the impact of quality measures on reimbursement, and the impact I can have on health policy as a leader.
Impact of Healthcare Economics on Chronic Disease
Data from the Centers for Disease Control and Prevention (2025) shows that healthcare expenditure for individuals with chronic and mental health conditions accounts for 90% of the nation’s annual $4.9 trillion, equivalent to 6% the nation’s GDP. Some diseases, such as heart disease and stroke, are the leading causes of chronic disease mortality, accounting for 1 in 4 deaths and costing over $400 billion in care costs and lost productivity annually (CDC, 2025). Hacker (2023) states that the estimated chronic disease cost is projected to reach $47 trillion globally by 2030, given the steady rise in prevalence and severity of chronic diseases. Factors such as long-term care and medications, lost productivity from the health impact, hospitalizations, and comorbidities, such as disability, are the major contributors to the high economic burden. When poorly controlled, chronic diseases reduce productivity, increase ER visits and hospital admissions, and increase morbidity and mortality.
Healthcare services delivery models have had various impacts on care access and outcomes for patients with chronic disease. Bundled payments eliminate the pay-per-service model and allow patients to receive care services and make single payments for these services. Researchers such as Karimi et al. (2021), Liao and Navathe (2022, and Oddleifson et al. (2024) show that bundled payments have a positive impact on care services access, quality of life, and disease outcomes for chronic diseases such as heart failure, diabetes, and cancer. However, there are conflicting results on the cost-savings impact of the care model, with some researchers noting a consistent increase in healthcare expenditure (Karimi et al., 2021). The value-based care model prioritizes outcomes, prioritizing disease management over costs, emphasizing early interventions and access to care. Unlike fee-for-service models, value-based care incentivizes quality and efficiency and prioritizes patient satisfaction through shared decision-making, care coordination, and proactive management (Gibbs et al., 2021). Chronic disease coverage and reimbursement models under the various insurance programs are also a crucial factor in influencing access and utilization of care services, and subsequently, care outcomes. A high insurance coverage among individuals with chronic disease significantly influences their health outcomes (Peng & Zhu, 2021). Another significant healthcare economic factor is the rural chronic disease management program. The program aims to enhance access to services and care providers in the rural areas where access and availability negatively affect pricing.
Interventions as a Leader to make an Impact on Chronic Disease
Nurse leaders have a good degree of influence in care delivery and patient outcomes. As a nurse leader, several interventions can help improve chronic disease management and reduce the burden of chronic disease in the hospital setting. Implementing chronic care models for diseases with the highest burden, such as diabetes, cancer, and heart disease, can have a high impact as they ensure holistic and person-centered disease management (Grudniewicz et al., 2023). The chronic care models are crucial for ensuring patient-centered care, hence better success in care outcomes, as individuals have unique responses to illnesses. Leveraging technology interventions, such as telehealth, to enhance follow-up and monitoring of patients, as well as remote management of conditions, can further improve the efficiency of chronic disease management (Williams & Shang, 2024). Another intervention is advocating for preventive and promotive interventions, such as routine screening for chronic diseases and early interventions, such as lifestyle education for patients at risk. Makhmirzaeva et al. (2025) note that screening for health conditions is a recommended intervention in disease and risk identification and helps ensure timely interventions and complications prevention, hence better population health outcomes. These interventions can significantly influence care through timely diagnosis and holistic management of chronic diseases.
Quality Measures and Reimbursement
Quality measures/ performance metrics such as the star ratings, healthcare effectiveness data and information set (HEDIS), and Medicare Access and COP reauthorization Act (MACRA) significantly influence reimbursement. MACRA reform repealed the sustainable growth rate formula with the quality payment program, which shifted the reimbursement approach from volume to value-based. MACRA gave rise to the merit-based incentive payment system, where providers are rated on quality, cost, interoperability, and improvement activities, and the advanced alternative payment models that include accountable care and bundled payment models (Centers for Medicare and Medicaid Services (CMS), n.d.). The Medicare Star rating system evaluates Medicare Advantage and Part D plans, where users rate the system from 1 to 5, and the ratings help users understand and make decisions on the best care services access. The ratings also accrue variable bonuses from Medicare annually, boosting revenue and building a reputation that helps collect more revenue. Rowan et al. (2021) note that the rating system ensures quality decision-making on care access and promotes continuous improvement in care quality by hospitals and care providers to maintain good ratings.
HEDIS is a set of standardized performance measures by the National Committee for Quality Assurance contracted by CMS and entails over 90 measures and evaluates areas such as effectiveness of care, access to services, and patient satisfaction with care services (Centers for Medicare and Medicaid Services (CMS), n.d.). HEDIS ties reimbursement incentives to performance on the HEDIS measures, including bonuses to providers who meet or exceed the benchmarks and directly influence Medicare star ratings, which further determine reimbursement rates for Medicare Advantage and Medicaid plans (CMS, n.d.). These quality measures link quality scores to Medicare Advantage payments and penalties, which shifts the facility’s attention to ensuring achievement of quality outcome metrics. Other measures, such as hospital readmission rates, also influence reimbursements and provoke hospitals and care providers to provide quality care and care continuity in their homes, thereby reducing readmissions and associated cost deductions (Fleishman et al., 2023). Thus, quality measures significantly influence reimbursements, which in turn significantly influence hospitals’ and care providers’ efforts in managing illnesses. As a nurse leader, understanding these quality measures can help align care delivery with the quality metrics that drive reimbursement.
Nurse Leader’s Impact on Health Policy
Advocacy is among the primary leadership roles of a nurse. Leadership positions provide some degree of authority in influencing policies to improve health outcomes. As a nurse leader, an important impact area is advocacy for chronic disease funding, support for community health programs, and equitable access (Shamlan et al., 2023). Chronic disease management efforts at all levels of health promotion are crucial, and adequate funding is crucial. Healthcare resources are limited, and preventive health services are often neglected due to the high burden of curative needs. However, adequate funding can help improve preventive efforts and save on the high curative care costs. Community health programs that focus on education and screening are also crucial for early detection and management of illnesses. Equitable access through adequate insurance coverage and the availability in rural areas can help address care disparities caused by limited access to care services. Mistry et al. (2021) note that community resources, such as community health workers, are valuable in the identification and management of chronic diseases, and their empowerment is paramount. Advocating for their support through community programs is thus a necessity. Thus, advocacy in these three areas is crucial to ensuring quality population health outcomes. Active participation on policy boards and providing the necessary legislative testimony to ensure the policies align with population health needs is crucial. The nurse leaders in these boards provide rich and valuable perspectives into effective strategies in managing chronic diseases and other health issues of significant economic burden in the US.
Conclusion
Chronic disease is a major health concern in the US and globally. The prevalence, morbidity, mortality, and care costs burden of chronic disease warrants an in-depth evaluation considering the current vulnerabilities, such as an aging population. The healthcare economics, such as current care models and policies, significantly influence care delivery and outcomes. As a nurse leader, interventions such as implementing chronic disease care models leveraging technology and routine screening for chronic diseases can help diagnose chronic disease early and promptly intervene. Quality measures such as HEDIS, star rating, and hospital readmission reduction programs have been instrumental in influencing reimbursement rates and, subsequently, care provider and hospital commitment to continuous quality improvement. In nursing advocacy, advocating for equitable access to community health programs and funding for chronic disease will support efforts to reduce chronic disease burden. These interventions will help improve the management of chronic diseases and improve population health.
References
Centers for Disease Control and Prevention (2025). Fast facts: Health and economic costs of chronic conditions: Chronic disease. Accessed October 18, 2025, from https://www.cdc.gov/chronic-disease/data-research/facts-stats/index.html
Centers for Medicare and Medicaid Services (CMS), n.d. MACRA: Value-based purchasing program. Accessed October 18, 2025, from https://www.cms.gov/medicare/quality/value-based-programs/chip-reauthorization-act
Centers for Medicare and Medicaid Services (n.d.). Healthcare Effectiveness Data and Information Set (HEDIS). Accessed October 10th, 2025, from https://www.cms.gov/medicare/enrollment-renewal/special-needs-plans/data-information-set
Fleishman, J., Aslam, A., & Nayak, R. (2023). RWD114 Is Medicare’s Hospital Readmissions Reduction Program (HRRP) delivering on the decade’s promise? A trend analysis. Value in Health, 26(6), S382. https://doi.org/10.1016/j.jval.2023.03.2143
Gibbs, J. F., Guarnieri, E., Chu, Q. D., Murdoch, K., & Asif, A. (2021). Value-based chronic care model approach for vulnerable older patients with multiple chronic conditions. Journal of Gastrointestinal Oncology, 12(Suppl 2), S324. https://doi.org/10.21037/jgo-20-317
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Hacker, K. (2024). The burden of chronic disease. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 8(1), 112-119. https://doi.org/10.1016/j.mayocpiqo.2023.08.005
Karimi, M., Tsiachristas, A., Looman, W., Stokes, J., van Galen, M., & Rutten-van Mölken, M. (2021). Bundled payments for chronic diseases increased health care expenditure in the Netherlands, especially for multimorbid patients. Health policy, 125(6), 751-759. https://doi.org/10.1016/j.healthpol.2021.04.004
Liao, J. M., & Navathe, A. S. (2022). The path ahead for bundled payments. JAMA, 328(16), 1592-1594. https://doi.org/10.1001/jama.2022.18191
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Mistry, S. K., Harris, E., & Harris, M. (2021). Community health workers as healthcare navigators in primary care chronic disease management: a systematic review. Journal of General Internal Medicine, 36(9), 2755–2771.
Oddleifson, D. A., Holmes, D. N., Alhanti, B., Xu, X., Heidenreich, P. A., Wadhera, R. K., Allen, L. A., Greene, S. J., Fonarrow, G. C., Spatz, E. S., & Desai, N. R. (2024). Bundled payments for care improvement, quality of care, and outcomes in heart failure. JAMA cardiology, 9(3), 222–232. https://doi.org/10.1001/jamacardio.2023.5009
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The purpose of this assignment is to address health care issues facing the United States in terms of economics and quality. Choose one of the following topics (suicide rates, chronic disease, obesity, health care disparities, or missed care) and write a 1,250- to 1,500-word paper addressing the following:
Discuss the impact that health care economics has on your topic.
Discuss what you could do as a nurse leader to make an impact on your chosen issue in your professional setting.
Analyze the impact of quality measures on reimbursement.
Describe what impact you can have on health policy as a nurse leader.
Include 3–4 peer-reviewed resources.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.