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Nurse practitioner representation in health plans is a win-win


Including more nurse practitioners in a greater number of health plans can improve the experiences of patients as well as the bottom line.

It isn’t often that healthcare executives – or any kind of organizational leader – can simultaneously improve the experiences of their patients (or customers) and their bottom line. Yet health plan decision-makers are in this highly enviable position. They can provide more choice, safely, to their members/patients and improve cost efficiency by including more nurse practitioners in a greater number of health plans.

For nearly half a century, nurse practitioners have been practicing primary, acute and chronic care in a wide variety of healthcare settings, from independently owned clinics to hospitals to VA facilities. Here they evaluate patients; make diagnoses; order, perform, interpret and supervise diagnostic tests; write prescriptions; and manage and treat acute and chronic illnesses. More than 900 million visits were made to nurse practitioners in 2013.

The longevity of nurse practitioners has made it possible for scores of independent researchers to collect, analyze and publish data concerning the care they provide. The findings are striking:

  • Nurse practitioner outcomes are equivalent to and often better than those of physicians. This understanding has led a growing number of renowned national policy organizations and government bodies to call for more autonomy for nurse practitioners across the country. Such groups currently include the Institute of Medicine, the National Governors Association, the National Conference of State Legislatures, the Federal Trade Commission and the AARP.
  • Patients are more satisfied with the care of nurse practitioners than other providers. The nurse practitioners approach – holistic and patient-centered with added health education and counseling, and more time spent during appointments – has proved extremely popular across demographics. A Wall Street Journal poll last year supports this data; it found that 65% of the newspaper’s readers had used and had confidence in nurse practitioner providers.
  • Nurse practitioners are highly cost effective. Not only do nurse practitioners excel at keeping the overall patient population out of the hospital and the emergency room, they’re especially skilled at serving the needs of the growing number of Americans with chronic diseases like diabetes and heart disease – major drivers in healthcare costs. Nurse practitioners see such patients in growing numbers and are shown to help them get these conditions in check. They decrease hospital admissions, increase treatment adherence, stem disease progression and improve outcomes.
  • The nurse practitioner workforce is growing. While there is a well-documented physician shortage, especially in high-needs, medically underserved and geographically remote communities, nurse practitioners remain one of the fastest growing healthcare professions. What’s more, they’re serving these vulnerable patient populations in large numbers. This trend is expected to continue, especially as the nurse practitioner profession becomes more publicized. To illustrate, U.S. News & World Reportranked nurse practitioner as the fourth best overall job of 2014.

With such findings, it’s difficult to imagine why more health plans don’t already include vast numbers of nurse practitioners. The sad truth is that for many years medicine has followed a hierarchical, physician-dominated system – one that is now being modernized to enhance value and improve care.

Consider the “Nondiscrimination of Health Care” section of the Affordable Care Act (Section 2706), which states that an insurer “shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable state law.” The intent of this provision is to provide patients with access and choice of health care provider, including such providers as nurse practitioners, without discrimination.

This section of the law illustrates clearly how our healthcare system is evolving – purposefully, deliberately and for all the right reasons. By complying, health plans are acting in their own best interests as well as the best interests of patients.

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