It has been five years since the Affordable Care Act was signed and much attention has been focused upon website problems, delays in implementation, litigation and less than universal expansions of Medicaid in different states, as well as successes in signing people up, and increases in the numbers of people covered by health insurance, particularly young adults and those with pre-existing conditions. Increased coverage is not the only outcome desired; transformations in the delivery of health care have also been purposefully advanced including achieving better health, better care and lower cost, and implementation of incentives and penalties related to addressing healthcare goals. Care Transition, Accountable Care Organization, Patient Centered Medical Home, Preventive Health and bundled payment mechanisms are advancing change throughout the U.S. by responding to health management concerns with holistic, person in environment and patient as partner emphases. Self-management of their conditions by patients, person-centered care, multidisciplinary approaches and the value of partnerships with community based agencies are being discovered, sometimes as if they are new concepts. And in many ways they are “new” as they did not feature prominently in past healthcare delivery but now are at the forefront of moving healthcare from an acute to a chronic care focus. These ideas are embedded in theoretical perspectives such as the Chronic Care Model  driving healthcare reform and supporting growing use of low cost evidence and community-based interventions. They have their own models for widespread dissemination (e.g., the expanded Chronic Care Model and the RE-AIM Framework) but are challenged by (1) poor understanding of the value and availability of evidence-based self-management interventions; (2) skepticism among professionals and providers, (3) a lack of linkages of program need and delivery particularly in electronic exchange of information, and (4) still to be established reimbursement mechanisms. Resolving these challenges will be the next critical step for healthcare reform and nurses and other healthcare professionals must decide if they are ready to be the innovators who will realize the potential of these approaches.
McCallion, Philip and Ferretti, Lisa A., "Building Capacity for Self-Management Interventions: The Challenges" (2015). Social Welfare Faculty Scholarship. 7.