Adopting a nurse-led model of care to advance whole-person health and health equity within Medicaid

Background: Medicaid payment reforms and delivery model innovations are needed to fully transform U.S. healthcare structuring and provision.

Purpose: To synthesize nurse-led models of care and their implications for improving health care access, quality, and reducing costs for Medicaid recipients.

Methods: A critical review of the literature regarding nurse-led models and implications for addressing social determinants of health (SDOH), adopting population health approaches, managing complex care, and integrating behavioral and physical health care within Medicaid.

Discussion: Three interrelated findings emerged (a) investing in dynamic nurse-led models is important for mitigating SDOH and adopting value-based care, (b) regulations preventing nurses from practicing at the fullest extent of their training and licensure limit clinical impact and value, and (c) directed payments can establish value-based expectations for Medicaid managed care.

Conclusion: Adoption of a nurse-led model of care has the potential to advance the goals of reducing inequity and promoting whole-person health within Medicaid and nationally.