NURS FPX 4065 Assessment 3 Ethical and Policy Factors in Care Coordination

Student name

Capella University

FPX 4065 A3

Professor’s Name

Submission Date

Ethical and Policy Factors in Care Coordination

Slide: 01

Hello, my name is _______, and I will discuss some of the ethical and policy challenges related to care coordination for filling care gaps at the Riverside Community Health Clinic.

Slide: 02

A healthcare system is said to have a coordinated continuum of care when patients receive the necessary care in an organized manner and without interruption, even when the care is provided in disparate locations or systems. The coordination and delivery of care are largely influenced by federal, state, and local policies. Through the Affordable Care Act (ACA) and Medicaid expansion, and the more recent initiatives of Patient-Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO), healthcare providers have the means to coordinate services among one another and collaborate in the delivery of care (Khatri et al., 2023). Thanks to those policies, many Americans have better access to care. Recent statistics indicate that more than 45 million Americans have enrolled in two ACA-related programs and that the ACA has resulted in more health coverage than any other program. Although significant progress has been made through those programs, the ethical dilemmas involving inequitable access to and provision of healthcare services remain.

Slide: 03

Effect of Governmental Policies on Coordination of Care

Healthcare policy shapes community healthcare and care coordination. Certain Federal statutes and state Medicaid programs shape the provision of and the funding for healthcare services where I work at the Riverside Community Health Clinic. These policies dictate the formation of care teams and the processes for referring services and the delivery of care to the underserved. Certain provisions of the ACA complement and enhance the coordination of care. The ACA created the healthcare delivery model of the Patient-Centered Medical Home (PCMH) and the Accountable Care Organization (ACO), which, when fully operational, will improve provider communication and foster more consistent and continuous care. Research shows there was a significant increase in access to care following the implementation of the ACA, and the national uninsured rate decreased from 16% in 2010 to approximately 7.7% in 2023 (Hempel et al., 2023). The ACA has enhanced the coordination of healthcare and has improved the management of chronic diseases for the most at-risk populations. Most healthcare workers will now emerge from training post-ACA and will employ the principles of both the ACO and the PCMH, providing the most effective and timely patient-centered care.

Slide: 04

Affordable Care Act

Care Coordination has potential for major impacts with the introduction of the ACA. First, the PCMH and ACO are examples of new models of care coordination introduced with the ACA. From 2024 data, the ACA has coverage of over 45 million people, with over 20 million people enrolled in the ACA marketplace. Models of care coordination developed through the ACA are influencing providers to improve information sharing; to partner to support and promote primary and preventative care; and to partner to offer support for the sustained and ongoing management of chronic health conditions (Nass et al., 2022). With coordination and collaboration, there are still roughly 5 million people uninsured in the United States. Most of this population is immigrants, with many remaining unprotected as a result of their immigration status, leaving many ethical concerns to be addressed for equity and justice in the health care system.

Slide: 05

Medicaid Programs

For low income families, Medicaid ensures accessibility to various health care services. Additionally, it provides long-term, chronic health care needs the accessibility to primary, preventive health care services. The projection of 79.6 million combined Medicaid program participants in 2024 equates to 32% of the population at that time. Medicaid’s growth has increased the availability of services, and subsequently, the demand for those services, and has made recruiting healthcare professionals the most challenging (Karam et al., 2023). Additionally, due to the changing nature of the healthcare system, care coordinators will provide essential services to underserved patients by making appropriate referrals and following up with these patients to ensure that there is no disruption in the healthcare services that these patients need.

Slide: 06

State Immunization Requirements

The provision of health services hinges on the design and interdependence of multiple health services (or systems) including and extending outside of the clinical setting. Vaccination laws are public health interventions that seek to strengthen multiple system collaborations to improve public healthcare. As a result of these interventions, the healthcare workforce is better equipped to inform and engage the public regarding available preventive healthcare services such as vaccination. This would not only improve the healthcare workforce’s ability to inform the public regarding the availability of flu vaccinations but also other means to alleviate the healthcare burden associated with flu-related illnesses (Maltezou et al., 2022). As of 2023 – 2024, the flu vaccination rate in the U.S. stood at 47.2% with significant inter-age group vaccination rate disparities. A multi-system collaboration is necessary to demonstrate the extent of the limitation of preventive healthcare services in the public domain.

Slide: 07

Ethical and Policy Implications in Care Coordination

The expansion of healthcare access through policy inevitably results in ethical dilemmas for healthcare providers. Specifically, it creates inequities and ethical concerns for Riverside Community Health Clinic when policies expand access for select groups of the population while still leaving disparities in healthcare access and inequities in service. Many vulnerable populations, such as undocumented immigrants, continue to lack health insurance, leaving significant barriers to healthcare access and service inequities (Maltezou et al., 2022). Resource constraints and system inequities lead to ethical dilemmas for nurses as they are forced to make decisions to prioritize among patients. As part of ethical decision-making, care coordinators are required to utilize the four principles of ethics, i.e., beneficence, nonmaleficence, autonomy, and justice, when providing care to the best of their ability within the constraining context and limitations of the existing policies.

The Riverside Community Health Clinic’s ethical dilemmas reflect the impact of local and state factors. The expansion of Medicaid increases healthcare access for previously uninsured low-income individuals; Slow referral times and reimbursement caps create dilemmas related to the prioritization of patients’ needs (Maltezou et al., 2022). Ethical dilemmas are also present for nurses in relation to scheduling due to the high demand for care and low available staff. These challenges, coupled with the commitment of nurses to the social contract, ensure the commitment of the profession to the advocacy for the equitable and continuous person-centred care as well as the core nursing ethical standards in the coordination of care.

Slide: 08

Impact and Consequences of the Policies

Health Policy can impact care coordination in both a positive and negative sense. For instance, multiple new healthcare insurance options, including expanded Medicaid, have come as a direct result of the ACA, which have greater preventative care services as a direct result of greater healthcare access. However, one negative impact the ACA can have on healthcare systems is limiting a patient’s access to the right set of providers. The ACA has undoubtedly created more access to care, but has also created more administrative burdens for providers. Every new insurance policy requires changes in provider documentation. This reduces the amount of face time providers have with their patients. Additionally, the ACA has caused the total cost of healthcare to exceed $5 trillion. This exemplifies the challenges encountered when trying to create a system of effective healthcare. The focus should be on creating an effective system of managed and coordinated healthcare that will ultimately lower the cost and improve the quality of the service offered.

Slide: 09

Impacts on the National, State, and Local Levels

Patient care coordination is mainly a function of the Affordable Care Act (ACA) on the national front, alongside the value-based payment models that take into account responsible metrics. They measure patient outcomes, and the documentation of the provision of care is of high quality. Because of this, nursing and care teams are compelled to review their staff performance metrics and document the care that they provide (Kyle et al., 2025). Standardized care and quality assurance come at the cost of an administrative and compliance burden on the nurse, who will have reduced time to provide care to patients. As a result, nurses will have to satisfy compliance and develop an ethical nursing practice and an effective patient-centered communication practice.

On the state front, the expansion of Medicaid provides coverage for low-income, underserved persons and increased access to healthcare. As a result, the number of patients who utilize the healthcare system increased. This led to a rapid increase in demand for healthcare services, resulting in longer wait times for both primary and specialty care (Metiso & Mboweni, 2025). It has resulted in an unequal distribution of healthcare practitioners in rural areas, coupled with barriers to patient access, leading to a growing number of patients who are unable to access the specialized services they need. These systemic issues reflect an urgent need to implement improved care systems to manage patient flow and service provision in a more equitable manner.

The social determinants of health involve a myriad of localized factors that contribute to reduced effectiveness in care coordination, including irregularities with transportation, temporary or unstable employment, low income, and no-shows to appointments. Ultimately, all of these factors contribute to poor follow-up and coordination of care that leads to negative health outcomes for affected individuals. The Riverside Community Health Clinic nursing staff have adapted their practice to incorporate transportation-related social determinants of health by providing community resources and services, and partnering with local agencies. This framework promotes access to health services, improves patient involvement, and affirms the ongoing commitment to the care plan.

Slide: 10

The Role of Code of Ethics in Care Coordination

Riverside Community Health Clinic utilizes the American Nurses Association’s Code of Ethics as a framework for the delivery of coordinated care. The ANA provisions also articulate the barriers of the healthcare system and the vulnerabilities of the patients and outline the barriers and the steps that nurses can take ethically to address the issues of the healthcare system. For instance, under provision 1: respect for human dignity, nurses will conduct intake assessments of new patients to determine the patients’ language needs and the preferred culture and level of health literacy, which will be used to develop the care plan. Under provision 2: commitment to the patient, nurses maintain the uninterrupted care of the patient by making the necessary connections for the patient to generate the resources and services offered through the sliding scale and the medication assistance program, rather than allowing the patient to leave with needs that are still unmet. Under provision 3: protecting the safety of patients, nurses will inform case managers of patients who have been identified as high-risk and are being discharged from care after a hospitalization. The ethics of nursing illustrate the impact of the ethical provisions of nursing on the referrals, the discharge process, and the communication among the healthcare team.

The Code of Ethics provides guidance for coordinated care and makes provision for multidisciplinary partnerships. Nurses create integrated care plans to further continuous care in the fight against health inequities through their partnerships with other healthcare professions. Barriers in the health system, or policies that indirectly oppress people, create challenging situations for many patients. Within the Code of Ethics, the nursing profession has the provisions to support the advocacy role of the nurse and promote moral courage. There are three areas that exemplify the quality of care at Riverside Community Health Clinic: 1) equitable resource distribution, 2) the prevention of harm through prompt care, and 3) total accountability. The foundation of the Code of Ethics in healthcare is the clinical effectiveness of care, fairness, and compassion, with a deep commitment to the respect of diverse communities.

Slide: 11

Factors Contributing to Health Disparities and Access to Services

Riverside Community Health Clinic examines health inequities and barriers to health services through the lens of social determinants of health and systemic inequities. This primarily includes the impact of poverty, lower levels of education, food and housing insecurity, lack of or inadequate health insurance, and low health literacy – and is often compounded by rural and urban inequities. Such determinants lead to a greater prevalence of chronic health conditions and lower overall health status (Hickson, 2023). These inequities lead to a greater reliance on emergency services for health needs due to the lack of consistent primary health care. This includes the hospitalization of patients for chronic health conditions that are otherwise avoidable. Additionally, the absence of continuous primary health care services or the inclination to seek health care services only in the advanced stages of chronic health conditions contributes to the complexity of managing chronic health conditions. Cultural barriers and/or lack of trust in the health care system contribute to the avoidance of health care services. This includes a reluctance to utilize health care services that are aimed at the prevention of illness and disease.

Utilization of the ANA Code of Ethics and the collaborative principles of advocacy and beneficence assists nurses in developing a more effective network of social workers, community organizations, and case managers. These network professionals help nurses gain access to the social determinants of health, such as housing and transportation, food, and medication resources, and help nurses transport patients to and procure for them needed resources. Nurses educate patients with chronic illnesses to help them learn to control the chronic illness to which they are subject via chronic illness self-management and medication adherence. Ease of access for the underserved population to health and social services will reduce avoidable hospitalizations and improve health outcomes.

Slide: 12

Conclusion

 Medicaid and the ACA have provided policy opportunities for improved access and greater care coordination in the health system, which come at the expense of ethical dilemmas of equity, access, and resource and service allocation. To resolve the ethical dilemmas, focus on the patient and the care being given; the Code of Ethics for Nurses with Interpretive Statements is essential. When the Code and the supporting policies are implemented, the quality and care of diverse populations are improved and coordinated at the Riverside Community Health Clinic.