NURS FPX 4065 Assessment 3 Ethical and Policy Factors in Care Coordination
Student Name
Capella University
NURS-FPX 4065
Instructor’s Name
October, 2026
Ethical and Policy Factors in Care Coordination
Slide: 01
Hi, my name is ……, Today, I will be discussing the factors affecting care coordination, as it relates to addressing gaps in the delivery of health care services at the Sunrise Community Health Center. Hello, I’m Sameera. Today, I will discuss factors that affect care coordination and help fill gaps in health care service delivery at the Sunrise Community Health Center.
Slide: 02
In order to properly carry out care coordination, it is important to improve the health outcomes for patients. Care coordination is crucial for vulnerable populations that may face barriers to accessing health care services. Many healthcare policies have an impact on Sunrise Community Health Center’s service delivery, funding, and access to care. Patient Protection and Affordable Care Act (PPACA), Medicaid expansion programs, Patient-Centered Medical Homes (PCMH’s), and Accountable Care Organizations (ACOs) are among the policies that are helpful in supporting care coordination in the community (Baten et al., 2024).
These types of health care policies improve the level of coordination among health care providers and also improve patients’ access to care. There are, however, a number of ethical issues that arise, including fairness in the provision of resources, the allocation of limited resources, and providing equitable access to care for those who receive care. Health care providers such as nurses, care coordinators, and the like, will need to evaluate the impact of government policies on the provision of patient-centered care services and report to their organization.
Slide: 03
Effect of Governmental Policies on Coordination of Care
Healthcare policies affect the way co-ordination is done in community organizations. At my practicum site, in Sunrise Community Health Center, these government healthcare policies greatly impact staffing, referral systems, and preventive care programs. Those with chronic conditions or complex health issues need to be particularly well-coordinated. A systematic review indicates that the coordinated care model can lower hospital readmission rates for high-risk patients by almost 15 – 20 % and enhance health outcomes (Dhaliwal & Dang, 2024). Government policies have an impact on health care delivery, and it is important for health care providers to be aware of and use these policies to ensure timely and appropriate delivery of patient care.
Slide: 04
Affordable Care Act
The Affordable Care Act (ACA) is one of the most influential healthcare policies that has impacted care coordination in the United States (U.S.). The ACA increased health insurance coverage and introduced a new model of care for health insurance providers, such as the PCMH and ACO that promote collaboration between health care practitioners (Department of Health & Human Services, 2024). Since the law was enacted, the ACA has increased health insurance coverage in the U.S. to over 40 million people, and so has enhanced access to preventive and primary care services (Kaiser Family Foundation, 2024). This approach to care at Sunrise Community Health Center involves working together with the nurse, doctor, and social worker to get better outcomes for the patient and provide seamless care.
Slide: 05
Medicaid Expansion Program
Medicaid expansion is one of the biggest factors in care coordination affecting low-income care recipients. Since the passage of the ACA, numerous states have started to make a series of changes to their Medicaid eligibility requirements to increase the healthcare coverage of low-income individuals. There are about 90 million people enrolled in Medicaid in the country (Kaiser Family Foundation, 2025). The increased access to care provided by Medicaid has added more pressure to the care delivery teams. With their volume of patients, care coordinators at Sunrise Community Health Center are doing more than ever to coordinate referrals and support the healthcare journey for patients and their families, sometimes with limited resources.
Slide: 06
State Immunization Requirements
One of the other key considerations in the public health policy realm that can impact care coordination is the existence of state immunization requirements. State immunization requirements under public health policy contribute to the promotion of preventive healthcare and help to prevent the spread of infectious diseases. At the onset of the COVID-19 pandemic, many healthcare providers became key participants in vaccine distribution activities, educating patients, and providing subsequent support and care. According to reports, a total of around 670 million doses of COVID-19 vaccines have been given to people in the United States (Centers for Disease Control and Prevention, 2025). All of these vaccine doses were part of coordinated, effective preventive health care services that were provided by several States and healthcare systems, with the goal of supporting the health of the communities they serve. Effective public health policies work together and effectively, as illustrated, to lead to the provision of effective care coordination systems across the healthcare system.
Slide: 07
Ethical and Policy Implications in Care Coordination
Healthcare policies often present challenges in the field for workers in care coordination to deliver equitable and efficient care. The ACA, which made health care more available, has set up a scenario where there are still significant service delivery gaps for the most vulnerable groups; for example, it has been well documented that a large number of undocumented immigrants are uninsured. Around 45% are estimated to have no form of health insurance coverage, resulting in extreme concerns over finding equity and justice in access to health services (U.S. Department of Health and Human Services – Office of the Assistant Secretary for Planning and Evaluation, 2021).
When making decisions at the patient level, nurses must balance these decisions with the implications of the ethical principles of non-maleficence, beneficence, autonomy, and justice when considering such situations. Care coordination staff are often faced with difficult ethical choices when they have to allocate scarce resources. Likewise, other policy measures such as Medicaid expansion have increased access to health care services, though they have also resulted in problems at a system level, such as provider scarcity and the slow pace of service delivery. Thus, the care coordination professional has an ethical issue to consider when deciding to provide care for a patient whose need is higher than that of a patient with lesser need (McConville & Mustala, 2024). Limited staffing and limited resources in the healthcare system contribute to the problems that arise when trying to coordinate care for patients at the local level; therefore, healthcare workers are often faced with having to make ethical decisions as they try to ensure patient-centered care.
Slide: 08
Impact and Consequences of the Policies
The effectiveness of healthcare providers’ coordination of care can be affected by policies in healthcare, either positively or negatively. With regard to positive impacts, policies can be useful in increasing access to healthcare services, enhancing interdisciplinary partnerships, and encouraging preventive care. For instance, the Medicaid expansion has led to an estimated 5-7% rise in the use of primary care services (Ma et al.,2022). Policies, however, also affect the administrative requirements healthcare providers have, such as documentation, insurance verification, compliance, and more, leading to stress and burnout for nurses and care coordinators. This therefore reduces the quality of patient care provided.
Slide: 09
Impacts at the National, State, and Local Levels
There has been a transformation in national policies on healthcare coordination. Value-based care has provided new models of care coordination through healthcare policies, particularly the ACA, to enhance quality of care and outcomes. The value-based healthcare model demands a constant flow of monitoring, documenting, and reporting of patient outcomes on the side of the healthcare providers, which can result in a heavier administrative workload. It has been found that continuous assessment of performance and compliance with requirements can cause stress and reduce time spent with patients in value-based systems (Khalil et al., 2025). This can affect the effectiveness of care coordination and patients’ experience.
Medicaid expansion has benefited access to health care services – at the state level – particularly among low-income and underserved populations. The rise in patients, however, has been coupled with a lack of adequate resources to deliver timely care, resulting in delayed care. Research indicates that almost 25% of patients in underserved regions struggle to receive timely specialty care (Dismore et al., 2025). Local health policies influenced the behaviors of patients with regard to the use of health services, especially during the COVID-19 pandemic. The lack of trust and misinformation were obstacles to access to care and impacted health professionals’ communication practices with patients. There is a wide range of policy impacts on care coordination at various levels, highlighting the need to balance regulatory requirements, costs, and patient-centered care.
Slide: 10
The Role of the Code of Ethics in Care Coordination
The Code of Ethics is a key element of nurses’ work in coordinating care in a way that is ethical, and thus fair and respectful to patients when coordinating care. This code is informed by principles of autonomy, beneficence, nonmaleficence, and justice. The nurse identifies the use of these principles in making effective decisions in coordination of care. Sunrise Community Health Center nurses will champion their patients who may not be able to access health care services due to financial constraints, culture, and lack of insurance (American Nurses Association, 2025). In order to ensure equal access and quality of care to all patients, regardless of who they are, advocacy is essential.
Nurses engage in advocacy and work with other health care professionals, such as social workers and case managers, who are delivering services that respond to the medical and social determinants of health to provide comprehensive and coordinated care for their patients. Team-based, patient-centered approaches build a coordinated and comprehensive care package to improve health for underserved populations by tackling social determinants of health (Foss et al., 2023). In line with the Code of Ethics, nurses will also deliver culturally competent, fair, and patient-centered care, which can play a significant role in minimizing the health disparities among patients.
Slide: 11
Factors Contributing to Health Disparities and Access to Services
The factors that contribute to health disparities and access to services. Social, economic, and systemic factors all play a role in health disparities in patients served by Sunrise Community Health Center. Patients do not access care very well – many of them are uninsured, and culturally insensitive and distrustful of medical care providers. All these converge to make it challenging for our patients to access care – poverty, lack of education, lack of housing, lack of insurance. Without the ability to afford care, patients will either be reluctant to visit the physician or will delay visits to physicians, thereby degrading their health. Research indicates that patients would not receive care or put it off when they can’t afford it, and therefore will not receive care or delay their visits to physicians (Park & Fung, 2025). Nurses collaborate with social workers and community groups to deliver a holistic approach to care in response to these health disparities, including medical, social & psychological support. All these elements together are a reflection of the moral conviction of justice.
Slide: 12
Conclusion
There are policies, such as Medicaid Expansion and the ACA, that have led to opportunities for access and coordination of care. However, they also present many ethical issues regarding equitable access and appropriate use of resources, as well as determining which patients should be prioritized. The nurse code of ethics gives nurses guidance as to how to advocate for the care of patients fairly and to foster fairness and cooperation. Sunrise Community Health Center is constantly faced with the challenge of effectively coordinating healthcare services while also complying with government mandates, while still meeting our ethical responsibilities to provide patients with equitable and quality healthcare services.
References
American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association. https://codeofethics.ana.org/home
Baten, A., Noman, A., & Rahman, M. N. (2024). Affordable Care Act Medicaid expansion, access to health care, and the financial behavior of the United States adults. Journal of Public Health Policy, 45(4), 740–756. https://doi.org/10.1057/s41271-024-00522-0
Centers for Disease Control and Prevention. (2025). Centers for Disease Control and Prevention. U.S. Department of Health & Human Services. https://www.cdc.gov/
Department of Health & Human Services. (2024). U.S. Department of Health & Human Services. HHS.gov. https://www.hhs.gov/
Dhaliwal, J. S., & Dang, A. K. (2024, June 7). Reducing hospital readmissions. NIH.gov; StatPearls publishing. https://www.ncbi.nlm.nih.gov/books/NBK606114/
Dismore, L., Frew, K., Wakefield, D., Bryan, C., & Swainston, K. (2025). Remote and rural communities face inequalities in access to specialist palliative care. Could telemedicine enhance care? A qualitative study of patients, carers, and healthcare professionals’ experiences of video consultation. Palliative Care and Social Practice, 19. https://doi.org/10.1177/26323524251380632
Foss, R., Fischer, K., Lampman, M. A., Laabs, S., Halasy, M., Allen, S. V., Garrison, G. M., Sobolik, G., Bernard, M., Sosso, J., & Thacher, T. D. (2023). Disparities in diabetes care: differences between rural and urban patients within a large health system. The Annals of Family Medicine, 21(3), 234–239. https://doi.org/10.1370/afm.2962
Kaiser Family Foundation. (2024, May 28). The Uninsured Population and Health Coverage | Kaiser Family Foundation. https://www.kff.org/uninsured/health-policy-101-the-uninsured-population-and-health-coverage/?entry=table-of-contents-trends-in-the-uninsured-rate
Kaiser Family Foundation. (2025, April). Medicaid and CHIP eligibility, enrollment, and renewal policies: States resume routine operations following the unwinding of the pandemic-era continuous enrollment provision. https://www.kff.org/medicaid/medicaid-and-chip-eligibility-enrollment-and-renewal-policies-as-states-resume-routine-operations-following-the-unwinding-of-the-pandemic-era-continuous-enrollment-provision/
Khalil, H., Ameen, M., Davies, C., & Liu, C. (2025). Implementing value-based healthcare: A scoping review of key elements, outcomes, and challenges for sustainable healthcare systems. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1514098
Ma, Y., Armstrong, D., Forte, G. J., & Yu, H. (2022). Effects of the Affordable Care Act Medicaid Expansion on the compensation of new primary care physicians. Medical Care, Publish Ahead of Print. https://doi.org/10.1097/mlr.0000000000001740
McConville, S., & Mustala, S. (2024, January 17). Medi-Cal has expanded health coverage in California. Public Policy Institute of California. https://www.ppic.org/blog/medi-cal-has-expanded-health-coverage-in-california/
Park, S., & Fung, V. (2025). Health care affordability problems by income level and subsidy eligibility in Medicare. Journal of the American Medical Association (JAMA) Network Open, 8(9), e2532862–e2532862. https://doi.org/10.1001/jamanetworkopen.2025.32862
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. (2021). Health insurance coverage and access to care for immigrants: Key challenges and policy options. https://aspe.hhs.gov/sites/default/files/documents/96cf770b168dfd45784cdcefd533d53e/immigrant-health-equity-brief.pdf