Contributor – Kathleen Donaher-Keough, PhD, RN

Why This Matters to Nursing

From a nursing policy perspective in the United States, defining collaborative care as an Essential Health Benefit (EHB) aligns reimbursement, workforce utilization, and quality outcomes with what nurses already do every day: coordinate, assess, educate, and sustain care across settings and time. Primary care fragmentation disproportionately increases nursing workload, moral distress, and preventable utilization. Policies that lower premiums without protecting collaborative, team-based care shift burden downstream—onto nurses, patients, and families.

Emancipatory Knowing in nursing is defined as the human capacity to be aware of and critically reflect on the social, cultural, and political status quo and to figure out how and why it came to be that way” Sociopolitical knowing focuses specifically on the environment of care – the policies and  institutional practices that influence nursing practice. These fundamental aspects of our discipline direct our attention to the policies that shape the practice of nursing, and compel us to be actively involved in the policy-making process. I invite you to recognize Collaborative Care as an Essential Health Benefit, and to take action to support the policy decisions that are needed at all levels that shape our practice. Consider these guidelines as you take action in your own communities. 

Nursing-Centered Policy Position

Nursing organizations should support:

• Extension of Affordable Care Act (ACA) – also known as “Obamacare” – enhanced premium tax credits, and
• Statutory definition of collaborative care as an EHB, applicable to:
  • ACA Marketplace plans
  • Association Health Plans (AHPs)
  • Employer-sponsored plans

This ensures that affordability reforms do not erode care coordination, behavioral health integration, or chronic disease management.

Core Nursing Argument

• Access without collaboration is not access—it is episodic contact.

Collaborative care:

• Preserves continuity (a core nursing value)
• Supports RN/APRN-led care coordination
• Reduces avoidable Emergency Department use and hospitalizations
• Improves patient experience and equity

Advocacy Talking Points (Nursing Voice)

For Legislators / Staff

• Nurses see the consequences of fragmented coverage firsthand: missed follow-ups, unmanaged depression, and duplicative testing.
• Collaborative care is evidence-based, cost-effective, and already recognized by CMS through quality and payment models.
• Defining collaborative care as an EHB protects primary care quality while allowing market flexibility.

For CMS / Regulators

• Aligns EHB standards with existing CMS quality metrics and value-based purchasing goals.
• Supports nursing-sensitive outcomes (care coordination, patient engagement, chronic disease control).

For Coalitions

• This is a unifying position across nursing, primary care, behavioral health, and patient advocacy groups.

About Kathleen Donaher-Keough, PhD, RN

Kathleen is nursologist with a passion for integrating nursing science into contemporary wellness, coaching, and leadership development. She is particularly interested in the practical application of Peplau’s and Rogers’ theories in health promotion and human flourishing.