Collaborative relationships may or may not involve financial integration. If the type of collaboration includes a financial component, hospitals, health systems, and providers should consider their relative power and experience in insurance negotiations, medical billing, and revenue cycle management. 

Collaboration that involves financial integration should occur in a cooperative way that does not devalue or silence the expertise of doulas. Even when established healthcare practices utilize their revenue cycle management expertise to help doula organizations, it’s important that the assistance does not come at the cost of doula expertise and knowledge to inform final decisions and program designs.