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The Integrated Care Learning Community--A New Hampshire Experience

Posted By Bill Gunn, Thursday, February 17, 2011
Updated: Friday, June 10, 2011

I work in a community health center and a family medicine residency program in New Hampshire. Along with many in the Collaborative Family Healthcare Association (CFHA) I have wanted to be able to "group up” and find ways for those doing collaborative work to get together and share their successes and barriers. The CFHA has been trying to stimulate regional efforts through conferences and summits; enlisting interested stakeholders to meet as part of the annual conference. I have noticed however that there are many more out there who don’t write about what they do, they don’t meet at regional summits and they don’t go to conferences, they just do great things! We all want to avoid isolation and add to the momentum to cause a "tipping point” effect for integrated/collaborative care.

Five years ago in New Hampshire, a relatively small state known for conservative politics and primaries, there was a significant effort to define what mental healthcare reform could look like to bring the state from its current "D” rating back to its previous "A” rating a few years ago. I served as co-chair along with the Executive Director of NAMI, Mike Cohen on a workgroup focused on integrated care. We met for two years with physicians, consumers, behavioral health practitioners and administrators to produce a document that reflected our summary and recommendations about what needed to happen to integrate care. The results were published and through a meeting with the governor and many legislators we all learned more about improving our current healthcare status. The bumper sticker read "Mental Health is part of Overall Health”. The ball moved a bit forward.

White papers are great and there are lots of them. But how do you keep the ball rolling? Enter the learning community! The terms "learning collaborative” and "learning community” have been used by many including the Institute for Healthcare Improvement and the National Council for Community Behavioral Healthcare. Learning communities are more grass roots and open to all interested parties Our first meeting with thirty interested stakeholders, met for three hours without a break and created a significant local "buzz”.

Since that first meeting in October of 2008 we have continued to meet bi-monthly for the past two years. This year we have reorganized and are having a fall and spring meeting each with a local guest presenter. Last fall, Craig Jones, medical director of the Vermont Blueprint for Health was a guest speaker and he talked about the critical importance of his state’s incorporation of behavioral health professionals in their health reform pilot projects. Medical (Health) home projects all over the country are learning the lesson that incorporating behavioral health is a key component. Following are some key points that may facilitate creating an Integrated Care Learning Community.

1. Actively engage those individuals who are already moving ahead with some form of integrated care.

2. Engage as many different ‘world views” as possible. We had CEO’s and CFO’s of several local mental health centers as well as community health centers, behavioral health consultants in community health centers, academic researchers, primary care physicians in private practice and in community health centers, state administrators from Health and Human Services, (Nancy Rollins, state deputy commissioner was the co-leader of this initiative) and substance use administrators and clinicians.

3. Create a mailing list to function as a list serve so members can communicate with each other between meetings.

4. Keep the initial focus on sharing knowledge and best practices. While the Antioch NE research project (mentioned below) was an ongoing project, busy professionals can lose sight of the primary purpose of this group by creating to much of a "to do” list. This can be a natural outgrowth later.

5. Keep the idea of policy advocacy at the forefront. As state legislators or medical home pilot projects become more interested in this effort, membership of the learning communities can be a way to become involved in these more comprehensive efforts.

These learning communities are a great way to informally organize. They could even be seen as state or regional chapters of CFHA to increase contact between national meetings and try to keep up with the expanding knowledge in the field. I look forward to hearing more stories about other efforts to create these around integrated care.

Here are three examples of integration projects happening here in NH that you will likely not have heard about.

Mid-State Health Center located north of Concord in Plymouth NH. Here psychologist Vince Scalese and physician Fred Kelsey had been working in parallel practices for 30 years. Through work and over the occasional beer, they often revisited the idea of "Wouldn’t it be nice if we got together in practice”. So five years ago, Vince agreed to merge his practice with Mid-State for which Fred served (and continues to serve) as the Medical Director. The Electronic Health Record that has been in place since 2003 was tweaked to include templates for behavioral health services. This was done so patients would have a truly shared record that was designed for the way the both clinicians documented. The CEO of Mid-State, Sharon Beaty, worked to break down administrative and financial barriers for them, built a new building with behavioral health in the center of the action and together Mid-State is making it happen.

Antioch University New England located in western New Hampshire. Psychologists Jim Fauth and his colleagues received local funds to provide support in evaluating local projects in five community health centers in the state. Representatives from all five heath centers joined the learning community and reported on the populations on which they were focused and ways in which they were trying to improve care delivery to those populations. Four of the five centers have embedded behavioral health services and have benefited from the efforts to participate together in a joint evaluative project.

Avis Goodwin Community Health Center in Dover, New Hampshire. In partnership with Great Bay Mental Health, leaders of the project worked with Intermountain Health Care to secure a grant that would put psychological and social services together with medical services. They used protocols and processes that Intermountain has employed for several years. Sandy Rose, PhD, psychologist and owner of Great Bay recently shared her research with the learning community on the use of informed consent forms to be used in primary care.

This is just mention of a few examples. There are many more and the capacity to follow and advise these projects has been very stimulating…………but you get the idea. The excitement over finding like minded folks who were local was a great thing!

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