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Integrated Care Learning Community – New England Style

Posted By Bill Gunn and Julie Schirmer, Thursday, December 6, 2012
Updated: Monday, December 3, 2012

What the heck is a "learning community?” The definition we are using is: a group of like- minded individuals working together to learn what’s working, what’s not working, and how to change our systems to be more collaborative. This collaboration is necessary with patients, families, health care teams and systems.

Management consulting guru, Peter Vaill, describes the constantly changing world we are in as being in "constant white water”. There are no pools to recover and rest before the next set of rapids. We just need to learn how to paddle the boat better through the white water of change. Rather than just working harder, Vaill proposes strategies of working smarter, specifically working "reflectively smarter” and "collectively smarter”. The learning community model uses both strategies. The integrated care "river” is moving forward all over the country. In the aftermath of the election and the move towards population-based "accountable care organizations", we all need to work "collectively smarter.”

White water

"There are no pools to recover and
rest before the next set of rapids. 
We just need to learn how to
paddle the boat better through the
white water of change."

There are other organizations using this strategy. For example, The Institute for Healthcare Improvement (IHI) sponsors ” learning collaboratives”, bringing in hospitals, clinics and other organizations to provide technical assistance for their change efforts. The National Council of Behavioral Healthcare sponsors learning communities among behavioral health organizations, which provide integrated primary care health services for the severe and persistently mentally ill.

We need to look for partners in our local systems and in our geographic regions to share sustainable models, influence new policies, and collect mutually agreed upon data to discern the impact of different models of care. CFHA has been a leader in conducting national meetings held in regions where there is strong interest and activity in integrated care. Each of the meetings has held a local "summit” that has brought together leaders from the region to learn together and ideally create integrated care workplans.

We know that many folks from other parts of the country think that in New England "good fences make good neighbors”, but our experience with integrated care has shown this not to be true. We have created a steering committee and workgroups around training, advocacy and quality improvement with representatives from Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut. We have had monthly steering committee phone calls, two face-to-face meetings, and plans for more to work on projects of common interest in the region. These projects are in the areas of training, advocacy, and quality improvement.

There is another organization, the Family Medicine Education Consortium (FMEC), whose mission is to move important primary care health projects along and to promote family medicine. The goals of FMEC and CFHA overlap around integrated behavioral health care. The two organizations sponsored two preconferences in the fall of 2011 and 2012 on Supporting Sustainable Integrated Care. The 2011 meeting kicked off the New England Learning Community. The 2012 meeting in Cleveland, Ohio set the stage for a state-wide Ohio Learning Community and planted the seeds to bring together the 4-5 Pennsylvania integrated care state-wide organizations in the fall of 2013.

The Ohio proceedings included lessons learned from providers, administrators, funders, and foundations. Jennifer Hodgson started the meeting with an overview of the impact of the Accountable Care Act on behavioral health integration and the cutting edge advocacy work taking place in North Carolina. The panelists and discussions were very dynamic. The meeting ended with learning community strategies for the states represented at the meeting. The Ohio group has created a listserve and is approaching a couple of groups in northern Ohio to "house" a state-wide learning community, connecting it to the good work of Janice Bogner and colleagues at the Health Foundation of Cincinnati Susan Labudo-Schrop at the University of Ohio College of Medicine Family Medicine Department (NEOMED).

One of the surprise outcomes of this Ohio meeting was identifying the North East Learning Community Theme Song. We had not yet read Randall Reitz's blog regarding a theme song for the CFHA. So, although we "ain't got much money", we do have fun AND a theme song! If you are at all curious, click here to view the original Youtube version. We really like the chorus. It's catchy, great to dance to. Yet we need to rewrite the rest of the lyrics As with behavioral health integration, we aren't satisfied with the traditional organization of the song. An integrated care transformation is needed to benefit patient satisfaction, clinical outcomes and cost! Maybe selling the rights to the new lyrics will bring in money to support our efforts. Stay tuned!

In southwest Virginia, another regional effort is taking place, sponsored by Radford University and the primary care clinics in that area. Cathy Hudgins and Bill McFeature have organized an annual conference and provided technical assistance to clinics and behavioral health organizations in that area.

Through the North East, our hopes are to connect these efforts: informing our care, strengthening our ability to learn from each other, uniting to influence policies to improve care, and "taking it to the streets". We have an assumption that there are many more efforts local and regional efforts to promote integrated care and we hope this blog will encourage others to let us all know what you are doing.


Bill Gunn

Bill Gunn PhD is a faculty member of the NH/Dartmouth Family Medicine Residency in Concord, NH and holds a clinical appointment at Dartmouth Medical School. He is a board member of the Collaborative Family Healthcare Association. Bill is a co-author of Models of Collaboration (2006) and The Collaborative Psychotherapist (2009). He coordinates with Julie Schirmer, LCSW an integrated care "learning community” in New England which meets regularly. He is membership co-chair of CFHA, and co-chair with Nancy Ruddy, PhD of the Division 38 primary care subcommittee.



Julie Schirmer
Julie Schirmer, LCSW is Director of Behavioral Health at the Family Medicine Department of Maine Medical Center and Assistant Director of the Family Medicine Clerkship at Tufts/Maine Medical Center School of Medicine. She is Co-chair of the North East Regional Integrated Care Learning Community, Past President of the Family Medicine Education Consortium, and upcoming Director of the Behavioral Science/Family Systems Educator Fellowship of the Society of Teachers of Family Medicine. She is author and co-editor of Behavioral Health in Primary Care: A Global Perspective(Radcliffe, 2010).

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