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The Pros and Cons of Patient Portals: Can Integrated Electronic Health Records Help Empower Patients?

Posted By Peter Y. Fifield, Friday, February 3, 2012
Providers spend a significant amount of time with patients problem solving effective ways to manage chronic health issues. Through the use of Motivational Interviewing for example, providers focus on increasing patient self efficacy; "how do I guide this patient in owning their own health?".

With the rapid grown of Health Information Technology (HIT) I'm optimistic that HIT, specifically the use of patient portals, will provide more tools for not only improving patient satisfaction and reducing costs, but also in addressing another real issue in healthcare: Increasing patient autonomy.


Patient portals become a window of opportunity for managing our own health. Metaphorically speaking it is like maintaining our car with the use of that dusty paperback in the glove compartment: The vehicle maintenance log. We resource the maintenance log to see what work has been done in the past and as importantly, what work needs to be done in the future. To compliment this log, we use the gauges on the instrument panel. We read the tachometer, the gas gauge, and the engine lights to understand what the vehicle needs. These data complete the feedback loop so we now know how to act: Get gas, inflate tires, flush your transmission.  You get the idea.

A patient portal could act in a similar way. Medications, appointment times and blood pressures could all be accessed via the encrypted portal and assist the patient in being a better manager of his or her own body. I can hear it now "there's an app for that"...imagine remote blood sugar sent from the glucose monitor to our medical record via the patient portal. Diet and exercise routines could be managed daily, calorie counts entered at each meal; all of this managed on your own medical portal (and possibly complimentary smart phone applications). Most important, it can all be updated and facilitated in real-time by patients or their HIT devices. There is a market here just waiting to explode.

With such potential, why is it then that so many providers have an issue with the use of patient portals? I heard one physician say: "not on my watch" and a BHC say: "I'm unsure of the benefits here" regarding initiating a patient portal access initiative at a local primary care clinic. In the spirit of investigating this enigma, I have listed a few key components of patient portals below that I think provide the most fodder for the cannon in terms of eliciting arguments from both camps. Just to clarify, in this blog I am referring to patient portal access to the patients own electronic medical record (EMR) not the "never-used" Electronic Health Record (EHR) that are typically little more than a hi-tech headache.

1. Patient portals can be thought of as a gateway to patient data, health record content, and web services associated with the hosting provider. Patients get secure, encrypted access via use of a patient ID and password; a similar process that allows clients access to other very sensitive information such as online banking. Unlike with online banking, medical information is often sensitive information and keeping unwanted eyes from seeing your portal could prove difficult. As this one article shows, the views on confidentiality are mixed.

2. Providers grant patients access via their username and password and through the patient portal, the patient may be able to perform the following tasks:
  • Check their appointment schedules and requests an appointment
  • View lab results and basic patient information such as BMI, BP, and weight
  • Examine medical and billing statements
  • Request prescription refills
  • Complete new patient intake forms and registration information
  • Complete ongoing assessment forms such as PHQ 9, GAD7, DUKE 17, etc.
  • Correspond with medical personal via encrypted email services
An interesting philosophical question here is that if the medical chart really belongs to the patient, why is it the provider that is granting access? Who is really driving the bus here? This may be a reflective residue of the slowly fading paternalistic role providers have played in the past. It could be argued that until the patriarchal paradigm is shifted to give power to the patient, they simply will not have it.

3. Through reviewing provider satisfaction research, one of the most often heard complaints is that the providers do not have enough time with patients. Period! In addition, providers spend significant time discussing symptoms and providing medical advice that they do not bill for. Simply stated, there are too many things to address aside from the Chief Complaint. Through the use of the portal providers and support staff can communicate back and forth with the patients and send messages such as appointment reminders, electronic statements, and lab results.

Historically, part of the provider-patient relationship included correspondence via phone. We could consider the patient portal a very high tech, and easy to facilitate version of that same information exchange, however; it would be more informative for the patient and much easier and less time-consuming for the provider.

4. The patient can complete much of the patient visit information and yearly paperwork prior to the visit. Existing patient intake and medical forms can be uploaded onto the website for the patient facilitating the process for not only the patient and provider, but for the support/office staff as well.

5. All of the interaction on the patient portal can be set to directly integrate into the chart. Although I disagree with this on a philosophical level [see above], pragmatically the medical practice is the ultimate authority regarding how much data is conveyed to the patient. Said otherwise, the patient does not have access to all of the doctor's records at any time. Patients only see what doctors want them to see and thus the physician note remains protected.

Portals could provide more patient access to a very valuable resource: Provider knowledge

Ideally, using a high quality patient portal allows the patient to upload their records to a central repository. The continuity of care between different doctors of different specialties, in different locations, becomes a reality for the self-efficacious consumer.

6. The portal is accessed through the practice’s web site. Educational material [including pdfs, photos videos etc] and links to other websites [i.e.patientslikeme.com, sermo.com, dailystrength.org] can be posted on the web site as well to provide adjunct services and supports. Many practices post educational information such as diabetes information, exercise options, support service information, times and dates of groups being held, diet/meal planning suggestions, and medication information, etc. on their practice web site as a service to their patients.

With the HITEC Act in place, it is reasonable to say that more and more providers will continue to venture into the world of high-tech charting. Patients could have far more access to their provider's vast knowledge by complementing the face-to-face visit with portal access and thus create a more interactive relationship with their medical record.

I see this as exchange of information via patient portal as a compliment to the face-to-face appointment; an extension of the office visit, if you would. Providers are the keepers of an infinite amount of medical knowledge and currently there are 2.7 physicians per 1000 people in the US. The informational bottlenecking lies in the finite space in time providers have to transfer that information to the patient. In a 15 minute visit we all know this is impossible. The patient portal could act as an expansion of this 15 minute window and would allow for more patient access to a very valuable resource: Provider knowledge.

Patient portals are obviously no panacea for the health care crisis. Ultimately nothing replaces patient accountability when it comes to overall health outcomes. However; the patient portal could function as an integral tool in increasing patients’ motivation for healthy living by giving patients access to their own information.

Inevitably technology will continue to play a role in patient care and most likely patient portals will be more widely used.

My question is, why not now? I'd be curious to hear other opinions out there regarding the pros and cons of using patient portals. Is there anyone out there in the CFHA audience already using them? How has it worked? What are your thoughts?


Pete Fifield is the Manager of Integration and  Behavioral Health Services at Families First Health and Support Center; an FQHC in Portsmouth NH. In his off time he is the Managing Editor of CFHA Blog and makes all attempts to keep up with his wife and two sons.

The view expressed in the blogs and comments should be understood as the personal opinions of the author and do not necessarily reflect the opinions and views of the Collaborative Family Healthcare Association (CFHA). No information on this blog will be understood as official. CFHA offers this blog site for individuals to express their personal and professional opinions regarding their own independent activities and interests.

Tags:  CFHA  health information technology  Integrated Health  patient portal 

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Collaborative Family Healthcare Association: Value Added For Canadians

Posted By Ajantha "AJ"Jayabarathan, Thursday, January 5, 2012

Kentucky had settled into the month of October in 2010, when I arrived there to attend the 12th annual CFHA conference. It was not only my first visit to Kentucky but also my first attendance at the conference and I was ready for an adventure. I expected to hear, see and learn much that was different from my home city of Halifax Nova Scotia.

 People spoke with a distinct drawl that was friendly; the skyscrapers loomed; the city blocks hosted an interesting array of monuments and storefronts; the downtown core was both inviting and somewhat dangerous in its layout; and I plunged into this journey of discovery.

I sat with three hundred and fifty other participants at the conference and happened to be the sole visitor from Canada. The candid, direct styles of the keynote speakers and the bold imagination in their ideas grabbed my interest. The sessions were equally rich and thought provoking. I found myself volunteering my comments, answering questions, getting easily acquainted with other participants and even hosted a lunchtime discussion on Compassion Satisfaction!

The members of the CFHA board and their executive team appeared genuinely interested to make my acquaintance and learn about their sister organization in Canada (National Working group on Shared Mental Health Care). And to top it all off, they invited me to join their membership committee, so that we could work towards strengthening ties between our respective organizations. Before too long, I was invited to write a Blog for the CFHA (V-Forming Healthcare), they joined forces with the planning committee in Halifax which was organizing the 12th Canadian Conference on Collaborative Mental Health Care, an entire month was dedicated to blogs written by Canadian authors and they sent email invitations to their membership, promoting the Halifax conference.

Never before, had I experienced such like-minded dedication to promote, advocate and develop the concepts embedded in Collaborative Mental Health care; and it was happening to benefit both Canadians and Americans.

In Canada, the essence of Collaborative Care is currently being embedded in many provincial re-organized health systems as well as the Mental Health Commission of Canada. It is defined in the newly launched 2011 position paper from the Canadian Psychiatric Association and College of Family Physicians of Canada as Mental Health, addiction and primary care practitioners working together, with people and their family members, to ensure that an individual reaches the services they need, when they need them, with a minimum of inconvenience. It is;

  • Built on personal contacts
  • Based on mutual respect and trust
  • Based on effective practices
  • Responsive to changing needs with openness to new ideas
  • Shaped by context, culture, local resources, shared goals & local solutions
  • Contingent upon five key components – Effective communication, Consultation, Coordination, Co-location and Integration


In Canada, this model of care started with psychiatrists and family physicians working together to provide care differently than established traditional models in the mid-1990s. In 2005, this model was expanded to involve 12 other partners in the work of the CCMHI (Canadian Collaborative Mental Health Initiative); pharmacists, nurses, occupational therapists, social workers, psychologists, dieticians and first voice/consumers/people with lived experience.

Meanwhile, in March of 1993, 15 colleagues from the fields of family medicine and family therapy met to develop a better healthcare paradigm in the USA. This model aimed to address pressing clinical and economic problems.
Naming their vision the "collaborative family healthcare model", they formed an organization to bring together those interested in this innovative approach. In July 1995, CFHA held its first national conference in Washington, D.C. It was well attended and received glowing reviews. The Collaborative Family Healthcare Coalition was up and running.

CFHA is a member-based, member-driven collaborative organization. Collaboration isn't just a word in the organization's name; it defines who we are, how we interact with each other and other organizations. We believe deeply that collaboration is an essential element necessary for re-visioning healthcare, specifically, and society, generally.

CFHA promotes a comprehensive and cost-effective model of healthcare delivery that integrates mind and body, individual and family, patients, providers and communities.CFHA achieves this mission through education, training, partnering, consultation, research and advocacy. We not only host a leading-edge conference every year, we also are active in every other aspect of healthcare change: development, design, delivery and assessment.

October 2011 found me in Philadelphia at the CFHA's 13th annual conference. A new city to discover, new colleagues to hear from, a new set of keynote speakers to present material to evoke and provoke new directions in evolving models of care. I presented the 2011 Canadian position paper alongside Dr. Roger Bland one of the other co-authors, and was one of five Canadians at the conference. The Canadian organization and its work were presented as part of the exhibitors, mirroring CFHA's presence at the Halifax conference earlier in the summer.

Collaborative practice is about how we practice together….how we treat each other….how we benefit from each other's perspective and the partnership that we bring to the table so that people and their families are served to their benefit. It is different from traditional team based approaches. To truly "experience” what it feels like, one has to be open to the ideas and diversity of people involved in this model of care.

Your attendance at the annual CFHA and Canadian conferences could serve as a starting point for you. Robust information and the evidence base for this model of care are available on their websites: cfha.net and shared-care.ca.  Consider looking at the material on these sites. Consider attending the conferences. Consider these alternative models of care in your practice of primary care and mental health care, and imagine what it could be like……..and you may find yourself in Vancouver, British Columbia in the summer of 2012 and Austin Texas in the fall of 2012…..ready for an adventure……and return awash with new ideas that have fuelled your hidden passion to work collaboratively….and you will have found what now energizes my daily practice of medicine!

Ajantha Jayabarathan (AJ) is a Family Doctor practicing in Halifax, Nova Scotia. She is well recognized in the Atlantic region of Canada due to her columns on television. She is an Assistant Professor at Dalhousie University and co-chaired the organization of the 12th Canadian Conference on Collaborative Mental Health care in Halifax 2011. She also co-leads the advocacy coalition, Healthynovascotians.com

Blog Disclaimer:

The view expressed in the blogs and comments should be understood as the personal opinions of the author and do not necessarily reflect the opinions and views of the Collaborative Family Healthcare Association (CFHA). No information on this blog will be understood as official. CFHA offers this blog site for individuals to express their personal and professional opinions regarding their own independent activities and interests.

Tags:  Canadian Collaborative  CFHA  family medicine  primary care 

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INTRA-Disciplinary Care: Can Mental Health Professionals Work Together in Primary Care?

Posted By Jennifer Hodgson , Thursday, December 1, 2011
Updated: Thursday, December 1, 2011
The burgeoning success of integrated care brings with it a complicated by-product. The diverse range of behavioral and mental health professionals are stepping up to the plate. Many of these professionals, trained under the "old guard” as competitors in the market, are now tasked to re-align in the context of a new paradigm. The following represents insights from a year-long conversation (tongue in cheek) between two friends and colleagues, one a clinical psychologist and the other a medical family therapist who are in search of a model of intra-disciplinary collaboration.

Dr. Jodi Polaha, Most Awesome Clinical Psychologist (and humble too):

Last fall, I sat through an uncomfortable board meeting. I was charged to work with a Clinical Social Worker, Licensed Practicing Counselor, a Counseling Psychologist, and a Licensed Nurse Practitioner to develop an integrated care training program as part of a rural workforce development project. Whose students could provide treatments in behavioral medicine? Whose students could help develop programming? Whose students understood research well enough to do program evaluation? "Ours!” I said, smiling.

So did the other professionals in the room.

"NOT!” I shouted in my mind. I tried to keep my facial expressions in check, but it was hard. Everyone knows social workers help people get food stamps and find support groups, right? Everyone knows our counseling friends deal mostly with life-adjustment issues, right? And everyone knows that clinical psychologists are superheroes, trained in the scientist-practitioner model, who REALLY CAN do everything…RIGHT?

I was challenged by this conversation, and recognized my long-held, inaccurate stereotypes of other mental health disciplines, including my own. Still, some questions made me itch: Can mental health professionals from various training backgrounds work harmoniously in integrated care? If so, could their roles be interchangeable? Should they be?

I took my questions to Dr. Jennifer Hodgson. Who would know better than the president of CFHA? Granted, she is a marriage and family therapist (or medical family therapist as she calls herself these days), so she lacks the finely-honed analytical skills of a clinical psychologist. She can pick out a cute suit, though, so I felt it was worth a try.

Dr. Jennifer Hodgson, Supreme Marriage and Family Therapist:

First, I would like to say, when Jodi Polaha approached me with questions about intra-disciplinary collaboration, I had to hide my confusion. Why would a clinical psychologist be concerned about this? Don’t they mainly do testing and inpatient work with serious and persistent mental illness? Isn’t their training mainly in one specific area of health or mental health? What are they doing in primary care? I would not want a foot specialist operating on my eye, after all! How does she figure she is a team player with the likes of medical family therapy, who, we all know, leads the field in advancing integrated care! I know what is going to happen, she just wants psychologists to take over the leadership of this integrated care movement. Arguably, they do have Medicare in their back pockets, but so do social workers. Does that mean though that they are better integrated care clinicians?

There are so many inaccuracies in how different mental health disciplines are trained that perpetuate the ideas that others are less well trained simply because of their degree. Why can’t a social worker, pastoral counselor, professional counselor, or family therapist (had to get my field in there somehow) run an integrated care service with a blend of professions present? Of course we can work harmoniously Jodi, but we first have to be willing to be vulnerable and willing to learn from one another in the field.

I have gotten to a place where I just want all mental health disciplines to stop figuring out who is best based on degree and to start taking classes together, training in the field together, and promoting policy for parity together. We would be even better together…if only we knew how to share the space. It is the old adage of those who have power want to hang on to it and those who want it are working hard to get it. I tell my students that there is plenty of room in the sandbox so no need to throw sand to create space.

Most healthcare professionals just want someone who can do the job and cannot understand why some mental health providers cannot work together easily. I go back to how people were trained, Jodi, and I believe strongly that we can be retrained to learn models of integration that embrace multiple disciplines in the same location. We can share the work, divide the responsibilities, and promote one another’s strengths. We can embrace hiring someone not because of the degree, but because he or she meets the patient population’s needs and has the core competencies (to be determined) to provide integrated care services.

It starts at the training level and I believe CFHA is the place where we can drop our labels and learn the core competencies needed for the work. I know my calling is to train the next generation to behave differently, but it starts with me and sometimes I struggle with it too. I want to understand why we cannot just drop the entitlements...but as a systems thinker I know that change happens slowly, thoughtfully, and organically (with a smidge of encouragement from associations like CFHA).

Dr. Jodi Polaha

It’s funny, in spite of my reaction to that board meeting last year, this year in Philadelphia, I had so many positive interactions with professionals from so many varied disciplines. In that forward-thinking environment, Jennifer, it was truly effortless to meet the spirit of your ambition for all of us. I learned from social workers, public policy people, and physicians. I exchanged cards with a school psychologist from Florida, with similar research interests to my own. The energy in this mixed group was incredibly engaging and specific credentials, training history, and even experience seemed to fade away. In another week, I am off to a clinical psychology conference and, reflecting back, I feel I was more among "my people” at CFHA than I will be there.

It occurs to me that the mental health professionals involved in integrated care have so deftly cast off the old guard notions about the 50-minute session, the cozy psychotherapy room, and even the term "mental health.” I’d like to see your vision become a reality, Jennifer. Perhaps, the stereotypes and competitive dispositions will be the next to go.


Jennifer Hodgson, PhD, is a licensed Marriage and Family Therapist, Associate Professor in the Departments of Child Development and Family Relations and Family Medicine at East Carolina University, and outgoing President of CFHA. She has over 18 years clinical experience and has served on numerous boards and committees related to healthcare and mental health care issues. She is co-author to the first doctoral program in medical family therapy in the nation.


Jodi Polaha, Ph.D. is an Associate Professor in the Department of Psychology at East Tennessee State University where her primary professional interest is research, training, and workforce development in rural integrated practice. In addition to her work, she spends lots of time with her husband and two young boys swimming, biking, and hiking in the surrounding mountains.


The view expressed in the blogs and comments should be understood as the personal opinions of the author and do not necessarily reflect the opinions and views of the Collaborative Family Healthcare Association (CFHA). No information on this blog will be understood as official. CFHA offers this blog site for individuals to express their personal and professional opinions regarding their own independent activities and interests.


Tags:  CFHA  family medicine  family therapy  Philadelphia 

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CFHA in Philadelphia: A Field Trip for ETSU Doctoral Students in Clinical Psychology

Posted By Jodi Polaha, Wednesday, November 23, 2011
As a school girl, I always loved going on field trips, what kid doesn’t? What I know now is that it is just as fun, and maybe even more so, to guide one.

A few weeks ago, I took five students from East Tennessee State University (ETSU) to Philadelphia to see the Collaborative Family Healthcare Association in action. The students are in their second year in our doctoral program in clinical psychology, which has an emphasis on rural, integrated care. This semester, the students are taking my course, Primary Care Psychology; devoted to learning the language of contemporary healthcare, understanding the rationale and research behind integrated care, and evaluating models for its administration. Overall, the conference was a great way to bring to life the great potential and actual effects of their "book learning.” In particular, I was pleased to see that the content was not redundant with classroom-based knowledge, but advanced what they have learned. And, it was exciting for them to have employers asking, "When will you be finished?” with a position in integrated care in mind!

I thought blog readers might like to hear from these up-and-coming professionals themselves, so I asked them, "What impressed you most about the conference?”

Laura Maphis
I chose to earn my Ph.D. in psychology at ETSU, because I was hoping to learn how to "do” integrated care. What I have learned so far is that there is no instruction manual for "doing” integrated care, that it is a pioneering endeavor, and that the more I learn, the more questions I have. For instance, how are we going to do this in primary care when primary care has its own unique problems (e.g., fewer physicians seeking generalist careers)? How are we going to do this with multiple insurance/coverage barriers? How are we going to do this with little legislative support? As a graduate student new to the integrated care frontier, I felt the excitement of this "frontier” enhanced by the vastness of it (so many questions!), as well as the isolation of having only a small minority of U.S. care providers on-board. I am super impressed with how the 2011 CFHA conference was able to give shape and form to this vastness by honing treatments for specific disorders, treatment modalities, issues inherent in working with special populations, ethical concerns, billing and reimbursement considerations, cultural considerations, issues at the provider level, and education and research as they pertain to integrated care. Moreover, the collaborative nature of the CFHA conference made me feel, if only for a few days, part of a majority. As a result, I feel more capable of navigating this frontier in the future, and know that I will be in good company.

Sheri Nsamenang
My trip to CFHA happened right when I needed better shape to my career aspirations. Aside from the things I learned from listening to talks by renowned leaders in the field, the mentoring opportunity, the friendliness and the willingness of conference attendants to discuss the practicality of collaborative care, I was inspired by the informative research presentations at the poster sessions. While I have increasingly become conversant with the clinical practice of collaborative care, I have been less familiar with conducting research in primary care settings. As I visited various researchers and learned about their projects, I was exposed to a plethora of research topics, ideas, and designs. Although I did not necessarily leave the conference with an idea to research, I left with ideas on how I could design studies, examine interventions, and how to examine non-conventional data such as patient charts in a primary care setting. Off additional importance, I left feeling that there was an audience for primary care research. A highlight moment for me as I walked from one poster to the next, was meeting researchers from Japan. As an international student, this encounter made me realize that, CFHA was an association I could rely on in the future if I were practicing collaborative care somewhere in Africa.

Alishia Foster
At this conference, the model I had become accustomed to reading about had taken on new life. I felt I was part of a dynamic process of change and that the struggles of integrated care are also my own struggles. For example, sustainability was a prominent topic, and I found myself debating with my fellow students over pitching integrated care to insurance companies, the use of H&B codes, as well as the reality of current dependence on grant funding for many programs. Amidst the brainstorming over those few days and after, I felt that we are the generation rising up to follow in the footsteps of those we’ve read about such as Strosahl and Blount and be the innovators for a changing age of health care. The conference was an enlightening and encouraging experience, reassuring me that I am on the right track!

Jamie Tedder
What impressed me most about the conference was the "boots on the ground” mentality that was such a pervasive theme across so many of the sessions. It was exciting to hear about various integrated care research and projects that are having an impact and helping people in the here and now. I felt like I could easily take the information I gathered at the conference and immediately apply it to my own clinical and research experiences. During the First-Timer’s Orientation, CFHA’s outgoing president Jennifer Hodgson made the remark that CFHA is where she feels rejuvenated professionally and I certainly now echo that statement. The new perspective I gained from the conference has completely reshaped how I view my current program of research as well as the direction I would like to see my professional career take in the future. This grad student has definitely been inspired to lace up my boots and hit the ground running!

Jenny Barnes
Of the many impressive aspects of this conference experience, I would like to address the outstanding sense of community. It was such a great feeling to engage with like-minded up-and-comers and professionals who are truly committed to high quality care. Though the different healthcare disciplines may have their differences, one would never know from observing the interactions at this conference. It can be easy to think only in terms of one’s own "bubble,” so it was refreshing to see that the push for collaborative care is happening nationwide, and not just on paper, but in real, boots-on-the-ground applications. As well, the passion at this conference was palpable, and speaking of passion, I could not think of a better way to kick off the conference than with Dr. Brenner’s opening plenary session! Overall, this conference was a great learning experience and I’m glad we made the trip from east Tennessee. This is a conference I definitely plan to attend in the future as I stay abreast of the newest innovations in integrated care.

In closing, it’s worth mentioning that I am grateful to CFHA, who provided a scholarship to each student to defray the registration cost. I am also grateful to my Department Chair, Dr. Wally Dixon, who provided funds to cover transportation and hotel costs. Without this support the field trip wouldn’t have been possible… and that would have been a real loss for the students considering all they gained at the conference in Philadelphia … not to mention the cheesesteaks!


     Left to right:                                                            
     Sheri Laura, Jamie, Jenny and Alishia

The view expressed in the blogs and comments should be understood as the personal opinions of the author and do not necessarily reflect the opinions and views of the Collaborative Family Healthcare Association (CFHA). No information on this blog will be understood as official. CFHA offers this blog site for individuals to express their personal and professional opinions regarding their own independent activities and interests.



Tags:  CFHA  collaboration  ETSU  Philadelphia 

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CFHA is a member-based, 501(c)(3) non-profit organization dedicated to making integrated behavioral and physical health the standard of care nationally. CFHA achieves this by organizing the integrated care community, providing expert technical assistance and producing educational content.