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Integrated Care: A Critical Strategy for Chronic Illness, Prevention, and Pediatric Health

Apr 22, 2025
RE: Talking Points for CFHA Members Engaging Policymakers, Medicaid Leaders, and Local Officials Integrated care—the coordination of medical and behavioral health within primary and specialty settings—is a key solution to […]

Integrated Care: A Critical Strategy for Chronic Illness, Prevention, and Pediatric Health

by Neftali Serrano

RE: Talking Points for CFHA Members Engaging Policymakers, Medicaid Leaders, and Local Officials

Integrated care—the coordination of medical and behavioral health within primary and specialty settings—is a key solution to the most pressing health issues of our time. It is also perfectly aligned with the vision of Make America Healthy Again (MAHA): the root causes of chronic disease, promoting wellness, and protecting our children and adolescents.

Why Integrated Care Supports the MAHA Platform

Chronic Illness Root-Cause Care

Integrated care treats chronic conditions like diabetes, heart disease, and chronic pain by pairing medical management with behavioral support (e.g., stress reduction, adherence strategies, lifestyle change). It reduces over-reliance on pharmaceuticals and increases patient agency.1

Pediatric Health and Early Intervention

Behavioral health integration in pediatric settings helps children and families address anxiety, trauma, developmental delays, and family stress—before these become lifelong conditions.2

Prevention and Health Autonomy

Integrated care empowers patients through early intervention, behavior change support, and shared decision-making. It helps prevent escalation of mental health and physical conditions through timely, personalized support.3

Policy Recommendations for State and Federal Leaders

  1. Fund Integrated Care Teams in Primary & Pediatric Clinics
    • 1.1. Allocate Medicaid and federal resources to support embedded behavioral health in routine medical care settings including models such as PCBH and CoCM.
  2. Build the Workforce for Community-Based, Whole-Person Care
    • 2.1.Invest in training Behavioral Health Consultants, care managers, consulting psychiatrists, peer support specialists and community health workers specifically for primary care and prevention-focused roles.
  3. Enable Same-Day, Behavioral Health Support
    • 3.1.Reform payment and regulation to support brief, evidence-based interventions for mental health and substance use—especially in early stages and for populations with poor access to care.
  4. Incentivize Measurement-Based Preventive Care
    • 4.1.Promote simple, scalable technology tools to track behavioral health symptoms like we do medical labs—ensuring progress, accountability, and patient-centered planning.

What’s at Stake

  • 60% of U.S. adults have a chronic illness
  • Pediatric behavioral health crises are escalating
  • Substance use deaths and anxiety diagnoses continue to rise

Footnotes

  1. https://pubmed.ncbi.nlm.nih.gov/21190455/ ↩︎
  2. https://pubmed.ncbi.nlm.nih.gov/34807644/ ↩︎
  3. https://pmc.ncbi.nlm.nih.gov/articles/PMC8412979/

    Photo by Andy Feliciotti on Unsplash ↩︎

Why Texas?

Aug 5, 2024
Do We Engage Or Protest States With Regressive Healthcare Policies? As the CEO of the Collaborative Family Healthcare Association (CFHA), I want to address a topic that has been on […]

Why Texas?

by Neftali Serrano

Do We Engage Or Protest States With Regressive Healthcare Policies?

As the CEO of the Collaborative Family Healthcare Association (CFHA), I want to address a topic that has been on many of our minds: our decision to host conferences in states with regressive policies related to healthcare for women and other justice issues that impact healthcare professionals and the patients we serve.

To begin, I’ll state at the outset that our decisions are made with careful consideration and a conscious stance of engagement rather than absent protest. And, we don’t pretend to have all the right answers. We, meaning the CFHA board and staff, together with member leaders, come together and make the best decision possible for each situation. So, here are some of the reasons why we chose Texas as location for our upcoming conference.

A Stance of Engagement

Our decision to hold conferences in states with controversial policies is not an endorsement of those policies. Rather, it reflects our commitment to engagement. We believe in the power of dialogue and the importance of being present in these regions. By choosing to engage, we aim to foster discussions, share knowledge, and provide support to our members who are directly impacted by these policies. On balance, we asked ourselves whether being present and engaged was more efficacious than protesting via our absence and it was hard to see protest winning over presence.

Supporting Our Members in All States

We have members across the country, including in states with regressive healthcare policies. Abandoning these states would mean abandoning our members who live and work there. These dedicated professionals rely on CFHA for support, resources, and community. We cannot turn our backs on them during challenging times. Instead, we choose to stand with them, offering our support and ensuring they know they are not alone. This is especially true for Texas where some of our most ardent members, including our President, hail from. These teams are caring for women as they struggle with reproductive issues. They are caring for migrants as they struggle with immigration issues. They are caring for LGBTQ+ populations as they struggle to find support. It does not feel right to abandon those care teams.

Because They Asked

We host conferences in areas that members ask us to host conferences, and our San Antonio conference came to be as a result of an application put forth by a group in the southwest Texas region, much the same way our last conference was held in Phoenix, AZ as a result of an Arizona-based group. The planning committee, which hails from that region, is excited to show off their state and the many ways they have overcome barriers to care, including political barriers. This is crucial not just for Texas but for care teams coming from other states with regressive policies to have exemplars and encouragement that you can still provide quality, team-based care in difficult political environments.

A Long-Term Perspective

The issues we face in healthcare are complex and multifaceted. They will not be resolved overnight, and we cannot afford to ignore red-leaning states for decades to come. Change is a long-term process, and we must remain engaged and active in all regions to drive progress. By being present and vocal, we can contribute to meaningful change over time. In other words, we don’t see these issues resolving quickly and thus a decision to protest by avoiding red-leaning states could essentially mean 10 or more years of absence from these states.

Fostering Dialogue and Support

Our conferences are more than just events; they are opportunities for connection, learning, and growth. They provide a platform to discuss pressing issues, share best practices, and support one another. In states where healthcare policies are regressive, our conferences become even more critical as they offer a space for care teams to come together, find solidarity, and develop strategies to navigate the challenges they face. We have opportunities to have these discussions in San Antonio. And we have created a virtual Community Conversation in September ahead of the conference to ensure that we are primed to play an active role in supporting our Texas-based care teams.

Respecting Different Approaches

I want to acknowledge and respect that some may choose protest as their form of engagement. Protest is a powerful tool for change, and those who choose this path have our respect and support. However, given our relatively small size and purchasing power, CFHA believes that our greatest impact comes from being present and actively engaged.

I want to emphasize that our choice to host conferences in all states is driven by a commitment to our members and the belief that engagement is a powerful catalyst for change. We will continue to stand by our members, support their work, and foster dialogue, no matter where they are located. I’m sure some of you disagree with our stance and some may even choose not to come to the conference as a result of its location. I get it. These are tricky times around the dinner table. We just hope we can still be at the dinner table and continue the conversation.

Photo by Aarón Blanco Tejedor on Unsplash

Shaping the Future Together: Our Vision for Integrated Care

Feb 22, 2024
February 2024 As we look ahead, I’m filled with optimism and excitement for the journey we’re embarking on together. Our mission at the Collaborative Family Healthcare Association (CFHA) has always […]

Shaping the Future Together: Our Vision for Integrated Care

by chris

Photo by Joshua Earle on Unsplash

February 2024

As we look ahead, I’m filled with optimism and excitement for the journey we’re embarking on together. Our mission at the Collaborative Family Healthcare Association (CFHA) has always been to push the boundaries of integrated care, and today, I want to share with you the key strategies we’re focusing on to make that vision a reality. This isn’t just about the work we do; it’s about who we become in the process – a community of healthcare professionals and allies breaking down unnecessary barriers to team-based, whole-person care.

1. Workforce Development: Planting the Seeds Early

Imagine if our understanding of integrated care began not just in professional training but as early as high school and undergraduate studies. That’s the future we’re building towards. We’re introducing a new membership tier aimed at connecting with students at the high school and undergraduate levels. This effort is all about going upstream to influence the foundation of training in integrated care. We are also looking to partner with accreditation bodies and other organizations with power in the guild training spaces. By weaving integrated care principles into the fabric of early education, we’re not just preparing the next generation of healthcare professionals; we’re revolutionizing the way care is conceived from the ground up.

2. State by State Policy Development: Local Action, National Impact

From the rolling hills of Tennessee to the bustling streets of New York, we’re nurturing state-based efforts to reshape policy and practice. Our work in states like GA, CA, TN, NY, and WI is a testament to our belief in the power of local action to drive national change. Each state has its unique challenges and opportunities, and by supporting state-specific initiatives, we’re laying the groundwork for a more inclusive, integrated healthcare system across the country.

3. Reflecting the Whole Care Team: A United Front

Integrated care is not just about bringing medical and behavioral health professionals together; it’s about valuing every voice in the healthcare chorus. That’s why we’re creating a Medical Director for Integrated Care position and partnering with esteemed medical societies like AMA, AAMC, and AAFP. Our goal is to diversify our membership and truly reflect the entire care team. Just take a look at our spring conference presenters and you’ll see the breadth of representation we are aiming for. This collaborative approach is key to creating a holistic, patient-centered care model that recognizes the contributions of all healthcare providers.

4. Embracing and Elevating New Voices: A Home for All

Diversity, equity, and inclusion (DEI) are not just buzzwords for us; they’re principles that guide our actions. We’re committed to being a home for all, where every member feels valued and heard. Our new Content Creators Workgroup is just one way we’re creating opportunities for our members to share their talents and perspectives. By amplifying diverse voices, we’re enriching our community and shaping a more inclusive future for healthcare.

5. Value and Measurement-Based Care: The Proof Is in the Outcomes

In today’s healthcare landscape, demonstrating value is paramount. We’re championing the importance of engaging in value-based contracting discussions within your institutions through our two dedicated workgroups focused on value-based care contracting for integrated care and measurement-based care promotion. This commitment to value and measurement-based care is crucial for advancing our mission and proving the effectiveness of our approach. I would like to personally ask every director or team lead to consider setting a goal this year for learning more about your organization’s contracting efforts and to begin trialing an approach to measuring your patient outcomes, especially for PCBH (I’m a big fan of the Outcome Rating Scale, for example). CoCM is already ahead of the game in this respect.

Join Us in This Journey

This is a call to action for each of you. Get excited, dig in locally, and engage with our workgroups, Special Interest Groups (SIGs), and events. Your participation is the fuel that propels us forward. Having witnessed nearly 20 of our 30 years of our impact and growth I have good reason to be optimistic that we can continue to create foundational change.

As we embark on this journey, remember that this is our collective mission. It’s about creating a future where integrated care is not just an ideal but a reality for everyone. Let’s establish our true north and walk this path together, with optimism, dedication, and a shared vision for what healthcare can and should be. And, by the way, this vision is not static. If we are missing something here, let us know.

Here’s to our shared future,

Neftali Serrano, PsyD

CEO, Collaborative Family Healthcare Association

Written with assistance from ChatGPT.

Photo by Joshua Earle on Unsplash