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integrated care

No One Cares About Strategic Plans

May 19, 2025
It’s true. The large majority of us roll our eyes when it comes to strategic plans and their myriad of KPIs, other acronyms and promises about the future. The truth […]

No One Cares About Strategic Plans

by Neftali Serrano

It’s true. The large majority of us roll our eyes when it comes to strategic plans and their myriad of KPIs, other acronyms and promises about the future. The truth is that what is most essential about an organization’s viability and efficacy is its strategic vision, not it’s guesses about what it could accomplish in an undetermined future. To this end we at the Collaborative Family Healthcare Association: The Integrated Care Association, present our version of a strategic plan.

It’s probably not fair to call it a strategic plan, but it most certainly is the end-result of our strategic planning process. In it we reaffirm our mission and values, we update our identity statement, update our strategy screen and ask ourselves the one big question we think will dominate our sphere in the next few years. In short, we are attempting to be ready for whatever the wind blows our way as we continue the work of organizing the integrated care community, creating high quality content and high value consultation.

Our mission and values remain unchanged with the exception of a reorganization of our values. Whereas before our values were listed in bullets, now our values summarize our commitments in sharp statements. This should help us better communicate our values compared to a laundry list of statements in different domains. For example, we remain committed to both fostering health equity and evidence-based care. Now our values are reflected in the statement:

  • Disseminating and operationalizing evidence-based practices for patients and families who are at risk for health inequities through integrated care practice and policy

Our identity statement is similar to our past identity statement but now indicates a willingness to partner beyond North America where our contributions might be helpful. The CFHA board also made sure that our support of professionals included and named all stages of career development.

by serving aspiring, emerging, and experienced integrated care team members…

Our strategy screen provides a series of questions the staff and board can use when considering new opportunities or challenges. This mechanism provides a systematic way to process changes in the environment and assure that consensus emerges from our planning work. This also creates efficiency since we all are working from the same strategy screen.

Our “Big Question” rounds out the document with a question we will keep top-of-mind as go about our work.

How do we refine and preserve our identity while adhering to our values and growing as a source of influence in our dynamic healthcare system?

This question comes about from an acknowledgment on the part of the board that as we grow our identity will be challenged. How do we remain faithful to our purpose even as we experience success? How do we continue the process of figuring out who we can best be in the space of promoting integrated care as the environment inevitably shifts around us?

So, no there are no KPIs in this document. In fact, the document itself is not even the most important product of the process, which by the way is modeled after this not-for-profit strategic planning approach and this facilitation approach. The most important product of the document is a board and staff that are unified and prepared to face challenges and opportunities in an ever-changing healthcare landscape. That preparation helps lead to the business and strategic decisions that are the traditional goal of strategic plans. It also helps our Integrated Care Association remain nimble and adaptable, strengths of small not-for-profits like CFHA.

BTW- We do value data, so we have internal core metrics we keep and report on both at the individual staff level and quarterly at the team level. So we are definitely not anti-metrics!

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 ↩︎
Dr. Don Bloch, a key founder of CFHA.

CFHA Luminaries Reflect On Whether The Vision For Integrated Care Has Been Realized

Aug 21, 2024
By Joellen Patterson, PhD, LMFT The foundation of this small project was a curiosity about whether, and if so to what extent, Don Bloch’s (physician, key founder of the Collaborative […]

CFHA Luminaries Reflect On Whether The Vision For Integrated Care Has Been Realized

by Neftali Serrano

Dr. Don Bloch, a key founder of CFHA.

By Joellen Patterson, PhD, LMFT

The foundation of this small project was a curiosity about whether, and if so to what extent, Don Bloch’s (physician, key founder of the Collaborative Family Healthcare Association) ideals for integrated care as voiced at Wingspread (first CFHA meeting) have been realized in the world of integrated care today. C.J. Peek wrote an article nearly ten years ago about where integrated care stood in respect to Bloch’s ideals at that point in time, and this short paper is meant be a near 10-year follow-up to Peek’s work (Peek, 2015). This project was motivated by the ongoing selection process for a new Families, Systems, and Health (FSH) editor, in the hopes that a reflection of where integrated care was, where it stands now, and where it may would help inform the selection committee. (Since the inception of the project those editors have now been selected.)

From December 27, 2022 to January 27, 2023, the following people were interviewed about the state of integrated care, especially in comparison to its original formulation as presented at the 1994 Wingspread conference: Dr. C.J. Peek, Dr. Susan McDaniel, Larry Mauksch, Dr. John Rolland, Dr. Gene Kallenberg, Dr. Bill Doherty, and Dr. Mac Baird. These individuals were asked about successes of integrated care, current roadblocks to increased adoption and implementation of integrated care, the role of the family, and thoughts and ideas of future direction for FSH. Though many of the interviewees prefaced their answers by stating they had moved on from working in integrated care in the last ten or twenty years, nearly all still had insights about the successes and areas of growth for the field and for FSH. 

Don Bloch’s vision as visualized by C.J. Peek (Peek, 2015)

Interview Findings

All interviewees agreed that integrated care has made progress in the last 20-30 years. Some interviewees thought of this progress as more widespread acceptance of the importance of integrated care, while others pointed to the increased number of practices instituting (their own version of) integrated care. At the same time, interviewees were quick to point out roadblocks. One of the two primary roadblocks for increased adoption and implementation of integrated care is the lack of conducive financial payment systems. McDaniel sees the fee-for-service model as inhibiting further growth of integrated care and implementation of its central tenets. This was Peek’s opinion too, as he expressed that payment systems are still anchored in the mind-body split. At the same time, he notes that several sites have been able to take advantage of alternative payment schemes like shared savings and pay-for-performance, though these are still workarounds. The second primary roadblock expressed among interviewees is the “how to” of implementation, about which there still isn’t enough research. See below for more commentary on this.

Roadblocks for increased adoption and implementation of integrated care

  • Existing payment models (e.g. fee-for-service) do not support high levels of integration 
  • Need more evidence (RCTs, or other studies with comparison groups) supporting effectiveness of integrated care
  • Lack of unified conceptual definition of integrated care
  • Mind-body division still prevails as dominant healthcare view
  • Lack of manualized implementation strategies
  • Lack of involvement of family

One of Bloch’s original visions for healthcare was that it would incorporate both the individual and the family. All interviewees agreed that the family is still not involved or utilized in integrated care. There were a variety of reasons posited for this idea. One was that there is no financial system (e.g. reimbursement) in place that rewards any involvement with the family. This problem is compounded by the public’s lack of awareness of why including the family might be beneficial, especially when many primary care appointments are preventative. Peek noted that one way in which family is involved is through healthcare systems’ involvement of communities, of which families are the primary unit of care. 

Another part of Bloch’s vision was the balance between the mind and the body. While most interviewees still lamented healthcare’s stuck place in this split, there were some ideas about how insight into this faux-duality may be shifting. Peek mentioned that research about chronic illness, ACEs, health behavior changes, and depression as a “foreground” issue have all encouraged the medical field to see the mind and body as intermixed. Mauksch thinks, too, that that increased insight into the epidemiology of mental health issues have made integration more logical, as such epidemiology sees the mental and physical colliding. Despite these at least conceptual advancements into the shallow nature of the mind-body split, the dualism still dominates business models and inhibits further integrated care adoption. 

A third part of Bloch’s vision was about the importance of striking a balance between generalists and specialists. Not many interviewees commented about this, but the ones who did agreed that there was there are still too much emphasis/reliance on specialists. At the same time, Rolland thought that it makes a lot of sense for families to be involved in specialty clinics because, presumably, the person is already sick. 

In addition to being asked about Bloch’s original vision, interviewees were asked about CFHA, the role of research in supporting integrated care, and FSH. There was consensus among the interviewees about the unbalanced nature of CFHA’s member (physicians and behavioral health providers) makeup. There are various reasons for this. For one, as Mauksch put it, it’s never been that balanced. Another reason in Mauksch’s eyes is that physicians have less time and are faster moving than BHPs, and often don’t have the same research and academic training as do some BHPs. Third, many (if not most) physicians still don’t have the incentive to incorporate integrated care into their clinics because of their clinics’ clinical leadership and administration.

A number of interviewees had suggestions about research needed to advance integrated care.  These suggestions fell mainly into two categories: proving the utility of integrated care and explaining the “how-to” implementation of integrated care. Many people advocated for the need for more studies with comparison groups illustrating the effectiveness of integrated care. Regarding the second point, many interviewees expressed the need for studies about how to “fit everything together” for an integrated care setting, including business model, delivery model, and education and training. In addition to these two main points, there were rumblings among several interviewees about how there isn’t even agreement in the research about what integrated care looks like (e.g. a singular model).

Some interviewees had thoughts about FSH and what types of articles it should publish. Rolland for example, thought the journal needs more conceptual papers (and fewer data-driven articles), needs to be more multi-disciplinary, and needs to refocus on how to make integrated care truly systemic. Mauksch had somewhat different ideas and expressed the negative consequences of contributors conflating the collaborative care approach and the PCBH approach, stating that PCBH does not have nearly the same strength of evidence as does the collaborative care approach. Kallenberg also had ideas for the journal and stated that there are too many special interest articles and one-off articles reviewing how integrated care was implemented at a single site. He suggested that the journal needs more papers about measuring the effects of integrated care, papers examining integrated care operational difficulties, and articles that target primary care physicians more in an attempt to realize the importance of integrated care. Thoughts and suggestions for FSH can be summarized by the following list:

Suggestions for FSH

  • The journal needs fewer “one-off” studies about case successes
  • The journal needs more rigorous studies involving comparison groups proving effectiveness of integrated care
  • The journal needs more articles addressing workflow, training, and operational issues
  • The journal needs to have articles that better attract physicians
  • The journal needs more conceptual papers (Rolland)

Conclusion

In summary, while the field of integrated care continues to make advances, it still faces external impediments, like financial payment systems rooted in the mind-body split, as well as internal difficulties, like lack of a “one-size-fits-all,” or even a “one-size-fits-most” approach for implementation. Nevertheless, there is more support for the idea of integration and its potential benefits for patients, healthcare systems’ pocketbooks, and providers. It is an open question in what capacity FSH will propel integrated care going forward. Will it focus on disseminating rigorous research to further prove the efficacy of integrated care? Will it provide more manualized approaches for non-integrated healthcare systems to move toward integration? Will it be a platform for conceptual and experimental inquiry into how integrated care may look? 

February, 2023

References

Peek, C. J. (2015). Don Bloch’s vision for collaborative family health care: progress and next steps. Families, Systems & Health, 33(2), 86.

JoEllen Patterson, PhD, LMFT, is Professor in the Marital and Family Therapy Program at the University of San Diego. She is also Associate Clinical Professor of Family Medicine, Global Health, and Psychiatry at the University of California, San Diego, School of Medicine.

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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

A Peak Into CFHA’s Storied Past: 29 Years Ago

Jan 5, 2023
New years often inspire us to look to our futures but they also often cause us to re-examine our past, so as CFHA turns 29 this January we thought we […]

A Peak Into CFHA’s Storied Past: 29 Years Ago

by chris

New years often inspire us to look to our futures but they also often cause us to re-examine our past, so as CFHA turns 29 this January we thought we would give you a snapshot of the very first CFHA newsletter from the Fall of 1994.

CFHA’s First Ever Newsletter, Fall 1994Download

While much has inevitable changed in the healthcare landscape and within our organization there is also great continuity in terms of philosophy and mission. Page 2 of the newsletter provides a good summary of the early efforts in what was then termed, “Collaborative health care.” You will likely also note a marked emphasis on family therapy and medical family therapy, emphases that continue to be a part of our rich community, but are no longer the singular emphasis of the association. The movement towards integrated care is indebted to the fore-runners of collaboration between healthcare disciplines, especially those involved in family-oriented efforts to transform healthcare delivery.

Names like Susan McDaniel, Tom Campbell, William Doherty, David Seabird, Alan Lorenz, Jepi Hepworth, John Rolland and many others dot the landscape of this early transformative period. It would be less than a year later when CFHA would host its first conference in Washington, DC title, “Transforming the Practice of Health Care: the Collaborative Solution.” For historical reference it is important to note that from the time of CFHA’s inception it would still be nearly 8 years until Katon and colleagues publish their IMPACT trial results and several years before PCBH implementation trials began in Seattle, WA. So these fore-runners were indeed ahead of their time in many ways.

Enjoy this time machine flashback. We will post more of these in the coming year as we work towards 30 years of promoting the integration of physical and behavioral healthcare in the US health system.

Photo by Mohamed Osama on Unsplash

Board of Directors Meet To Solidify CFHA Diversity & Equity Commitments

May 17, 2022
May 14, 2022 (Raleigh, NC) Neftali Serrano, PsyD, Chief Executive Officer After not having an in-person meeting in over three years due to the pandemic the CFHA Board of Directors […]

Board of Directors Meet To Solidify CFHA Diversity & Equity Commitments

by chris

May 14, 2022 (Raleigh, NC)

Neftali Serrano, PsyD, Chief Executive Officer

After not having an in-person meeting in over three years due to the pandemic the CFHA Board of Directors met in person in Raleigh, NC at the JC Raulston Arboretum to discuss how to continue to pursue Justice, Equity, Diversity and Inclusion (JEDI) commitments as an association. The day included a discussion on the appointed member process, an important way that boards solicit diversity in their ranks as well as a review of progress on JEDI issues and plans to include expert external facilitation.

The board also engaged in a review of its strategic plan, last updated in 2019. The board generally affirmed the relevancy of the plan including a strategy screen and series of “Big Questions” developed by the board at that time. The in-person quality of the meeting, board members felt, especially helped catch-up newer board members who were not part of that process.

The CFHA board meets 6 times per year and will next have an in-person meeting as per tradition at the annual conference in October. Work on JEDI issues will be on-going in collaboration with the member-led Just Medicine Committee

Board members engaged in a SWOT analysis of CFHAs efforts with regard to JEDI.

.