An incubator. A catalyst. A support group. An alliance.

These are some of the ways participants describe the Integrated Care Initiative Learning Collaborative, one of the Sunflower Foundation's main programs.

The Learning Collaborative brings together more than 70 health care professionals who are working to integrate physical health care with behavioral health care at their clinics.

Participants also include national experts in care integration as well as state officials with long experience in Kansas’ Medicaid program known as KanCare. Two collaboratives were convened this year, building on the first two in 2013.

“The Learning Collaborative has been a place where we can all explore solutions to very real, challenging obstacles toward making positive change,” said Matthew Schmidt, CEO of Health Ministries Clinic in Newton.

“This group is made up of people who are passionate about making change. People here aren't willing to just live with the status quo but are excited about what might be and what could be,” Schmidt said.

Integration of traditional primary care with behavioral health and substance abuse treatment has become more widely recognized as a progressive model of providing high-quality and cost-effective treatment, resulting in improved health outcomes and better patient experience.

But changing decades-old models of care delivery is challenging at best, no matter how committed those involved are toward the goal.

For example, Schmidt’s clinic is partnering with Prairie View Mental Health Center to integrate physical and mental health care. He said while many obstacles stem from “the way things have always been done,” others are systemic and cannot be solved at the practice level alone.

"Our fee structures aren't set up to handle care integration. The insurance companies don't know what to do with this type of care — they're not designed to do this; they're more locked into the fee-for-service model. And what we're talking about is a more comprehensive model that is more focused on outcomes than appointments,” said Schmidt.

To that end, he said, he’s hopeful that having state and insurance officials participating in the collaborative could help remove such barriers one by one.

"I really think of these collaboratives like an incubator. You're able to take all these individual experiences — what's worked, what hasn't worked — and bring them all together to discuss,” Schmidt said. "When you talk about this with people, it just sounds like common sense, and in a lot of ways it really is. But there are a lot of barriers that have stood in the way of this happening."

Marilyn Cook, another collaborative participant, is CEO of ComCare, the largest community mental health center in the state. ComCare’s integration partner is GraceMed, the largest of three federally qualified health centers, or FQHCs, in Wichita.

Integrating care on this scale magnifies similar barriers faced by smaller clinics like Schmidt’s.

"We're talking massive change — both for our FQHC partner and our organization,” Cook said. “We're actually asking our staffs to change the way care is delivered, and that disrupts both the medical culture and behavioral health culture. Having people from both cultures in a Learning Collaborative is just a very effective way to help with that change.”

Cook’s initial goal is to add primary care services for patients at ComCare. However, long-term goals include a full-service, integrated care site that will be open to the community: ComCare patients, GraceMed patients, as well as anyone without access to care.

“We’ve come a long way in a short time showing our staff what a difference it makes to integrate and coordinate care,” Cook said. “But the real key to this is going to be engaging patients in a different way — and that's going to take time. It's going to take several years to change our cultures to the point that we wouldn't think of operating any other way.”

Care integration is advancing across the United States, so models for success and models to avoid are becoming plentiful. However, models from other states aren’t often useful as guides in Kansas, said Salina family practice physician Dr. Robert Freelove.

“We’ve looked at models in other states and, while they work really well there, it’s much more applicable if we’re hearing from people in Kansas,” Freelove said.

“The collaborative has helped us understand different regulations and where the payors stand, especially with KanCare,” he said, referring to a session focusing on billing issues with state Medicaid officials and managed care organization representatives at the collaborative in April.

“Having KanCare representatives there to hear what we're trying to accomplish I think was very helpful on the bigger scale. They’re still trying to figure KanCare out, and if we can say, ‘Look, this is how we want to do it and how we think it should be paid for,’ well, I'm hoping that shapes policy at the payor level,” Freelove said. “Whether that leads to any substantive change remains to be seen. I'm hopeful. It's certainly better than not having the opportunity to talk to them at all.”

Perhaps most helpful, said Freelove, is that the collaborative provides a forum to better focus on finding solutions with his clinic’s integration partners: the Central Kansas Foundation (a substance abuse provider) and the Central Kansas Community Mental Health Center.

"The collaborative gives us a chance to be away from all the pressures and demands here at the clinic and be there with our partners to focus on those things we're trying to accomplish with them,” Freelove said. “That’s a critical piece to this puzzle — so, of course, the collaborative is a welcome opportunity.”

The Integrated Care Initiative is part of Sunflower’s Health Care program area, which is focused on improving health care for the whole person. This initiative helps safety-net providers integrate physical care with behavioral health care and at the same time, focus more attention on health and wellness (such as smoking cessation, other addiction treatments, healthy eating and weight management). Find a list of the initiative’s 15 current projects, each project’s partner organizations and more information here.