November 2019: The key ingredients in effective learning collaboratives


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Vol 2 Issue 11

Dear friends,

We can only move upstream if we go together. That’s a truth I often repeat as I work with Upstreamists who are paddling against the current to transform care in their communities. Lately I’m seeing the evidence of it more clearly than ever — in the form of the learning collaboratives that HealthBegins supports across the country.

Learning collaboratives are more than just groups of colleagues conversing with each other as they do parallel work. At their best, they’re organized, goal-oriented support networks of trailblazers who drive measurable improvements by sharing insights, tools, and encouragement exactly when needed. And they’re a crucial, growing piece of the movement for upstream care.

At HealthBegins, we’ve found that there are certain practices that make collaboratives more or less effective — which we’ll detail in our webinar next week.

One factor that often gets overlooked: place. In the past, health care has organized learning collaboratives by disease, patient population, or other categories. But I’ve come to believe that great power lies in place-based, goal-driven learning collaboratives, where hospitals and community partners that share regional upstream goals work side by side to achieve them. I believe we’ll see even more of these upstream learning collaboratives in the future. 

So it was much to my delight that I recently met one devotee of learning collaboratives in not one but two groups.

I met Dee Warrington first in Richmond, Virginia, where she was participating in a statewide (place-based!) upstream learning collaborative that HealthBegins recently launched with the Virginia Hospital and Healthcare Association. I ran into her again the very next week in Baltimore, at a meeting of organizations in the federal CMS Accountable Health Communities model, which we also support through technical assistance and trainings. 

“For me, there’s really no better way to address specific areas and start to move the transformation upstream than through a collaborative,” said Dee, who oversees government programs at Ballad Health, an integrated health system spanning northeast Tennessee and southwest Virginia.

Dee has already benefited from the collaboratives in tangible ways. Once, her peers’ support gave her the confidence to raise concerns about the wording of patient screening questions that Ballad Health was considering. Other times, she has felt free to call up colleagues from Rocky Mountain Health and elsewhere to bounce ideas around.

So far there’s been no problem building trust between institutions and even sharing information about failures, Dee said. Why? “We’re all thirsty. We are all thirsty for those lessons learned.”

As HealthBegins continues to build and nourish learning collaboratives across the country, we’re excited to chronicle what works and what doesn’t — and to share that learning with you. We’d also enjoy hearing from you. If you have ideas on best practices, please tell us

Also, a reminder: A number of you wrote us to voice your excitement last month when we announced our goal to build an armada of Upstreamists by training 25,000 of them in the next two years. If you’d still like to participate in achieving that goal together, please let us know!

Lastly, I want to close with an acknowledgment of the tremendous contributions of Kaiser Permanente CEO Bernard Tyson, who passed away earlier this month. He led Kaiser to adopt an approach to care that serves as a national model — and then pushed the organization to reimagine care again in order to address community conditions such as housing and food insecurity. We at HealthBegins send our condolences to those who worked closely with him. And just as his bold leadership will be missed, we Upstreamists must recommit to keep that vision alive.


Rishi Manchanda


From The Upstreamist, the HealthBegins Blog:

From Transactional to Transformational: The Next Level of Upstream Care

“Give a man a fish and you feed him for a day; teach him to fish and you feed him for a lifetime.” But what if he can’t afford the lesson? What if the pond is polluted? Why not teach a woman to fish? This post calls us to drive change on all levels of scale.

When Moving Upstream, Don’t Go Chasing Waterfalls

With so many emerging initiatives and projects to address social needs and social determinants of health, the opportunity to improve the lives of patients and communities is more real than ever. But we face a real risk of squandering this opportunity. 

Time to Manage Upstream Programs Like Investments

Through partnerships and collaboratives, healthcare organizations are launching programs to address social needs and social determinants of health. We have budgets and plans to reach specific goals, but is the way we’re spending our resources putting us on a path to achieve long-term goals for community health? At the moment, the answer is no. In this post, Rishi Manchanda outlines why it’s time to view upstream interventions as investments for long-term financial, health, and social impact.

Presenting powerful upstream results at an upcoming conference? Nominate yourself to be featured as a HealthBegins Upstreamist in Action at


How Learning Collaboratives Can Help Hospitals Move Upstream
Tuesday, December 3 at 11:00 a.m. PT / 2:00 p.m. ET

Hospitals are increasingly looking to move upstream to improve care and outcomes. They’re working to address social drivers of health at multiple levels, from individual social needs to broader social and structural determinants. Many are finding that an effective way to make this transformation is through learning collaboratives, in which multiple health systems share lessons, resources, and best practices as they go.

In this webinar, directors from leading hospitals, along with HealthBegins’ own Upstream Quality Improvement expert, Sara Bader, explain the dos, don’ts, and benefits of using learning collaboratives to move upstream.

Register Here


  • Rishi Manchanda, MD, MPH, President, HealthBegins
  • Sara Bader, Senior Manager, Upstream Quality Improvement, HealthBegins
  • Robbie Phillips, Senior Director, Social Determinants of Health, Truman Medical Center
  • Dana Codron, Northern California Regional Director, Community Health Investment, Providence St. Joseph Health

By the end of the webinar, participants will be able to:

  • List emerging best practices for hospital upstream learning collaboratives
  • Identify at least two challenges with these learning collaborative models
  • Describe new opportunities for hospitals and community leaders to accelerate learning and improvement on the journey upstream 

Cost: This webinar is free!

Can’t attend the live event? By registering, you will be able to access a recorded version of the webinar later.

Questions? Email us at

Interested in more webinars from HealthBegins? You can find recordings of all of our past webinars here.

Upcoming and Recent Events: Find HealthBegins Here

Upstream Opportunities

If you have fellowships, events, or other opportunities you’d like us to share, please email us at

Upstream News

Curated highlights of happenings affecting upstream care. Links are not endorsements.

CMS is changing how it pays doctors to coordinate care
Modern Healthcare (subscription)

Algorithmic bias in health care: A path forward
Health Affairs Blog

Hospitals pledge $700 million to fight economic, social disparities
Modern Healthcare (subscription)

Loneliness has become a big target for Medicare Advantage insurers. Here’s what they’re doing about it

Kaiser, mourning CEO Bernard Tyson, vows to continue his work
San Francisco Chronicle

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