OBJECTIVES: The cost and quality problems of health care in the US have been aggravated by separate silos for research and care delivery that limit the pragmatic value of research questions and delay the implementation and spread of what is learned. We describe a variation on the learning health system concept that engaged various stakeholders in a single state to work together on simultaneous knowledge generation and dissemination built on research questions that arose from the user community. STUDY DESIGN: Observational study. METHODS: We identified the 12 strategies used by the leaders of this project to develop and operationalize an observational study in a large sample of primary care clinics in Minnesota that had implemented care coordination as part of attaining certification as health care homes. RESULTS: The collaboration included the state health department, a research institute embedded in a health system, the 5 main payers, a measurement/reporting organization, 42 care systems with 316 primary care clinics, patient partners, and national consultants. This community developed a research proposal for an observational study about how to improve care coordination in primary care. We describe how this collaborative implemented and disseminated the study findings. CONCLUSIONS: By employing 12 strategies to answer questions that arose from the health care community, we opened a door between the 2 halves of the house of medicine.