01Heat a large, heavy-bottomed pot over medium heat. Add the sausage to the pot and cook until browned, using a wooden spoon to break up the sausage into crumbles, about 5 minutes. Using a slotted spoon, remove the sausage from the pot and drain any excess grease, leaving about 1 tablespoon of fat drippings in the pot.
02Add diced onions and carrots and sauté until onions are translucent and carrots are tender. Add garlic and Italian seasoning; continue to sauté for an additional minute or until garlic is fragrant.
03Sprinkle flour over the vegetables and stir to combine. Stir in the tomato paste. Pour in the chicken broth and water. Stir to combine, and bring a boil, then reduce to a simmer.
04Stir in the heavy cream, tortellini, and sausage. Simmer for 5 to 7 minutes or until tortellini is cooked through and tender.
05Stir in the Parmesan cheese and baby spinach. Season to taste with salt and pepper.