There’s some exciting work underway to transform the health care delivery system in Whatcom County–sort of a communitywide ACO on steroids. Plans for the Whatcom Community Health Association call for pooling public and private health care dollars under a community organization dedicated to supporting not only health care services but also the broader aspects of community health. (Read the ACO project overview here.)
We talked with Larry Thompson, executive director of the Whatcom Alliance for Healthcare Access (WAHA), the convening organization, to get some details.
Q: What prompted this initiative?
A: WAHA was created in 2002 to initiate community dialogue and action around transforming the health care delivery system. WAHA engaged the different groups that have a stake in health care–consumers, business, government, providers and plans–but early on, the timing and environment weren’t right for making sweeping changes. So WAHA focused on one worthwhile aspect: getting uninsured people care. Then in 2010, the passage of health care reform set off a lot of discussion about and planning for retooling the financing and delivery of health care within organizations, and to some extent, within the community. At the same time, over the last 20 years, we’ve developed a critical mass of evidence about what works and what doesn’t to help frame a big picture path of how to move forward with transforming the delivery system. We’ve never before seen this degree of creative energy and momentum around reforming health care delivery–now the time is right for significant transformation.
Q: What stage are you at right now?
A: We are in the first phase of developing the concept and mapping out who will participate and what roles they will play. We started discussions about how we might approach this as a community in December and hosted a community forum with the St. Luke’s Foundation in March. We have another community forum planned for June 24.
Q: Who is involved in these plans and discussions?
A: We have an 13-member steering committee with representatives from all the different stakeholder groups that is developing the concept of what a transformed health system would look like. Overall, there are about 70 people involved in task forces looking at different aspects of the project. Roughly 80-90 percent of the physician community is engaged in this process, including PeaceHealth St. Joseph Hospital, our two major medical groups, community health centers and the coalition representing independent physicians. We’re also working with representatives from mental health and long-term care, as well as the Bellingham-Whatcom Chamber of Commerce and Industry, Group Health and Regence, and Whatcom County and the City of Bellingham.
Q: What are some of the approaches you’re discussing?
A: We’re looking at a public/private organization that will aggregate funds and allocate them based on the needs of our population. The idea, which is similar to the regional health care authority concept bubbling up around the state, is to pool our funding resources so we can build our delivery system around patients’ needs instead of around funding streams. The concept includes plans for a communitywide Accountable Care Organization (ACO) in which providers would be paid for and share responsibility for more effective, coordinated, patient-centered care. This would include better integration among providers from a technical (health records) standpoint as well as a more holistic approach to patient care. But we’re talking about more than an ACO; we’re looking at what we can do beyond the borders of health care services to improve the health of our community. For example, instead of funding exotic surgeries, we might want to direct our community health resources toward preventing childhood obesity by helping school kids stay fit. Essentially we plan to chip away at the .5 billion that we spend every year on health care in Whatcom County by not only having the best health delivery system possible but also by keeping front of mind the greater good of the community outside the walls of hospitals and doctors’ offices.
Q: Do you think this model would work in other communities?
A: It can, and has, most notably in Grand Junction, Colorado. But not everywhere. It helps to have a history and willingness to operate collaboratively as a community. At this point, the majority of the ACO work around the country is in the private sector–a large health plan or health system decides to role the dice on this approach as a competitive operating strategy and goes about better integrating and organizing its own system of care around patients. Doing this as a community requires a certain level of trust. It also helps to have a can-do attitude, a willingness to stick with it when the going gets difficult.
Read the presentations from the first community forum:
- Dave Lynch, MD: The Case for Change
- Rud Browne: The Impact of Rising Healthcare Costs on Hiring Decisions in Washington State and the Critical Need to Drive Cost Reductions
- Dewey Desler: Whatcom County Health Care Costs
- Larry Thompson: Transforming Health Care In Our Community, A Progress Report