With health insurance reform on the horizon, Clark County commissioners are exploring the idea of creating a regional public-private partnership to serve at-risk populations.
o 12 to 21 percent of adults in Clark, Cowlitz, Skamania and Wahkiakum counties are uninsured.
o The University of Wisconsin’s Population Health Institute (looking at factors including death rate, low birth weight, smoking and binge drinking), ranks Clark County eighth-healthiest among the state’s 39 counties. Wahkiakum ranked 24th, Skamania 27th and Cowlitz 34th. San Juan County ranked first; Ferry County ranked last.
Vanessa Gaston, director of the Department of Community Services, and John Wiesman, director of Clark County Public Health, said during a Jan. 19 county work session that they’d been meeting with counterparts in Skamania, Cowlitz and Wahkiakum counties, as well with officials from the Cowlitz Tribe.
Representatives from Legacy Salmon Creek Medical Center, Southwest Washington Medical Center and PeaceHealth, which operates a hospital in Cowlitz County and recently became SWMC’s corporate parent, have been involved along with some health plan providers, Wiesman said.
o 12 to 21 percent of adults in Clark, Cowlitz, Skamania and Wahkiakum counties are uninsured.
o The University of Wisconsin's Population Health Institute (looking at factors including death rate, low birth weight, smoking and binge drinking), ranks Clark County eighth-healthiest among the state's 39 counties. Wahkiakum ranked 24th, Skamania 27th and Cowlitz 34th. San Juan County ranked first; Ferry County ranked last.
Gaston said the goal is to have the Southwest Washington Regional Healthcare Authority up and running by April 2014.
Gaston told commissioners there are unknown variables but the premise is that a regional approach would result in better care for the targeted groups — Medicaid patients and the uninsured — at reduced costs.
“We have a lot of people interested because no one is receiving enough money to do it themselves,” Gaston said.
Commissioner Tom Mielke, the chairman of the board — after saying “I guess I’m not aware of inadequate health care” and making it clear he objects to health care reform — said at the end of the session that Gaston should continue working on the idea.
“I think we need to go forward to find out more,” Mielke said.
The first regional meeting was in September, said Geoff Knapp, spokesman for the Department of Community Services.
“We don’t exactly know how it will pan out,” Knapp said. “It’s based on federal health care reform, but it comes down to state responses. We haven’t got clear direction (from the state).”
Gaston told commissioners that a regional partnership was attractive because federal money could be shared but the counties could retain local control over how services are rendered.
She said the public-private partnership would control the funding and award contracts to Accountable Care Organizations, which are part of the new infrastructure.
“That sounds very bureaucratic,” said Commissioner Steve Stuart.
“Right now, we are bureaucratic,” said Gaston, whose department currently manages money from the Department of Social and Health Services to provide mental health services and substance abuse treatment.
Regional approach
She said the regional partnership would allow providers to spend less time on contract management and more on patient care.
Mielke said the regional partnership sounded like a dangerous road to go down. If regional services are better than what individual counties can provide, why not go to a statewide system or national system? Mielke asked.
“So what Tom’s asking for is national health care,” joked Stuart. “Write that down.”
Gaston said the state would like to push the counties aside, and that’s what she’s trying to avoid.
“We won’t have any control” if the state implements a statewide plan, she said. And if a statewide, one-size-fits-all plan doesn’t work, the county will be left to clean up the mess.
She said once commissioners at the four counties sign off, the plan will have to be signed off by the state.
Gaston said Spokane and King counties are also interested in putting together regional partnerships to help avoid a generic statewide model.
Commissioner Marc Boldt backed Gaston’s idea, speaking up after Mielke talked about when he was young and chose not to have health insurance and the idea that everyone should have insurance treads on mandating personal behavior.
“There’s a certain amount of the population that has never had insurance, and that population drives our costs through the roof,” Boldt said. “The only place they know where to go is the ER. Or the jail.”
Stephanie Rice: 360-735-4508 or stephanie.rice@columbian.com.
