Washington Health Foundation

KEY WASHINGTON HEALTH FOUNDATION STRATEGIC INITIATIVES:

THE RURAL INITIATIVE

The Washington Health Foundation’s rise as a major health leadership organization in Washington state came through its 1992 Rural Initiative.  Originally formed in 1962 to serve as the education and research foundation of the Washington State Hospital education arm, and named the Washington State Education and Research Foundation (WSHERF), the Foundation was revitalized in order to implement this major effort to preserve and improve health care in rural areas of the state.

The opportunity arose through the Rural Hospital Assistance Program, a program approved by the state and federal government to provide major funds to sustain financially endangered rural hospitals across the state.  In addition to rural subsidies provided directly to the rural hospitals, another $3 million was generated to stimulate major change endeavors to improve rural health care.  The RHAP program was created by Greg Vigdor, staff lead for rural hospital issues in the Washington State Hospital Association, and he was appointed to serve as the President and CEO of WSHERF to use this money to create a new and meaningful rural program effort.

The creation of RHAP coincided with Washington state’s passage of a comprehensive health care reform bill in the 1993 Legislative Session.  The model adopted relied on private health plans competing to provide services to Washingtonians under an almost 100% coverage model in the state.

There were major questions as to how rural hospitals and providers would fit within this policy change, and much of the Foundation’s Rural Initiative aimed to answer this question with policies, programs and support to those willing to implement new models of care and health improvement.  The Rural Initiative was also imbued with the Foundation’s mission to improve health, and not just health care, in rural areas and through RHAP resources.

There was significant interest at the time by rural hospitals to form their own “Certified Health Plan”.  Rather than invest in one or several local study efforts, the Foundation instead undertook a comprehensive and detailed assessment of the feasibility of forming a CHP for all rural areas in Washington.  The outcome of this was that such an approach was not feasible, which ruled out any smaller efforts to become “insurers” too.

The Foundation then prioritized provider based strategies for reform, rather than those with insurance characteristics.  One major topic was the regionalization of rural health care, and WHF provided over $1 million in technical assistance and grant support to explore four different regional rural projects.  See the Regional Project Evaluation and the Major Project Summaries for North Central Washington, CHOICE, the Columbia Basin and Skagit Snohomish and Island (SSI) Counties.

With regard to health improvement, the centerpiece of the Foundation’s effort was to design and test “Community Health Network” models that would reorient local health care systems to comprehensive health improvement approached, in partnership with public health and other local organizations.  Many believed, and still do, that health care is best managed at the local level, and these models were intended to embrace local control and solutions.  The Foundation invested in testing such a model in Pacific County, and through General Fund revenues also invested and led an urban based effort in Spokane.  See the Major Project summaries for these projects.

For those communities and providers not part of these major Rural Initiative change priorities, but still interested in bigger change, the Foundation provided other resources.  One major theme was the formation of new financing and care model mechanisms in partnership with physicians through Physician-Hospital Organizations or Physician-Hospital-Community Organizations.  The Foundation also provided extensive support to rural hospitals and providers as they learned how to deal with managed care, including major conferences, a PHO Manual, a Guide to Managed Care for Rural Hospital Trustees, a contract review service, other substantive guides and individual support through Foundation staff or consultants.

Around the health improvement priority, such other support included an annual Healthy Communities Symposium, a Developer’s Guide to Community Health Networks, health improvement research and data, and technical assistance from Foundation staff and consultants.  Ultimately, this support ended up being part of the Foundation’s Healthy Communities Initiative.

During 1992 through 1998, WHF also provided other support under the Rural Initiative, including an assortment of grants.

Many credit the RHAP program and the Foundation’s efforts with saving rural health care in a number of rural communities.  The Rural Initiative also brought a great degree of change to health care in rural areas, though the impact of the overall change was muddled by the State Legislature’s repeal of the comprehensive health care reform bill in 1995.