The Vashon Healthcare District (VHCD) has inked agreements to boost counseling for island youth and access for older islanders making appointments off-island.

That leaves one major plank of VHCD’s mission still on the table: the future of urgent care on Vashon.

So far, the district has spoken with several private providers, the most promising of them being mobile urgent care provider DispatchHealth, a wing of MultiCare.

Meanwhile, VHCD has also talked with Vashon Island Fire & Rescue (VIFR), whose fire chief Matt Vinci has proposed using the expansion of VIFR’s Mobile Integrated Health (MIH) program to fill that gap instead.

The MIH expansion

Vinci argues that MIH has, since starting in February, already proven itself an effective healthcare delivery tool for islanders. It would be more cost-effective and straightforward to let its expansion help fill the island’s urgent care gap rather than use the DispatchHealth model, Vinci said.

MIH is a King County program, partially funded by an already-existing EMS levy, with the balance of its revenue made possible by local voters’ approval, in 2023, of a levy lid-lift measure for the district. The program proactively serves islanders in their own homes, with services including follow-up visits after surgery, wound care, fall prevention assessment, nutrition and wellness checks, and connecting islanders to ongoing support.

Currently, MIH takes referrals from VIFR itself and several island organizations. Islanders can also make appointments online.

VIFR will present a proposal at the agency’s July 31 board meeting to expand MIH so it can additionally respond to urgent healthcare needs, Vinci said. They’re still hammering out the details, but it would likely allow VIFR to expand the hours and days of MIH’s operations and add either a physician’s assistant or a nurse practitioner, plus a part-time clinical social worker, Vinci said.

If the board signs off on the expansion proposal, VIFR would aim to roll out that expansion by Jan. 1, 2025, Vinci said.

No matter what happens, MIH won’t replace 911, Vinci said. 911 will always be the right number to dial in an emergency.

Vinci also expressed skepticism that VHCD has the data to support bringing DispatchHealth on seven days a week, eight hours a day, as has been proposed. And he believes some of the services DispatchHealth would bring are already provided by MIH, including helping patients navigate primary care networks, get prescriptions filled, and find nutrition.

“I find that to be a duplication of services that are already being paid for by Vashon taxpayers,” Vinci said. “If they do decide to go down the route of bringing DispatchHealth on Vashon, they need to find a way to not interfere with the great work of MIH and outstanding work of our 911 crews.”

Yes, unnecessary overlap should be limited, but “multiple points of access” to healthcare is not necessarily a bad thing, VHCD Superintendent Tim Johnson said — it’s about the details and scope of work of that care.

“We are concerned more for the maximum number of people to gain the right services rather than for one or another organization to be the ultimate provider,” he wrote in an email. “And two taxing districts providing a variety of services either separately, together, or some combination of the two based on practical and collaborative community-based priorities is still two districts funding those services. The key here is maximizing quality of services and avoiding unnecessary duplication, not the number of agencies involved. More access tends to be better than less, all things considered.”

The DispatchHealth approach

This spring, DispatchHealth gave a presentation to VHCD laying out what a partnership could look like.

Under that proposal — which is just a starting point from which details could change — a nurse practitioner or physician’s assistant and a medical technician would drive to islander’s homes to offer eight hours of service per day, seven days per week. (The shifts would be 10 hours per day to account for ferry commuting.) An ER physician would be on-call when needed.

The estimated capacity would be around six patients per day, though this would fluctuate based on demand. And it’d be easy to start up: Within 90 days of a signed agreement, according to Dispatch, the program could be operational. (Were an agreement signed in August or September, the program would start around the same time as MIH’s expansion.)

That initial proposal estimated VHCD would use its tax revenue to pay Dispatch $700,000 annually. Dispatch would bill patient insurance and give most of that revenue back to the district, meaning the actual estimated fee for the district annually could be about $557,000. The final rate would likely fall between $500,000 and $750,000, Johnson said, depending on usage rates and other factors.

DispatchHealth and MultiCare have worked with Sea Mar before, and are familiar with collaborations with Mobile Integrated Health programs, according to VHCD’s report on their meeting.

Following a meeting with DispatchHealth and island healthcare providers, including VIFR and Sea Mar, VHCD is still looking over how it could all fit together, Johnson said.

VHCD can step in to subsidize valuable service for islanders that might otherwise be unprofitable for the island’s small population, Johnson said. And there is security and “peace of mind” in having weekends and evenings covered, he said — naturally, people won’t know in advance which days or times they’ll need to access urgent care.

“The ability to start at full week coverage and adjust up or down in terms of hours/days is preferable … and you can still get to the right size and model with reliable real-world data,” he wrote in an email.

Without speaking for any commissioner, Johnson said the board in general wants to provide urgent care “whether that involves working with DispatchHealth and the fire department, or only the fire department” — and they are still considering “a lot of complicating factors.”

“(DispatchHealth is) not looking to fence the fire department in,” Johnson said. “… Sometimes things that are already built and available are both ready to go and can buy you time to build the other things you want. We’re weighing whether or not they’re even competing interests.”

VHCD plans to invite DispatchHealth to meet with the community soon as well, Johnson said.

The July 17 VHCD meeting (which occurs after this edition of The Beachcomber reaches mailboxes) will include a report on the urgent care question, Johnson said. The meetings are held every third Wednesday of the month at 7 p.m. at the Vashon Presbyterian Church. This week’s meeting can also be attended over Zoom by visiting tinyurl.com/VHCDJuly17.

Field trip to Mason County

In mid-June, VIFR and VHCD crossed the water to visit Mason County, where a fire agency has launched a program very similar to Vinci’s vision for Vashon. (The Seattle Times profiled the agency in June.)

Amid a physician shortage, The North Mason County Regional Fire Authority found itself receiving more 911 calls for all kinds of medical care, not just emergencies.

So the authority’s Mobile Integrated Health Program — funded by grants and by the local public hospital district — now delivers urgent care through a physician assistant, nurse practitioner and others. It aims to address medical needs before they become a crisis. And it’s still expanding, including recently hiring a registered nurse.

If patients have insurance, the program bills their insurer; if they don’t, the program writes off costs, according to The Times.

Vinci and Johnson were both impressed by what they saw.

“It demonstrated that the most effective program is a local-based program,” Vinci said, “not bringing in a provider that may be here for a short period of time and doesn’t have ties to the island. … What they demonstrated to us, it absolutely can be done.”

Vinci said he remains in contact with the North Mason fire agency and is learning from their program.

“It was incredibly innovative,” Johnson said of the program. “A perfect fit within (that) community. They built around some assets that they had … (and) it fits a little differently than Vashon.”

Behavioral, voucher deals signed

VHCD commissioners on June 19 accepted a children’s behavioral health program proposal at their meeting.

That means the district has committed to funding a single social worker at the schools through VYFS and half of a full-time equivalent (FTE) VYFS therapist at Chautauqua Elementary School, making the current half-time therapist there full-time.

The district will also fund another half of an FTE therapist at the high school, through the DOVE Project, which makes the half-time therapist there full-time and allows them to provide services to youth through the summer.

It will also pay for a data specialist to study and track young people’s mental health needs.

The overall cost for the year is $268,000, Johnson said at the Community Council meeting on June 20.

Johnson said he hopes this success will become something of a specialty for the district — bringing together different island groups doing good work and funding smart projects between them.

“We really wanted to start out with something meaningful and scalable and collaborative, and everything just worked out really well,” he told The Beachcomber.

“This investment … will bring relief to VISD counseling staff and help our young people build the emotional resources and resilience needed to navigate life’s many challenges,” VYFS Executive Director Jeni Johnson said in a letter to the editor in this week’s Beachcomber.

VHCD commissioners also agreed to help plug a hole in VYFS’ medical voucher program, which is supported by grants from Granny’s Attic. A shortfall in those grants this year left the program in need, and VHCD has committed $20,000 for an entire year — the rest of 2024 through the second half of 2025 — to keep it afloat for at least that long.

“We wanted to make sure that VYFS was … able to offer those vouchers, (which) have a huge effect on people’s ability to access medicine,” Johnson said.

Johnson speaks at community meeting

Islanders at the June 20 Vashon-Maury Community Council meeting questioned Johnson on the specifics, with some saying the district’s endeavors appeared to be “mission creep” from its original voter-approved mandate.

Islander Steven Nourse said he was concerned about VHCD’s mission expanding beyond “basic care” and its original task of subsidizing primary care. The district, Nourse said, needs quantitative data — hard numbers, not just a vague sense of need — to justify its operations to taxpayers: “We need to have a professional survey done.”

Johnson said that VHCD’s investments in that direction are vitally needed on the island and are “careful” — he also pointed out that the investment includes data gathering to quantify how much behavioral care is needed.

Islander Scott Harvey said he supported VHCD’s projects but wanted to see a community referendum for fairness’ sake.

“I really believe that what you have are very good ideas … but I really believe in fairness to the community here,” Harvey said. “… What we have now is not what we voted for. … (It) should be on the ballot: ‘This is what we voted for originally, and here’s how the district has changed. Do you (support it)?’ “

Voters established VHCD in 2019, after healthcare providers including Neighborcare had left Vashon’s longtime healthcare clinic on Sunrise Ridge, citing financial difficulties. VHCD’s initial critical goal was to ensure that Vashon would have some kind of primary care. In 2020, the district engaged Sea Mar Community Health Centers to take over the clinic, with a $1 million taxpayer subsidy paid by VHCD. But in 2022, Sea Mar split from VHCD to continue operating the clinic without the subsidy.

True, Johnson says, VHCD has expanded upon its initial activities — but not its initial goals. He pointed to the original language given to voters for the 2019 ballot measure.

VHCD “will have the authority to own and operate hospitals and other health care facilities and to provide hospital services and other health services on behalf of the residents of the District and other persons,” according to that election’s voter’s guide.

The statement in favor said, in part, that a vote to form the VHCD would let the district “assess current needs including primary care, extended hours, urgent care and other needs not currently met,” enhance existing services with new or old providers and sustain health services to create long-term healthcare stability.

The district’s current activities fall square in those missions, Johnson said.

“I don’t want to be argumentative with people, because in the voter’s mind … the most important thing was keeping that clinic on the island, as was ours,” Johnson said. “But (that’s) not the only thing, and we’re continuing to collaborate … with the other providers and caregivers on the island … who see what the needs are.”