It’s official.

The Vashon Health Care District (VHCD) agreed during their Aug. 21 board meeting to ink a deal with mobile urgent care provider DispatchHealth, paving the way for the healthcare provider to begin operations on Vashon as soon as Oct. 1.

The joint meeting saw the boards of both VHCD and Vashon Island Fire & Rescue (VIFR) meet formally about their differing visions for urgent care on Vashon. Representatives from DispatchHealth also joined the conversation virtually.

VHCD’s board voted 4-1 (with only commissioner Alan Aman, who said the districts needed more time to talk, voting no) to authorize superintendent Tim Johnson to sign the DispatchHealth contract. He did so on Aug. 23, Johnson said.

The meeting culminated months of study and work by VHCD to sharpen their proposal to contract with DispatchHealth — and months of negotiations with VIFR, whose board earlier this month signed off on Fire Chief Matt Vinci’s plan to launch their own urgent care service by expanding the fire agency’s Mobile Integrated Health (MIH) referral program into a referral-and-response program.

“This has been a long and ongoing process for us,” VHCD board president Tom Langland said at the head of the Aug. 23 meeting.

It has also been a tense and at times openly conflicted process between the two agencies — including on Aug. 23, when Vinci and members of the VIFR board delivered passionate speeches urging VHCD to delay their vote and reconsider financially supporting the MIH expansion instead.

The road to Dispatch

Over and over, Johnson said, islanders have told VHCD that Vashon needs urgent care. So the board started a work group of commissioners and local healthcare experts to explore the topic.

VHCD spoke with MultiCare last year about operating a brick-and-mortar urgent care site on the island, but for various reasons — including MultiCare’s budget constraints and the island’s small population — that idea fizzled. MultiCare suggested the district instead consider DispatchHealth, a mobile urgent care provider.

VHCD began researching that late last year, and along the way, Johnson said, brought DispatchHealth to the island and talked to VIFR and Vinci.

“I think the chief and I have worn each other out talking about this,” Johnson said at the meeting. “That’s not a joke.”

The Health Care District this year landed on the idea of bringing Dispatch to the island for two years, serving as a plug-and-play urgent care provider with experience and immediate capability while Vinci and VIFR work to grow MIH, perhaps to the point that it can replace DispatchHealth altogether.

It’s part of what Johnson has repeatedly stressed is a rejection of an “either-or” mindset when it comes to MIH and DispatchHealth: “Let’s move forward together, but together includes, sometimes, bringing in some help,” he said.

The board’s signed resolution first commits the district to subsidizing and bringing DispatchHealth onto the island. (A copy of the agreement is attached below.)

VHCD – DispatchHealth contract by Alex Bruell on Scribd

DispatchHealth will be fully operational on the island by Oct. 1, Johnson said. The contract is for two years, with a “go/no” decision point about whether to renew the contract at the 18-month mark.

Eight hours per day, seven days per week, the Dispatch team will travel to islanders’ homes to treat acute urgent healthcare needs, including lacerations, minor bone breaks, strains and sprains, infections, nose bleeds, and sore throats. In most cases, patients will be seen the same day they request care, according to VHCD, and most insurance plans (including Medicare and Medicaid) will be accepted.

Second, the resolution commits the district to finalize its plan for providing affordable care for the uninsured and underinsured within 60 days.

Third and finally, the resolution commits VHCD to bring a plan to the board within 30 days for working collaboratively with VIFR on MIH, including for urgent care services.

A copy of the board resolution appears below.

Vashon Health Care District resolution by Alex Bruell on Scribd

Ready for primetime?

Most VHCD commissioners praised MIH during the Aug. 23 meeting and said its urgent care expansion is exciting — but they said they also believe DispatchHealth can start up faster and provide immediate professional urgent care to an island that desperately needs it.

Commissioner Wendy Noble, who has worked as a nurse practitioner, said DispatchHealth’s connections to a large medical system, existing infrastructure and “deep bench” of medical staff showed it can provide flexible and quality care.

“Being part of a larger medical system was critical to ensure access to adequate oversight, appropriate referrals … and access to infrastructure and technology,” she said. “The more I learned … and the more we talked with these folks, I realized they’re much deeper than just this mobile van. … I would certainly be comfortable calling them or having them see a loved one.”

Still, she added, she loves the direction VIFR is taking MIH and is happy to fund and expand its referral model.

Commissioner Sarah Day also praised VIFR’s MIH efforts and said she likes the model used by the North Mason Regional Fire Authority, an MIH urgent care program recently toured by VIFR and VHCD and which Vinci has said serves as an example of how VIFR’s augmented MIH could serve Vashon.

“But … I’m not confident that VIFR would be ready to start a program at the level of North Mason in January 2025,” Day said. “I feel like the program needs further development for medical backup and administration. … And all of the experts I’ve spoken with … have said your program is not ready yet. So I feel pretty obligated to go with a proven program that’s ready to serve.”

The North Mason model seems a great fit for a community that already has a hospital, ER and brick-and-mortar urgent care nearby, Langland said. But Dispatch brings dedicated and experienced urgent care staff, he said, and is a tested, known product while the community works on the great “potential” of MIH.

“I’m personally … kind of done delaying on this promise to fulfill the unmet gaps in our after-hours care,” Langland said.

Commissioner Bill Hamlin agreed. He said he’s impressed with DispatchHealth’s proposal and patience and wants to continue working with VIFR to develop a long-term solution.

But most of VIFR’s board members, and Vinci, disagreed.

Bringing DispatchHealth to Vashon “blunts momentum” in VIFR’s efforts to expand MIH, fire district commissioner Jim Whitney said, adding that VIFR will pull off the expansion regardless.

He disputed the idea that MIH urgent care, as a startup program, wouldn’t be able to fully serve islanders at first.

“King County EMS is no joke — it leads the nation, leads the world in how we provide care to the public,” Whitney said. “And MIH is part of King County, part of that model. … And I would argue, because of where we are, that Vashon is actually the model community for this program.”

(Whitney is the deputy chief of operations at the Redmond Fire Department, where he oversees the department’s MIH program. MIH programs also comprise his thesis project for his work at the Center for Homeland Defense and Security.)

“We do want to provide urgent care on the island with you, so we built a plan like you asked us to,” Vinci said.

That plan can provide less expensive and more seamless care under one tent instead of sharing the scene with DispatchHealth, he said. But VHCD’s own analysis and comparison of the plans is incomplete, Vinci said, a reason to pump the brakes on signing the deal and spend more time learning how MIH would operate.

“What’s challenging is your opening remarks — I feel like you’ve already made your mind up,” Vinci said. “I just feel like there’s so much more that this board needs to learn about before you make a decision, and I really would ask you to slow down. … This is a missed opportunity if you go with DispatchHealth.”

VIFR has provided EMS services on the island since the 1940s, VIFR commissioner Brigitte Schran Brown said — in-person, 24/7, 365-day-per-year care. That includes emergent care — immediate risk to life or limb — but also urgent care, she said, such as treating a sick child or a serious laceration, including at VIFR’s walk-in station. While it’s complicated to give a proper estimate, she estimated that about half of VIFR’s calls are for emergent care, and about half are for urgent care.

Reducing transports by treating patients — hence avoiding slogging through the ferries and long waits at hospitals — will save time, free up VIFR crews and mean more service for Vashon, she said.

VIFR Commissioner Candy McCullough was the lone no vote on the MIH expansion vote earlier this month, arguing that the district should collaborate with VHCD before moving forward.

MIH has been “a great asset,” but the North Mason model works because that region has better access to hospitals and clinics, McCullough said, and she advocated for collaboration between the districts to see if, eventually, an enhanced MIH can (in a friendly way) “run DispatchHealth out of business” on the island.

But “whatever it takes, I want to provide the best services to the community … I don’t care if it’s DispatchHealth or the Fire Department,” she said.

VHCD commissioner Alan Aman was the lone no vote against the DispatchHealth proposal.

“The proposal itself is very attractive, except on the financial side … where we haven’t actually considered our due diligence,” he said earlier in the meeting.

Aman hopes the proposal is successful, but said VHCD and the public needed a more thorough comparison of MIH and DispatchHealth around cost, insurance and other factors — and a frank and fulsome appraisal of how they’d work together — before making a decision.

“We really haven’t had substantial joint planning, sorry to say,” he said at the meeting.

(Foreground to background) Brigitte Schran Brown, board chair of Vashon Island Fire & Rescue, commissioner Jim Whitney, Fire Chief Matt Vinci, and commissioner Amy Drayer watch as a motion is approved for Vashon Health Care District to subsidize the operations of mobile urgent care provider DispatchHeath. At far left, Health Care District commissioner Alan Aman (at table) cast the only no vote on the motion. (Elizabeth Shepherd photo.)

Stepping on toes?

One of Vinci’s primary concerns is that many of DispatchHealth’s capabilities duplicate MIH services that already exist — such as helping patients with prescriptions, fall prevention and getting food.

“I would challenge both of our groups to sit down and slice out what their … contract is going to cover that isn’t being covered already,” Vinci said.

That re-admittance prevention and “bridge care” is only a small part of what the company offers, DispatchHealth staff said.

True, DispatchHealth provides a variety of acute care services, DispatchHealth’s Dr. Stefan Ammon said, including scheduled visits to patients to help them avoid needing to go back to hospitals.

But they do much more: “We manage heart failure exacerbations, COPD exacerbations,” he said. “We carry IV antibiotics. (we) manage folies, perform wound care, and suture lacerations. And these are all typically same-day visits — people call and we present within a couple of hours time.”

And “anything that happens inside the walls of an urgent care, we can do,” DispatchHealth Regional Director of Operations Corey Kunz added. “A majority of our business [is] patients who call us at some point in the day — they or their kid has an ear ache, (or other) common urgent care issues and concerns.”

In an interview, Johnson and Noble said VHCD specifically struck the hospital-at-home model from the contract with DispatchHealth, honing its offerings on Vashon to only what’s really needed — acute urgent care such as prescribing drugs, ordering x-rays and administering antibiotics — to avoid stepping on VIFR’s toes.

“They will not be doing the chronic episodic care around urgent care,” Johnson said. “We have control over what Dispatch does for us.”

Patients seen by DispatchHealth can be referred, with the patient’s permission, to MIH for more care, Johnson said.

VHCD invites VIFR to be part of the team for managing DispatchHealth, Johnson said.

“I told the fire chief specifically that even if he did not like the fact that we might bring DispatchHealth in, we were still going to invite him to be part of the implementation,” Johnson said.

Other possible costs

The initial cost estimate for DispatchHealth’s first year on the island is $560,000, plus a $25,000 upfront fee. The second year would see an inflation cost rise of 3%, Johnson said, though that increase would be waived if DispatchHealth meets 1,800 or more patients in the first year.

But one major additional factor remains to be ironed out — the cost of providing care at no charge to the uninsured. The district is still figuring out the precise cost, but Johnson said a quick, rough estimate of one uninsured appointment per day works out to just under $140,000 per year. That would bring the final yearly cost to around $700,000.

They plan to figure out a plan for caring for underinsured people too, Johnson said: “Our commitment is to make sure that nobody fails to use it because they can’t afford it.”

DispatchHealth’s average co-pay so far this year for insured patients is between $19 and $40, said DispatchHealth Vice President of Partner Satisfaction and Strategy Stephanie Lind. The maximum self-pay for services in an in-home visit is $375, she said.

(The insurance aspect of the urgent care plans is complicated and The Beachcomber will revisit that topic in a future article.)

Another clause in the contract stipulates that both parties (VHCD and DispatchHealth) must work in good faith to adjust services or compensation if a third-party evaluator determines the fair market value of DispatchHealth’s services is off from their compensation.

Fire District also moving ahead

On Monday, VIFR leaders said they would carry on with MIH’s expansion — with or without funding from VHCD to do so.

“There are too many variables to commit to anything,” said Fire Chief Matt Vinci, regarding any future partnership between the two taxing districts.

A VIFR board motion, passed at a special meeting on August 12, authorized Vinci to take action to initiate the first phase of MIH’s expansion, adding a licensed social worker and additional registered nurse to the program to operate MIH three days a week.

VIFR is currently advertising the positions and has received several applications, Vinci said.

The motion also authorized Vinci to seek funding for a broader expansion to establish MIH as a seven-day-a-week urgent care provider, with the hire of a full-time physician’s assistant in 2025.

These goals will be part of VIFR’s budget planning process for the coming year, according to Vinci — and will also coincide with the completion of a renovation of the district’s main fire station, which includes a state-of-the-art exam room for walk-in urgent care.

Vinci said he was currently in discussions with other potential funders and partners for MIH’s expansion, though it was too soon to identify any of those entities.

More simply, he declared VIFR’s intention: “We’re actively looking at ways to continue to expand MIH, whether Dispatch is here or not.”

VIFR’s current MIH program, launched on Feb. 21, currently provides home health care to medically vulnerable islanders who have been referred to the program by partners including Vashon Senior Center, Vashon Youth & Family Services, and Vashon Care Network. More partners, notably including Vashon Pharmacy, are expected to come on board soon.

Originally a one-day-a-week program, it quickly proved popular and expanded to two days a week in May.

Throughout the same period, Vinci said, he learned that VHCD was considering contracting with DispatchHealth to provide mobile urgent care on Vashon. At that time, he said, he engaged in discussions with Johnson and VHCD commissioners about his concerns that a corporate mobile healthcare provider could disrupt VIFR’s services in providing MIH and also emergency care to islanders.

“I told [Johnson] that urgent care in the home is what Vashon Fire does, and what we’re building with MIH,” Vinci said.

In mid-June, discussions between the agencies led to a field trip: Both VHCD and VIFR staff and commissioners traveled to Mason County to visit a fire department that has expanded its MIH program to include urgent care.

“Leading up to our trip together to North Mason, the entire discussion was, ‘Let’s see if we can do this Vashon-based,’ Vinci said.

VIFR’s plan to further expand MIH to include urgent care was created in response to a request from VHCD, Vinci, board chair Brigitte Schran Brown and MIH manager Lilie Corroon said.

But in an interview on Monday, all three VIFR representatives said they did not believe the VHCD board fully considered that plan because they had already decided, by mid-summer, to move forward to engage DispatchHealth.

VHCD’s decision on Aug. 21 proved that point, they said.

“They had clearly made their minds up before we got there,” said Schran Brown.

Corroon added that she felt that some on VHCD’s board had mischaracterized VIFR’s plan for MIH’s expansion — casting it as a means to gain leverage over further discussions weighing the two different urgent care proposals, she said.

“We wrote a proposal that they asked us to write,” she said. “We were proud of it, and then we needed our board’s support so that we could move forward and talk to funding partners in a more serious way. That’s just smart and the way it should go.”

Vinci said he will be keeping a close eye on DispatchHealth’s operations on Vashon in the next 18 to 24 months.

“As the person responsible for oversight of our district, I need to ensure that they’re not impacting services the taxpayers are already paying for — that they are not doing MIH services, that they are not getting involved in Basic Life Support services,” he said.

Vinci said he also plans to launch an educational campaign to ensure that islanders will continue to call 9-1-1 after DispatchHealth’s arrival on the island.

“Don’t sit and wait for care,” Vinci said, describing his message to islanders. “… If you have chest pain, don’t call DispatchHealth. If you think you’ve broken your leg, or if your child falls off a bike — don’t wait for an appointment.”

The VHCD-DispatchHealth contract stipulates that DispatchHealth’s services are not requested for conditions which require emergency medical transport — such as chest pain, rectal bleeding, stroke symptoms or significant trouble breathing.