After a year-long deliberation following their split with Sea Mar Community Health Centers, commissioners of the Vashon Health Care District have been forging a new course in serving the island’s health care needs — focusing on establishing urgent care services, growing behavioral health care, especially for children, and maintaining cash, if needed, for primary care.
The decision to focus on urgent care and youth behavioral health coalesced around the spring of this year, said District Superintendent Tim Johnson, following outreach to community organizations and direct talks with islanders. Comments during a town hall-style meeting in March centered on Vashon’s unmet need for an urgent care provider, something that’s been on the district’s radar for a long time, Johnson said.
Since that time, the District has explored partnerships with regional urgent care providers and even talked with mobile health care providers.
Right now, the taxing district has a sea of options — but it is still seeking answers.
The District doesn’t yet have specifics for the approximately $1,388,000 in programming reflected in its 2024 budget, which was passed on Nov. 15. The fate of its uptown property is yet to be determined. And getting providers on-island is easier said than done.
The District is eagerly exploring the idea of building a new urgent care clinic and talking with interested parties, but Johnson said he didn’t want to overpromise or jeopardize those relationships by sharing plans too early.
“When you’re in the stages of planning … you don’t really want to go out and just advertise every conversation you have, because it gets people’s hopes up … and you end up having to defend or justify things that were never real to begin with,” Johnson said.
The next few months will be pivotal for the District, as its commissioners and superintendent inch closer to inking agreements with urgent care providers.
“We’re looking at the end of March, early April, as having a concrete idea of what it is that we want to try to accomplish this year [2024],” Johnson said. “I think we, in the next few months, will be able to start bringing actual decisions to the board … and engaging the public on it. It’s not going to be very much longer.”
The budget
The 2024 budget assumes about $2.07 million in revenues, nearly all from the $1.95 million levy. In the four years the district has been in existence, that levy amount has stayed the same, district commissioner Eric Pryne said. (Pryne’s term in the district ends this year.)
For the tax year 2024, the assessed value of the island is down slightly, which means the collection rate for 2024 is estimated at about 43.5 cents per $1,000, higher than the collection rate of 38.8 cents in 2023, Pryne said. The district won’t have a precise number until the county assessor finalizes the assessed values for all levies, Pryne said.
Ultimately, “the taxes paid to the district by individual homeowners will remain about the same,” Pryne said.
That’s because collection rates go up when assessed values go down; the district is collecting the same total amount of money either way.
As an example, a home in Pryne’s neighborhood fell from $825,000 to $724,000 in assessed value from tax year 2023 to 2024. Based on the collection rates for each year, the owner paid about $320 to the district last year and probably will pay roughly $315 next year.
Budget revenue also includes about $25,000 in investment interest, and $96,000 in reimbursed rent for the Sunrise Ridge clinic from Sea Mar, the latter of which passes through directly to cover the rental payment, utilities, insurance and taxes for renting Sunrise Ridge. (The District leases the Sunrise Ridge clinic from Sunrise Ridge Health Services and subleases to Sea Mar.)
The district plans to spend about $1.74 million in 2024. About 80% of that amount, or $1,387,600, is for program funding.
Johnson estimates that, very roughly, $1 million of that program funding balance will go for urgent care, about $150,000 for behavioral health, and the remaining roughly $237,500 will be used for outreach and new programming.
Those are just preliminary estimates of how they’ll spend their program funding budget, Pryne cautioned: “I wish we were farther along (in) having nailed down details of these programs, but we (are not).”
The remaining $355,000 or so goes toward operational costs, including $40,000 for consulting and IT services and $87,000 for superintendent pay (last year that amount was $82,800).
That leaves the district with a surplus of $328,763. That money will be important for helping cover expenses during the first quarter of 2025, Pryne said, which is the period before the District begins collecting significant 2025 tax revenue. (Most people don’t begin paying their property taxes until April.)
“We will have almost no tax revenue coming in the first quarter of 2025, and need to have money from 2024 to cover expenses during those months,” Pryne said.
What about the money collected last year?
The District started 2023 with $562,305 in debt from King County, which it borrowed for operating costs, a property purchase, and for covering its operations in 2020 before the time it began to receive tax revenue in 2021.
The tax revenue from 2023’s roughly $2 million in revenues (again primarily from the $1.95 million levy) fully paid off that debt from King County, including a loan used to purchase land directly south of Kathy’s Corner Nursery in 2022 — and built up money for expenses and program funding, Johnson said.
And the money also helped the District put away reserves for subsidizing another primary care provider if Sea Mar leaves the island. That would allow the District to go a year without raising taxes, Johnson said.
This year, the District plans to maintain reserves of $750,000 for primary care, $500,000 for capital projects and $25,000 in operating contingency, according to its 2024 budget.
That half-million capital amount is a stockpile for the event that the District builds a new urgent care clinic — helping to avoid seeking a bond to do so, Johnson said. In the event Sea Mar leaves the island, the reserve could also be tapped to buy their future clinic property at the old Spinnaker building, Pryne said.
“But I think it would be preferable to use it for something of our own,” he added.
In a follow-up email on Pryne clarified the following: “I would support Health Care District purchase of the Spinnaker Building property only after Sea Mar’s proposed clinic there is built — and only if Sea Mar leaves Vashon — and only if the District determines that purchase of the new clinic is in the island’s best interest.”
District, Sea Mar timeline
The District was established in 2019 with 70% approval by Vashon voters, who responded to the message that Vashon needed to establish oversight of healthcare providers after a string of providers had left the Sunrise Ridge clinic due to financial losses.
As a King County Public Hospital District, the District’s purpose is to collect property taxes to subsidize health care for islanders.
The District ultimately engaged Sea Mar to operate the current clinic at Sunrise Ridge, which opened in late 2020. The district provided a $1.5 million-per-year subsidy to Sea Mar to sustain its operations on Vashon.
The Vashon-Maury Health Collaborative, a nonprofit helmed by healthcare advocates on Vashon, had worked behind the scenes to secure 2.3 acres of land close to Vashon’s town core, which the District finally purchased in September 2022 for a below-market value of $570,000, from B&B Northwest Properties, an entity controlled by longtime islanders Matt Bergman and Kimberly Bergman.
On the site, immediately south of Kathy’s Corner and mostly consisting of a flat field, commissioners said they hoped to build a new, community-owned healthcare clinic.
In announcing the District’s intention to buy the land in July 2022, Tom Langland, then chair of the board of commissioners, said that Sea Mar was “a highly motivated partner in the move to a new facility,” and then-Superintendent Eric Jensen said the district was involved with Sea Mar on an “ongoing collaborative approach to designing and building the new Vashon clinic.”
That partnership did not last long.
The District’s split with Sea Mar began with a termination letter sent by Sea Mar to the healthcare district on Aug. 24, 2022. The letter gave a Dec. 31 termination date for Sea Mar’s sublease of the Sunrise Ridge Clinic, as well as its services agreement with the district.
Two days later, a press release headlined “Sea Mar Community Health Centers to leave Vashon Island” explained that the district’s desired level of involvement in clinic operations conflicted with Sea Mar’s need to operate independently.
However, that same week, Sea Mar executives abruptly reversed course, announcing that they wanted to continue to operate at the Sunrise Ridge clinic while building Sea Mar’s own new clinic on Vashon, which would be operated independently from the district on the current site of the Spinnaker building.
Sea Mar also said that in building its new clinic, it intended to tap $3 million in a state appropriation that was originally made in 2018 to Neighborcare Clinic, but transferred to Sea Mar in 2020 when it took over the operation of the Sunrise Ridge Clinic.
The $3 million in state funding originally came in response to a request to Sen. Sharon Nelson, a Vashon resident, by members of the Vashon-Maury Health Collaborative.
A key negotiating point during Sea Mar’s split with the District was the fate of that $3 million appropriation, which was specifically earmarked to build a primary healthcare clinic on Vashon.
In the end, Johnson said, “Sea Mar has granted us an option, should they decide to leave the island, that we would have the first right to buy their clinic, and that they would adjust the market value of it by whatever percentage of that $3 million is in there,” Johnson said. “So they would recognize the $3 million as already contributed.”
The District’s purchase of the uptown property was finalized in September, and its tax subsidy for Sea Mar’s operations at Vashon’s Sunrise Ridge Clinic ended on the last day of 2022.
“We came to a mutual understanding … (Sea Mar has) been collegial since then, and I’d like to think the relationship’s a little better,” Johnson said, calling the period of the District’s exit negotiations with Sea Mar a tense time.
At the dawn of 2023, the District faced an existential question: How would it redefine its purpose and spend its tax revenue now?
A listening campaign this spring, which included meetings with local organizations, tables at grocery stores and public meetings at the Land Trust building, led to three priorities: Keeping money on hand in case Sea Mar no longer provided primary care, and developing urgent care and behavioral health care services.
Here’s what the District has planned so far as the agency irons out its short- and long-term plans.
Behavioral and urgent care
Behavioral care is a new frontier for the District, but it came up again and again during their listening sessions, Johnson said.
“A lot of things that make our island a wonderful place to be also close it in around you, especially when you’re a young person,” Johnson said.
At least to start, the District will focus on adding access to pediatric (birth to 18 years) behavioral health services, and is now meeting now with health providers, counselors and the school district to hone its plan, Johnson said.
“One of the big things we kept hearing was that the COVID crisis and a lot of other things really made it difficult for children,” Johnson said. “There’s not enough access, there are really long wait times and not enough counselors.”
Johnson said the District intends to work with organizations such as Vashon Youth & Family Services (VYFS), VARSA, and Neighborcare Health’s current healthcare clinic at Vashon High School, serving local youth (a separate Neighborcare entity from the primary care clinic that departed Sunrise Ridge in 2019.)
Funds from the District could fund the hire of an additional counselor at VYFS, for example, according to Johnson.
Urgent care, meanwhile, would likely involve subsidizing a medical service or provider to have one or two practitioners on the island, offering 12 hours of service seven days a week, Johnson said.
Urgent care is acute, but not life-threatening health service, falling in-between primary care and emergency care. It often treats injuries like minor fractures, urinary infections, or cuts requiring stitches. With an aging population and transportation challenges, it’s something islanders have brought up constantly, Johnson said.
“Our vision, long term, is to have a functional onsite urgent care,” he said. “… This is not a done deal, but we are definitely pursuing it. We have resources and we have a desire to do it.”
An emergency room or 24-hour medical center isn’t financially realistic for the island, Johnson said. So the District’s goal is to work with Sea Mar, Vashon Island Fire & Rescue (VIFR) and others to ease the pressure on their services and avoid cannibalizing existing primary or emergency care on the island.
“We’re already [at] roughly 40% of the population of what a normal urgent care clinic needs to be functional, which is why the District will more than likely have to step in and provide financial support,” Johnson said.
Sunrise Ridge would “probably not” work as a location for urgent care once Sea Mar leaves, nor would it make much sense to share a location with Sea Mar, Johnson said.
“We intend to honor our lease with Sunrise Ridge, but we don’t have long-term goals for that piece of property right now,” Johnson said, citing its lack of accessibility for many islanders as one reason the Vashon Food Bank had announced plans to move its operations to the town core.
“It’s very hard for people with mobility issues or transportation issues to get up there,” he said.
VHCD will continue maintaining the Sunrise Ridge property for as long as it holds the lease, Johnson said.
The District’s vacant uptown property is currently the most natural fit for an urgent clinic site, Johnson said — but added the District is still exploring options and hasn’t yet committed to a single plan for using it.
(The property costs $17,000 to maintain for the year in the 2024 budget, which includes vegetation control and a budget to demolish and clean up derelict structures on the property.)
In the meantime, the District is considering options such as mobile urgent health care — a fully-equipped urgent care van, essentially — to meet the need, Johnson said, adding that the District has already had discussions with mobile healthcare providers about the idea.
He said he’s also talked with Vashon Fire Chief Matt Vinci to ensure their plan doesn’t step on the toes of the fire district’s Mobile Integrated Health (MIH) program —which is already partially funded by King County’s existing Emergency Medical Services levy.
The MIH program will provide home visits to vulnerable islanders identified by VIFR as needing preventative check-ins by a firefighter and a nurse. Unlike urgent care, MIH will not be a program that islanders can access independently — referrals to the program will be made by the fire district.
Would the Health Care District roll back future taxes if there were no realistic options for urgent care?
“If we were to get to a point where we felt we didn’t have those realistic options … (or) realistic views for the property, we would obviously make different decisions about the levy and the property,” Johnson said.
A site for housing?
In August, Jason Johnson, executive director of Vashon HouseHold, made a presentation to the Health Care District’s board about the local affordable housing nonprofit’s work, which included a graphic showing how affordable housing could be developed on the uptown property.
While the District has no current plans to develop or subsidize a housing project there, the organization is considering all options — including partnering with a group interested in such a project, Tim Johnson said, at the District’s Dec. 6 public board meeting.
“We know that Vashon HouseHold is always looking for projects … so I asked them to come out and just talk to our board,” Johnson said in an interview last week. “We have not moved forward with any plans. … I’d be tickled pink if we had a project that ended up coming together with Vashon HouseHold providing, for instance, workforce housing.”
A clinic on the uptown property wouldn’t necessarily take up the entire property, and offering health services alongside housing could offset the cost of providing the health care, Johnson said. But any involvement would be an add-on to the District’s main projects, he said, not its chief focus.
Getting too involved in housing would mean that the District would be creeping away from its original mission, Johnson said.
“I wouldn’t even call it mission creep, I’d call it mission run,” Johnson said. “We are not trying to broaden our focus that far. … We’re just looking at whether housing or other social services or other medical services, or any other potential partners, would work on the property with us. … No one on the commission wants to make a snap decision or a silly decision about a pretty valuable asset like that property. … It doesn’t cost a lot to hang on to it. And it has value. So it’s not like we’re losing value as we go.”
Editor’s note: This online version adds a clarification from Commissioner Eric Pryne, received after the print edition of the Dec. 14 Beachcomber was published, regarding Pryne’s assertion that the District’s reserve fund could potentially be tapped, if Sea Mar Community Centers left the island, to buy a future clinic property on the site of the old Spinnaker Building.
On Dec. 15, Pryne clarified by email that he would “have zero interest in buying the Spinnaker property in its current state from Sea Mar. Purchase would be a possibility — and only a possibility — when and if their proposed clinic [on that site] is built, and if we exercise our right of first refusal to buy it should Sea Mar leave.”
