DispatchHealth usage is up, a commissioner is out and more contracts are getting inked at the Vashon Health Care District (VHCD).
Here’s what the board discussed and took action on at their Jan. 15 meeting.
DispatchHealth usage rising
Mobile urgent care provider DispatchHealth continues to see more patients and is building relationships with existing healthcare providers, according to data and interviews with healthcare agencies. VHCD last summer signed a deal to subsidize the provider on Vashon, starting in October.
DispatchHealth saw 142 patients in December, more than double its volume of 69 in October, according to data shared by the company. The agency has seen 312 total visits in its first three months.
December is the peak of the respiratory illness season, which may have contributed to the volume of visits that month. Between Christmas Eve and New Years alone, DispatchHealth saw 43 patients, VHCD Superintendent Tim Johnson said.
According to DispatchHealth, its net “promoter score,” which measures how many patients would recommend the service to others, sits at 98%.
“We have ended up with a product that’s better than what I personally had hoped we would achieve,” Johnson said.
DispatchHealth is now also working with Vashon Pharmacy, Sea Mar – Community Health Centers’ Vashon clinic and the Vashon Island School District Neighborcare clinic, Johnson said. “We’re starting to see a … cooperative sharing of the load. It’s really nice seeing those types of relationships starting to gel.”
The Beachcomber reached out to those three healthcare providers to confirm Johnson’s statements, but hadn’t heard answers from Neighborcare by its print deadline.
Tyler Young, owner of Vashon Pharmacy, called the relationship with DispatchHealth “really good:” “We have been able to refer multiple patients to get appointments in cases where patients fall outside of our inclusion criteria for treatment by a pharmacist. … Additionally, we have coordinated to have patients seen in our exam rooms, this was just one occasion where it was better for the patient and Dispatch was very agreeable to meeting them at the pharmacy. … I look forward to continuing to collaborate with them to take care of our island population.”
“Staff at the [Sea Mar] clinic state DispatchHealth has been an asset for Vashon,” Sea Mar Executive Vice President Mary Bartolo said, “(and) feel there is a good relationship with them. They are saving patients from having to go off island when we are not open. When our patients are seen by DispatchHealth they do fax a report to us, so our providers are aware of the visit and what occurred. (Their service) has not been a hinderance to our operations and staff are grateful residents have an on-island alternative for urgent care needs.”
As service grows, DispatchHealth may send another car, if needed, to pick up needed appointments, Johnson said.
“We are currently not looking at paying for an entire new crew out here, but they consider that a challenge that they need to meet,” Johnson said. “They have not asked me for extra money, and in fact, they have been willing to take economic hit on … some of the patients where they’re having insurance problems. So we’re getting good service. But it’s it’s getting busier faster than even they expected.”
Insurance coverage limits rollout
Though usage is up, insurance coverage continues to pose some challenges to the DispatchHealth rollout. Not all providers are yet covered, which requires the insurer to accredit DispatchHealth.
The urgent care provider takes most major insurers, including United HealthCare, Humana, Aetna and Cigna, and is working to strike deals with others, including Kaiser Permanente and Molina Marketplace.
Kaiser is the largest single insurer on the island, and Molina is the largest Medicaid provider that insures island residents, Johnson said.
Collectively, (and mostly from Kaiser), those plans probably cover around 3,000 or fewer people, or roughly 25% of the island, Johnson said, and are the significant remaining insurers with which DispatchHealth is still working to iron out agreements.
Coverage of Kaiser in particular has been a point of confusion.
According to minutes from the board’s September meeting, DispatchHealth at the time was “still working with Kaiser to finalize an agreement with the provider.”
Months later, when VHCD shared DispatchHealth’s report on October, its first month on the island, the health care provider had included “Kaiser Health – Medicare Advantage, Commercial & Managed Medicaid” in its list of in-network payers for acute care. However, the reports for November and December no longer included Kaiser in that list.
There is a signed contract between Kaiser and DispatchHealth, Johnson said, but it’s still in the implementation stage. Currently, Kaiser is not allowing patients to onboard themselves with DispatchHealth, Johnson said.
”The short answer on Kaiser is that DispatchHealth believed and believes they have a deal with Kaiser across products,” Johnson said in an email. “Somewhere in implementation at Kaiser that is not currently the effective case. Work is still ongoing, and … the public … will be very quickly notified of progress.”
Meanwhile, there’s Molina, which offers a managed Apple Health (Medicaid) program. DispatchHealth is seeking accreditation for that program, Johnson said. Molina also offers Molina Marketplace, a commercial plan for those who make too much for Medicaid but who don’t have access to health insurance through their job. This program also does not yet cover DispatchHealth.
“DispatchHealth has not been accredited by that group yet,” Johnson said. ” [We] don’t know if they will or not. Part of the problem is … it’s hard for DispatchHealth to chase every insurer down, especially ones that just have a few patients. So in that case, it’s really on Molina to come back to DispatchHealth.”
Ultimately, Johnson said, it will take time for the accreditation gaps to be ironed out. Their goal is to get as close as possible to 100% coverage of the island, Johnson said, but the district decided it was better to rollout DispatchHealth early rather than “wait until you’re insured with everybody before you start any service.”
“It’s really important for people to understand that in neither case, Kaiser or Molina, is it DispatchHealth holding up [the process],” he said. “[DispatchHealth] currently offers Apple Health through a number of providers. Molina was just one that was not accepting it. … I think at this moment, we really need to let the companies work together and solve problems.”
Those having trouble being seen with their current insurance can contact the district at info@vashonhealthcare.com to get help.
Compassionate care
For those who don’t have insurance, or their insurer isn’t contracted with DispatchHealth, the provider accepts a flat rate of $375 per visit — which covers any services they do, except for a few third-party services like imaging or labs.
But during the Jan. 15 meeting, the VHCD board unanimously (4-0, sans commissioner Alan Aman, who had departed the board) agreed to a “compassionate care” agreement that they hope will keep most non-covered patients from having to pay this fee.
Those who qualify will have their DispatchHealth visit covered by VHCD, while they get help signing up for insurance. VHCD has set aside $97,500 in its 2025 budget to cover the cost, reflecting an average of five uninsured visits per week.
Johnson said the goal is especially to reach the island’s undocumented community, who frequently do not qualify for healthcare options.
“The first question you get when you talk to somebody who has no insurance is, ‘How will I pay for this?’ The goal here is to make it as simple as possible,” Johnson said.
To receive compassionate care, a patient must currently be uninsured and willing to work with local social services organization Vashon Youth and Family Services to get insured, if possible. The patient must also be ineligible for Medicaid or Medicare. If they’re eligible for private insurance, such as Kaiser, they must have an income below 250% of the county poverty rate and face insurance premiums which VYFS determines are unaffordable.
VYFS staff will then create an appointment for them with DispatchHealth and help them sign up for some kind of insurance coverage and benefits. Those who have difficulty securing insurance can keep seeing DispatchHealth on the district’s dime, but must continue working with VYFS.
“We will not be taking on multiple visits for folks who are not willing to do the leg work with Youth and Family Services,” Johnson said.
The system will also apply to those with insurance plans which don’t cover DispatchHealth, like Molina Commercial or Kaiser, and who fall within the income range.
“If there’s somebody who has a Kaiser plan who is very low income and falls within the categories, and they need to be seen right now, that falls within the parameters,” Johnson said.
Commissioner resigns
VHCD board commissioner Alan Aman resigned from the board the night of the meeting, referencing perceived failures in some parts of the district’s work and financial decision-making.
The board is deeply committed to the community and has the right big-picture goals for helping Vashon — primary care, behavioral health and urgent care — Aman said. But “aspiration is insufficient,” he said, and the district only “spent a small fraction” of its cash last year for those healthcare goals.
Aman pointed to the district’s third-quarter 2024 financial statement, covering January through September that year. Only $10,800 was spent on program funding in that period, despite more than $1 million being budgeted for it.
The launch of DispatchHealth in October meant a new $560,000 yearly price tag (plus inflation) for the district, and the district has now set aside around $1.5 million for programming out of its $2.1 million 2025 budget. Though that spending is more substantial, Aman said some of it remains unexecuted — including money set aside for partnerships, such as a possible joint patient services program with Vashon Island Fire and Rescue.
Despite his efforts, Aman said, the district has yet to adopt some needed good governance practices. He was concerned, for instance, that the district did not embark on a full search process when seeking its executive, a position ultimately filled by Johnson. Aman characterized that not as an indictment of Johnson, but of the process that hired him.
And despite building up a reserve to take over primary care in the event that Sea Mar leaves the island, the district has “significant unfinished business” in managing those risks, he said. An agreement between the two struck in late 2022 after their split stipulated, among other things, that Sea Mar “make its best efforts to hire staff and provide resources to meet the needs of Vashon Island,” and that both entities publicly support each other’s efforts in good faith and collaboration. Aman has advised the district to take a stricter stance toward Sea Mar.
Both Johnson and Bartolo have described the Sea Mar – VHCD relationship as productive and cordial. “We touch base periodically and feel we have a good and positive relationship,” Bartolo said.
DispatchHealth has “promising initial results,” but as a venture-funded company seeking private investment, “we have not ensured that the use of public funds … does not unduly enrich investors,” Aman said.
And he shared concern that the district is not yet sufficiently collaborating with VIFR to coordinate services, a year after both districts began seriously pursuing their urgent care visions.
Aman’s critiques of the board’s collaboration with VIFR speak to a broader communication breakdown between the two boards that began in the summer of last year. He doesn’t apportion blame for the failure to collaborate solely to one board or the other: “I think both parties have full responsibility.”
But Aman says the disagreements were becoming clear a year ago, and that he recommended in June that VHCD should have worked with a third party facilitator or consultant early on to hash those disagreements out.
At the meeting, fellow board members praised Aman for his service and for being a voice of constructive criticism on the board, and said they’d take his critiques seriously.
Though she “didn’t always agree” with Aman, board member Wendy Noble said she valued his honestly about the board’s need to improve its policies and structure: “I appreciated your holding our feet to the fire.”
“I have found myself changing positions based on our interactions, and that’s not an easy thing for any of us to do at times,” Tim Johnson said. “I appreciate the diligence with which you approach this and the fact you care about it. Thank you.”
The Beachcomber asked Johnson how he’d respond to Aman’s critiques and what the board is doing on those topics. Johnson said he shares some of Aman’s beliefs but believes the district is making progress.
Yes, more of the budget should be spent, Johnson said, and: “We’re very careful about allocating resources based not just on a single year. … We had hoped to be doing urgent care much quicker … and its is costing a significant amount of money now, and we’re going to continue to have those bills for a while. … We’re trying really hard to maintain strategic discipline on where we can do the most good the most effectively.”
“The district has made progress” on governance, Johnson said. “(Aman) is correct that good governance practices are important and that we need to continue to be better at them, and we will.”
On their relationship with Sea Mar: “We feel that we don’t have a significant amount of leverage [over Sea Mar],” Johnson said, “(and) we are trying to be a collaborative, helpful [partner.] Obviously we would like Sea Mar to follow through on things that we think are important. But at the same time, we are not their boss. … I respect former commissioner Aman’s viewpoint. I just respectfully disagree.”
DispatchHealth, Johnson said, is a pioneer in the mobile urgent care field and provides a professional and respected service. If a similar provider offered that care through a nonprofit structure or other format, the district would consider it, Johnson said. “We have not ruled out a local solution, if that were to … provide the equivalent care.”
As for working with VIFR, Johnson said: “A partnership or a working arrangement would require two partners, and as of yet, we haven’t found a [shared] desire on a project. I’m not going to blame anyone for that. … We are hopeful, moving forward, that we can continue to work together, or start to work together.”
Senior center social worker
Also at the meeting, the board voted unanimously (4-0, sans Aman, who had departed the board) to fund a part-time social worker at the Vashon Senior Center at a cost of $7,000 per month during 2025. The social worker would work about 60 hours per month at a cost of $100 per hour (roughly 15 hours per week) and help older adults access Medicare and other resources. The other $1,000 in the cost would cover administration.
The hire, Robyn Stover, is a licensed social worker who has longer served islanders. “She was a perfect choice,” Johnson said. “She’s had countless encounters with the aging population and their families.”
The position is set to start this month, according to the district.
Also at the meeting…
• The board re-elected its existing officers. Tom Langland was re-elected board chair and Wendy Noble maintained her seat as secretary. The bylaw position of auditor was vacated by outgoing commissioner Alan Aman and will need to be filled once more.
• During public comment, Ron Smothermon criticized the district for declining to record and post video of their meetings, calling it a transparency issue. “I’m disappointed … that you’re worried about backlash from what people might pull from previous meetings, and that tells me that you aren’t willing to be transparent,” Smothermon said.
In his report to the board, Johnson wrote that doing so is not required by law; that people have expressed a desire to not be recorded when sharing comments to commissioners; and that snippets of recordings can be weaponized to smear or embarrass elected officials or speakers.
“I take Ron Smotherman’s comments under advisement,” Johnson said during the meeting. “I disagree [with those comments], but I respect the fact that he does show up … and I would encourage him to continue to do so.”