URGENT CARE

District needs joint planning, due diligence

On August 21 the Vashon Health Care District (VHCD) voted to approve an agreement with DispatchHealth (DH) for the provision of urgent care, offering a subsidy of up to $700K per year and potentially more to cover uncompensated care. DH is an experienced provider and we wish this effort great success. However, I voted against the proposal due to very incomplete joint planning work with VIFR and financial due diligence.

Urgent care is variably defined, but generally is care required within 24 hours, often delivered in settings of retail clinics, telemedicine, primary care, traditional urgent care and emergency services. The place of service is determined in part by the specific clinical need, and often also by what is accessible and covered under an insurance plan. The role of VCHD is to fill the gaps and work to ensure all providers function at the highest level possible.

VIFR has proposed the expansion of its Mobile Integrated Health (MIH) service, potentially capturing a significant portion of community need, at a cost of approximately $350K. Despite a summer of discussions between VIFR and VHCD, the August board meeting demonstrated there is no shared understanding of community needs nor a jointly designed urgent care service.

Urgent care services are largely funded through insurance benefits, often with copays and constrained by the provider networks available in specific plans. Urgent care often shows losses and it is reasonable for the VHCD to subsidize care, so long as the total cost per patient is fair compared to alternatives and insurance coverage is full.

DH is not currently included in the benefit plans for all island insurers. Finally, DH is a venture capital firm reportedly planning an IPO and looking to maximize its market value. An analysis of the basis of the subsidy is needed to ensure that public fund transfers to DH are reasonable and not excessive.

The way forward must include the immediate initiation of discussions between VIFR and VHCD with the use of a third party to establish a joint planning process and the completion of the financial due diligence concerning the DH agreement.

Alan Aman is a Vashon Health Care District commissioner.