Following its designation by the Washington State Health Care Authority (HCA) in 2015, the North Sound Accountable Community of Health (NSACH) incorporated as a nonprofit corporation in 2016 and appointed it Board of Directors in 2017. The NSACH is tasked with improving the health of the Medicaid population in the north sound region (Whatcom, Skagit, Island, San Juan, and Snohomish Counties) through practice transformation, how services are paid for, identification and filling of health gaps, health equity, and partner coordination. Participating entities include counties, health care, EMS, service providers, insurance companies, tribes, public health, and others.
NSACH’s initiatives and project plan strategies align well with SHD’s mandates and program areas. Overlapping work areas include immunizations, maternal child health, chronic disease prevention, oral health, and opioids. In particular, NSACH funding is targeted at the Medicaid population, clients for whom we often do not receive adequate funding to cover our costs. We hoped NSACH might be a funding source that would allow SHD to recover some costs as we serve these low income/high risk populations. The NSACH is also a well-funded organization, with substantial resources from a State Innovation Model (SIM) grant from the U.S. Centers for Medicare & Medicaid Services (CMS) delivered through HCA.
With the potential to partner with a well-funded entity that had similar mission to SHD, we entered into a partnership agreement with NSACH on June 20, 2018. On July 24, 2018, SHD received a payment of $28,000 for agreeing to be an NSACH partner. The deliverable for the agreement was for SHD to attend a two-day retreat to explore future potential partnerships throughout the region. The retreat was held August 8-9, 2018, and SHD staff attended.
The next step of the partnership process was to submit a Change Plan. The Change Plan is an inventory of activities SHD was already doing that benefit the Medicaid population and support NSACH. Most of the milestones and tactics were not applicable to SHD, but ones on oral health promotion and opioid prevention services fit well with our existing activities. We entered into a Change Plan agreement on November 2, 2018. We did not know how much funding would be available to partners; it all depended on how many partnering organizations applied. SHD received $56,000 on November 13 and $54,500 on December 25, 2018, only on the basis of submitting a Change Plan. This funding is for Change Plan activities already performed and does not obligate SHD for further work.
After SHD submitted the Partner Application we agreed to their Master Services Agreement (MSA) on July 2 that was not obvious or available at that time (Exhibit B).
Discussions with the Board and Health Officer indicated a concern about the data-sharing component of the MSA. A solution was to revise the proposed Special Project Agreement to ensure SHD will not be required to supply protected health information as a condition of the programs funded. This will be brought to the Board at a future date.