Hospital Engagement with State Transformation

November 13, 2014

To:      Hospital CEOs and Administrators, CFOs, and Government Affairs

From:  Claudia Sanders, Senior Vice President, Policy Development
Ben Lindekugel, Executive Director, Association of Washington Public Hospital Districts

Staff Contact: or 206-216-2508

Subject:  Hospital Engagement with State Transformation

The Washington State Health Care Authority (HCA) is moving forward with its plans to transform the health care system. The agency recently issued a grant opportunity to establish ten communities of health in the state. Now is the time for hospital leaders to make sure they are appropriately represented in the governance structures of these newly created organizations.

The state’s work on transformation has the potential to dramatically reshape the provision of care in Washington. The state is counting on new local structures, Communities of Health, to help shape state purchasing and address population health issues. All hospitals in Washington should be engaged in the work at the local level to form these new Communities of Health.


  • Review or have your staff review the recently issued notice on grant opportunities.
  • Determine which local organization or organizations in your area are likely to respond to this grant as the “backbone structure.” (See below on listings for organizations previously receiving planning grant funding).
  • Contact the local organization and find out how your hospital will be represented in the community of health governance structure.

Organizations must submit their letter of intent by November 19 and their application by either December 1 for early adopters or January 2 for others.

  • Determine if your hospital supports the proposed organizational structure, and if so make sure you are active in this process. If your organization has questions or issues with the proposed structure, now is the time to voice these concerns with the organization and/or with the HCA.

The state has begun to give shape to the reform plan passed last year by the legislature, HB 2572. The legislature funded two test pilots of local Communities of Health. HCA continues to pursue with its proposal to create 10 new structures across the state.

In the recently released grant opportunity, HCA proposes to select and fund the two pilots (earlier adopter regions) for up to $150,000 each. It also proposes to select organizations in the remaining 8 regions. These organizations will get design funding up to $100,000 each, contingent on funding becoming available through federal approval of the state’s grant application with the Centers for Medicare and Medicaid Services. The state expects to hear any day if its grant application for $90 million over the next four years has been funded.

The boundaries for the Communities of Health are intended to mirror the newly created Regional Service Areas. These 10 areas will be used for purchasing as the state moves to integrate behavioral, mental, and physical health.

Next Steps
With the state moving forward, hospitals should make sure these nascent organizations, likely to become the “backbone structures” for the local Communities of Health, will be effective ones that can help address population health issues in their area and provide feedback to the state on its health care purchasing for behavioral, physical and mental health. The state has previously awarded planning grants to organizations that will potentially become these new backbone structures. Awards have been made to the following organizations:

  • Public Health –Seattle & King County (King County region)
  • Pierce County Health Innovation Partnership (Pierce County)
  • North Sound Accountable Community of Health (North Sound)
  • Better Health Together (Spokane region)
  • CHOICE Regional Health Network (Peninsula, Thurston/Mason, and Timberlands)
  • Benton-Franklin Community Health Alliance (Greater Columbia)
  • Southwest Washington Regional Health Alliance (SW Washington)
  • Yakima County Accountable Community of Health (Greater Columbia)
  • North Central Health Partnership (North Central)

A backbone organization can apply to serve multiple regions, but a region cannot have multiple backbone organizations. While the state will be designating two regions as early adopters, it is unclear how many regions are interested in pursuing this designation, as well as the likely awardees. There may be more than two regions with interest. If funding becomes available through the federal grant, other areas will be funded to do similar work but on a longer timeline for the work products.

All organizations interested in applying for the grant should obtain the support of their local partners. Those applying as an early adopter pilot are required to provide names of partners to the state; the state will follow up with a survey to each of the named partners asking about their level of support for the applicant. Other regions, not interested in being early adopters, may also be looking for support as well.

The list of partners intended to be represented in the Communities of Health is extensive. Along with the medical sector (hospitals, Federally Qualified Health Centers, EMS, home health, long term care, community mental health centers, and health plans), it includes faith-based organizations, food system, housing, labor, consumers, local governments, social services, employers and many others.

Hospitals should make sure they participate actively in discussions on how these organizations will set up their governing structures for the Community of Health. Will the hospital be represented on the Board or Executive Committee? Are hospitals represented as a group? Who will be represented? How will decisions be made? How does the organization plan to engage those not directly involved in the governance structure?

Aside from actively participating in discussions at the local level, please keep WSHA informed as these new structures take shape. We anticipate there will be legislative interest again this year in the Governor’s plan and that the legislature will be working on refinements.

Background and References 

Grant Opportunity

The Plan for a Healthier Washington

WSHA Bulletin on HB 2572

HB 2572


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