BHT Community Strategy Development Timeline

Throughout 2016, we hosted multiple series of community feedback sessions where we worked to learn and build out our community’s perspective on regional health improvement strategies.

January Regional Gathering:
In January we hosted our first iteration of Community Linkage Mapping, an exercise we have been building and refining throughout the year where participants inventory their organizational relationships in an effort to build a “map” of our health system. Also in this session, participants broke out into dynamic Idealized Design feedback sessions in each of our Priority Areas.

February/March Community Linkage Mapping:
At the end of February/Early March we hosted an expanded second round of Community Linkage Mapping and Idealized Design. We spent the months of March and April synthesizing the information and building out our community strategy maps. A few voiced themes from those sessions included the need to:

  • Foster a culture of self-care and personal responsibility
  • Build on opportunities for communities to nurture grassroots health
  • “Coordinate the Coordinators”
  • Build a common platform to ease information sharing and access
  • Balance coordinated decision-making across the region, while honoring self-determination in local communities

Summary of May Leadership council meeting:
In May we debuted the first draft of our community strategy maps, which represent a snapshot of the feedback we heard in the previous sessions. After, we announced the formation of Community Action Strategy Teams which would meet throughout the summer to validate and expand the identified strategies and decide on appropriate indicators measure. Each was chaired by a BHT Board Member. From June-September, we hosted feedback sessions and conducted individual outreach using the Results Based Accountability framework. The resulting updated Community Strategy Maps for Social Determinants and Population Health were debuted in September.

In October, we began working with the Spokane Regional Health District Data Center to execute a process for finalizing our Community Linkage Map. We will be surveying organizations across the region, asking them to identify their organizational relationships, which we will be able to visually inventory in a “Network Analysis” (example). This network map will help us visually represent where there are gaps of care in our health system. The map will live on the BHT website available for the public to view and explore. We will gather survey responses until December 31st, and expect to have the analysis complete in 2017.  

When this map is completed, we intend to bring back this systems level view of our region to our Community Strategy Action Teams to validate our strategies and prioritize areas of impact. 


As you can see, staff was pretty excited about this announcement...

As you can see, staff was pretty excited about this announcement...

After months and months on the edge of our seats, we were thrilled to hear on Monday that CMS and Health Care Authority have come to principle agreement on the Medicaid 1115 Demonstration Waiver. The five-year demonstration provides up to $1.1 billion of incentives for delivery system reform and $375 million to support critical services for Apple Health clients over five years. 

Significant stakeholder and community input informed the four goals of this demonstration plan:

  • Reduce avoidable use of high-cost services such as acute care hospitals, psychiatric hospitals, and nursing home facilities.
  • Improve population health, with a focus on prevention and proactive management of diabetes and cardiovascular disease, pediatric obesity, smoking, mental illness, and substance abuse for Apple Health clients.
  • Accelerate Medicaid payment reform to pay providers for better health outcomes.
  • Bend the Medicaid cost curve below national trend.

The specific terms and conditions will be negotiated over the coming months, so it will still be some time before those dollars start flowing to health improvement projects across the state, but we've just leaped a major hurdle on the track to a Healthier Washington. 

You can read more from the Governor's media release here. 

Social Determinants of Health Strategy Map

DRAFT - Work in progress

After a summer of focus groups, we are thrilled to release an updated draft of our Community Action Strategies Map! Thank you to all who contributed feedback in one of our sessions. 

A reminded this document is very much in draft form. We intend for these maps to be a living document, that we regularly return to and update as needs and priorities change. Today, this map represents a snapshot of the most prominent themes we heard throughout the focus groups.


There are many factors that lead to whole-person health and most of those factors happen outside of a doctor’s office. We have identified 6 target factors in the Social Determinants of Health: Housing, Income Stability, Food, Transportation, Education, and Community Support

Originally, the ACH Leadership Council, Social Determinants Subgroup worked on the strategy mapping for these 6 areas collectively, but it was very apparent that we needed a more systematic approach where we could engage the regional experts in targeted discussion. In August, ACH staff and SDOH workgroup co-chair Pam Tietz participated in a Results Based Accountability training hosted by THEZONEPROJECT, which presented a fortuitous opportunity to reform the workgroup into targeted community "turn-the-curve" work sessions. We split the 6 social determinants into separate work groups and asked Leadership Council members to invite any pertinent individuals or organizations to join the meeting. Our goal is to engage as many people and organizations as possible for feedback and input.

Greg Knight, the Executive Director of Rural Resources and BHT Board member co-chair of this group helped coordinated outreach sessions in rural counties. Individual outreach is still being conducted for additional organizations, and the strategy map will continue to expand. 

Through these workgroups, the group identified over 160 key partners and organizations that should be included in this work.

To date, the ACH Project Team has engaged with over 65 individuals in various work groups and outreach.

September Leadership Council Recap

ACH Updates

This meeting featured updates on our Community Action Strategy Teams, our ACH Pilot Project, and Governance Structure. We have slides from these presentations available here.
We were thrilled to share out our updated Strategy Maps for Social Determinants of Health and Population Health. Our Community Action Strategy Teams were meeting all summer to help us understand our community’s perspective on regional health needs, and identify goals, metrics, and strategies for moving the needle. These maps represent a snapshot of the conversations we’ve heard. A huge thank you to all of you who donated some of your summer to these meetings. These maps are very much work in progress, and we intend for them to be living documents that are continuously updated as the work progresses and priorities change.
Another big update was the announcement of our first selected ACH Pilot Project. Starting in October, we will begin design sessions in Ferry County around a Jail Transition pilot to connect folks transitioning out of the Ferry County Jail and their families to stabilizing services. 

BHT and ACH Governance

We wrapped up the meeting with a presentation on the ACH and BHT governance structure. If you haven’t already, make sure you take a look at our Governance Policy which explains in-depth the role of our Board, Leadership Council, and Health Champions and how they intersect.
We are currently recruiting for 4 open seats on our Board, and need your help finding the right people to fill those positions. Click here to see our board recruitment packet, which includes more information about the commitment and an application. To apply, you must submit the application, your resume, and a letter of support from a current BHT Board Member or ACH Leadership Council Member, by Friday October 14th at 5pm.

Leadership Council – Community Commitment

We are also working to update and clean up our Leadership Council list. If you can’t quite remember what you signed up for when you joined the Leadership Council, take a minute to read through our recruitment packet. We will be asking all Leadership Council members to renew their Community Commitment to the ACH. Rather than deal with the hassle of asking all of you to print/sign/scan these letters to us, we will be sending out a DocuSign to each Leadership Council Member Organization with a request for contact information of each person who should receive ACH updates. Stay tuned…and as always feel free to email with any questions. 

Letter to Health Care Authority on Value Based Roadmap

Payment system reform is complicated, and we are so impressed with the hard work and energy the Health Care Authority has put into the Value-Based Roadmap. However, there are a few elements of this framework that raised some red flags for us. 

We took some time to write HCA a letter detailing some of our concerns. Give it a read here

The Health Care Authority then followed up with this letter as a response. We appreciate their thoughtful response, and willingness to hear our concerns and work together. 

Hood River Site Visit Canceled

A couple months ago, we chatted with our friends in Hood River about a site visit to see the Pathways work in action. We were excited to meet with local partners who had come to a similar conclusion that “coordinating the coordinators” and organizing community assets to improve health was a noble and achievable community goal.

However, the team in Hood River has been selected for a large investment from an important funder. They are under a tremendous amount of pressure to be ready for this big announcement. Most of us in this field can relate to the pressure that can put on non-profits and community efforts, and we know big investments are few and far between. Hood River graciously asked if we could delay our visit. We could not, in good conscience, ask them to power through on this, and so we are canceling the site visit. 

We know this is a let down, however there will be another opportunity to get up close and personal with Pathways at the Pathways to Community Care Coordination Summit in Ohio on September 29th and 30th. 

While we were excited about the site visit to Hood River, we think the technical assistance and networking with many of the regions implementing the Pathways model may even be better! More info below:

Pathways to Community Care Coordination Summit

Register today! Click here to complete the Enrollment Link
Date: September 29-30, 2016
Location: Akron Children’s Hospital, Akron Ohio

Scholarships are available to cover travel costs and the registration fee for this event. Scholarships will be available on a first-come, first-served basis. Click here to request a scholarship.

For questions, please contact

More on the Pathways HUB

On Tuesday July 19th, we hosted a second presentation on the Pathways HUB, this one from Dr. Sarah Redding. This webinar more specifically looked at the process of building a HUB and achieving certification, as well as some examples of specific Pathways and how to build or bundle one's own Pathways. Once again this was a lively discussion with ample question and answer time from Dr. Redding, and we are so grateful she took the time to share with us. You may watch the webinar or download the slides here in case you missed it. 


Integrated Care Community Strategy Team meetings delayed

We have decided to hold off on starting out Integrated Care work group until September. Our Social Determinants and Population Health work groups are identifying strategies that address health upstream, and our ACH Project Team is exploring the Pathways HUB model to see if it fits for our regional project. We feel the decisions made by these groups will be crucial in shaping our Integration strategies, so we've decided to delay. If you want to be involved in the Integrated Care work group once if forms, shoot us an email

Presentation from the Pathways HUB

We would like to extend a huge thank you to Bob Harnach and MIke Bonetto for presenting on the Pathways HUB to our Regional Project Team. Their presentation gave us a lot to explore, and we look forward to continuing conversations within the community action team around the viability of this model for our region. 

If you would like to know more about the Pathways HUB, Mike & Bob were gracious enough to share their slides and a recording of the presentation. 

Pathway to our Regional Health Improvement Project

We’ve been eagerly awaiting news on the Medicaid Transformation Waiver but, since we aren’t ones to just sit around, we’re moving full speed ahead.

We’ve spent months synthesizing the wealth of information generated in our Idealized Design and Community Linkage mapping sessions to develop and inform our Regional Health Improvement Plan and the selection of a Regional Health Improvement Project. During our focus group conversations, our community worked together to inventory existing linkages between community resources, and identify where linkages were broken or non-existent. Across those conversations, one need presented itself over and over again: the need to “coordinate the coordinators.”

The diversity of partners in our ACH Leadership Council members demonstrates the leadership and dedication needed to radically improving the health of our region. We agree the most emergent need is not to scale any one community resource or service but to build stronger and more navigable connections between the coordinators and resources already available.

This was realized in our design sessions as a need for “air traffic control” or a patient-centered workforce that helps coordinate services across all sectors. Independent organizations need the flexibility to explore their own models and develop their strengths, but to nurture healthy community, patients need services that communicate, collaborate, and speak the same language of care.

From this idea, we’ve pulled together a workgroup to explore the Pathways HUB model and serve as the steering committee for our Regional Health Improvement Project. Alisha Fehrenbacher from Empire Health Foundation, presented on to the ACH Leadership Council in March on her experiences implementing the Pathways HUB model (view her slides here) in Oregon. It is an evidence-based model currently deployed in over 20 regions of the US, that positions care organizations around a centralized HUB, and has been shown to effectively address risk factors, improve health and reduce costs.

We feel confident this model has a lot to offer our region and are excited to explore it further. The workgroup will continue to develop our plan throughout the summer, with the hope that we will be in position to hit the ground running once we hear about the waiver. If you are interested in joining the Leadership Council, please email Alison@betterhealthtogether

May ACH Leadership Council Update

Thank you to all who joined us to talk next steps for our ACH. And a special thank you to the Health Care Authority for driving all the way across the state to help bring some additional clarity on our role as an ACH.

This was a big meeting that produced some concrete action items for Leadership Council members. In case you missed it, here is the recap and documents:

We started the morning with a presentation from Kali Morris from the Health Care Authority on the role of the ACH in Medicaid Transformation. You can view those slides here. In her presentation, Kali made some comparisons to Medicaid transformation work happening in New York, and shared some lessons learned from their efforts. If you are interested in learning more, you can read this report on New York's DSRIP Program put together by The Commonwealth Fund. On the topic of Value Based Payments, HCA also shared this helpful visual on Alternative Payment Models.  

After that we looked at our refined Community Strategy maps. Consider these our first draft as we synthesize the wealth of information that came out of our Idealized Design Sessions. The next step will be to form workgroups, each chaired by a BHT Board Member, to validate strategies, develop metrics, and finalize our community linkage maps. We will be forming a workgroup for each strategy map, reflecting our three ideal states of design. For more information, please review the following charters:

  1. Integrated Care
  2. Population Health
  3. Community Determinants of Health

Additionally, we've made some headway on selecting our regional health improvement project around the development of a centralized community referral system ("air traffic control") based on the Pathways Community HUB model. We will be forming one additional workgroup to explore this model and serve as the steering committee to launch our project. You can take a look at the ACH Project Team Charter here

We are looking for volunteers to join one (or many!) workgroups, with the intent of meeting through the summer, to have Strategy Maps finalized by September 20th. If you are interested in joining one of these workgroups, please read through the above charters and consider which group best fits your expertise, and email your interest to Alison@betterhealthtogether.  

We also shared with everyone Empire Health Foundation's new Oral Health Access document. Please take a look and feel free to share!

That was a big update! But we are thrilled to have some actionable to-dos as a group. Thank you all for your willingness to jump aboard. 

Hello Rubber, Meet The Road!

Hello road, meet rubber!

Over the past 18 months, we have worked hard as a region to prepare for health transformation. We’ve established the right partners at the ACH table, selected priorities, imagined our ideal state of health, and now it feels like the forces of opportunity and hard work are aligning to create the ideal environment for big impact.

In some ways it feels like a long road, in other ways, just a start. Either way, the BHT team and I are more energized and enthusiastic than ever before. We see the potential of this work to unleash radical improvement the health of our region.

It’s clear we’ve been talking about the right things: Payment Reform, Investment upstream and in community determinants of health, regional decision making and the need to make stronger community linkages. And now we are ready to take this ACH for a test ride. In the coming 90 days we’ll be selecting our regional project, hearing a (hopefully positive) announcement about the Medicaid Waiver and launching further education on the state’s effort to accelerate the change from fee for service to value based purchasing. These big initiatives are about to move from talk to action. I’m proud of our region for embracing this, even when many of us weren’t sure if there was any there-there, but now we’re ready. It’s going to be a wild ride. I’m glad to be here with this amazing group of partners.



PS- Our blog is chocked full of great resources on Payment Reform, Access to Care and Prevention news. Don’t forget to check it out.

ACH March Leadership Council Meeting Recap

Thanks to all of you who joined us for our March ACH Leadership Council meeting. It was a great discussion and gathering, with a full room of partners in person and online.
Cool things to know
The State expects to hear in late April if we are successful in our Medicaid 1115 Waiver application. We will keep you posted as we learn more.
April is Spokane Gives month, United Way and partners will host a month of volunteer opportunities in Spokane. Check out the volunteer projects here and see how you and your teams can Give to your community.
The new Apple Health Foster Care program, Apple Health Core Connections, will launch April 1st managed by Coordinated Care. This new program will bring increased care coordination to children in all stages of the foster care system.
A number of organizations are seeing Spring time growth and bringing on new hires to increase their capacity to serve our region. We are especially excited about Newport High School’s hiring of an additional school nurse.
And if you are a Bloomsday fan, start training now at Providence and Group Health’s free Bloomsday training clinics.
Next Steps in ACH Development
We’ve been synthesizing the wealth of information and ideas generated at our Community Linkage Mapping and Idealized Design sessions over the last two months. We debuted and discussed our first strategy map Priority area: Scaling Community Based Care Coordination. We received helpful feedback to further streamline the use of the maps. The feedback included more context, clear prioritizing and the sharing of the current community efforts for each of our strategy areas. There is much work still to do, so stay tuned!
Thought Starting Presentations
Alisha Fehrenhabcher, shared some of her experiences and lessons learned from her work with Health Matters of Central Oregon on the Pathways to Health Hub model. This model demonstrates a pathway (sorry for the pun) forward for our Scaling Community Based Care Coordination based on an evidenced based practice that is scalable across regions and sectors. We are lucky to have her in our BHT region.
Our friends at SNAP Spokane shared their new Low Acuity Transportation Pilot program aimed at reducing the cost of ambulance rides by creating alternative transportation to more appropriate care centers. This is a great demonstration of community entrepreneurship. Go SNAP Go!
Lots of great work happening in our region! If you missed the meeting, we have all of the slides and handouts available for you here: 

As always, if you have questions or comments, let me know.

Alison Carl White
Executive Director