Insurance Update

As a follow-up to our last post on changes in the individual and small group health insurance markets, the Commissioners are very excited to share this news that is hot off the press. Following her outreach, the Superintendent received communication this morning from the Senior Network Executive at Premera Blue Cross (parent of LifeWise) expressing the company’s commitment to work together to ensure residents of San Juan County experience minimal disruption with the changes taking place in January 2020.

We now know that the new LifeWise network specific to Individual exchange plans will include ALL San Juan County providers who are currently contracted with Premera. The network will also include the UW Medicine Lopez and Orcas Island Clinics as an in-network provider.

There is more good news!

While the new LifeWise specialty network is slightly more narrow than their traditional Premera network, an exception was made to enable patients receiving care from the UW Medicine Lopez or Orcas Island Clinics to be referred into UW Medicine for specialty or hospital care, and be handled as in-network. This is very positive and will allow for improved continuity and coordination for patients needing higher levels of care.

As far as the rest of the network, Providence/St Joseph, Swedish, PeaceHealth, Seattle Children’s and Skagit Regional Hospital will all be in-network for LifeWise. Those facilities that will not be in the new LifeWise network are some of the larger hospital systems and providers, primarily in King, Snohomish and Pierce Counties. They include: Multicare, Virginia Mason, Overlake Hospital, The Everett Clinic, Evergreen Hospital, UW Medicine (except for patients receiving care from the UW Medicine Lopez or Orcas Island Clinics) and Seattle Cancer Care Alliance.

We are awaiting more details on the Medicare offerings and will share information as it becomes available. As always, please feel free to contact the Superintendent at apresson@lopezislandhd.org with questions or concerns. You can also provide feedback directly on the website by visiting the form on the Community Engagement tab.

 

News from the Board

Thank you word bubble. Message in pop art comic style.The LIHD Board of Commissioners wants to thank the more than 200 Lopezians who took part in the 2019 Health Care Survey. Results are being tabulated and an analysis will be presented at the July 24th Regular Board meeting. A summary report will be posted on the website by the end of July.

In addition to this work, we know insurance concerns are top of mind for Lopezians. The LIHD Superintendent has been staying in close contact with the Office of the WA Insurance Commissioner (OIC), as well as the contracting teams at LifeWise (Premera) and UW Medicine. We are optimistic that through her diligence and advocacy, supported strongly by the three SJC Public Hospital District Boards, the OIC has recognized the unique challenges of our rural, remote community, and has requested more information from LifeWise on both air ambulance services and network access.

In response to concerns raised, LifeWise is revisiting their Access Plan to ensure they will be able to provide access to all medically necessary covered services within time and distance standards required by the OIC. As of this morning, the contracting team at UW Medicine confirmed that LifeWise is now willing to consider the UW Medicine Lopez Island Clinic as in-network. While the contracting process is not completed, this is welcome news.

It’s important to note that all of the information reported is specific to individual and small group plans. We are continuing to seek out details from the appropriate parties to determine what Medicare plans will be available in the coming year. It’s likely there will not be an individual Medicare Advantage option; however, nothing is confirmed to-date.

We recognize this is a stressful time, and Lopezians are anxious about the health care offerings in 2020. We will continue to share information as soon as it becomes available. For now, we hope that the community can rest a little easier knowing that your interests are being very well represented.

 

 

Communications

In our third post designed to respond to questions raised at the June 19th Community Conversation, we share a few ways the Lopez Island Hospital District strives to communicate in a transparent, timely and open way with all members of the community.

On a monthly basis, the LIHD Board of Commissioners meets to discuss items of importance to District operations, as well as any concerns specific to changes in health care delivery. There’s an opportunity for Public Comments at every meeting, and the  Superintendent produces and posts very detailed meeting minutes. You will find those on the Minutes tab.

The LIHD has an active Communications Committee, and early last year they took on the task of producing the health care newsletter, HealthMatters, that had previously been produced by CWMA. The Chair of the Communications Committee, Iris Graville, is very appreciative for the active participation and collaboration of the Committee members. This includes representatives from CWMA, Lopez Island Fire & EMS, UW Medicine and an individual representing the voice of the Lopez community. Together, the Committee developed a publication schedule and article topics. The first issue of the newly formed HealthMatters 2.0 Newsletter was published last October in the center two-pages of the Islands’ Weekly.  A second issue was published earlier this year, and the next issue is scheduled for publication in August. Copies of Issue Nos. 1 and 2 can be accessed by clicking on the links below.

The Board recognizes there are different needs within each segment of the population, and the Commissioners consistently look to engage ALL members of the Lopez Island community in the health care conversation. One specific area of focus, that was mentioned at the June 19th meeting, has been on the Hispanic population. The Superintendent has been working closely with the Family Resource Center to ensure the needs and experiences of that population are being met. She is currently in the process of having the 2019 Health Care Survey translated into Spanish, and is working with the Hispanic community to design a Community Conversation specific to meet the needs of their community.

Please continue to watch for upcoming posts that will share some of the work underway that speaks to concerns we heard around mental health resources and support.

How the LIHD Spends Your Property Taxes

At the recent Community Conversation, participants wanted to know more about the LIHD budget process and how funds are spent. The Lopez Island Hospital District is required by RCW 70.44.060(6) to hold a public hearing on the proposed annual budget. The process begins late summer when the Superintendent prepares an initial draft budget for Board consideration. After review at several Regular Meetings, a proposed budget is submitted to the Board on or before November 1st. The District then holds a public hearing on or before November 15th, with notice published once a week for two consecutive weeks in the Islands’ Weekly. We also post a Notice on the website, which will look similar to what was posted for the 2019 Budget & Levy Hearing.

At the hearing, the Superintendent presents the detailed budget, and any taxpayer may appear and be heard. Following the hearing, the Board adopts the annual budget by Resolution. All budget materials can be found on the Budgets, Agreements & Governing Documents tab, and the 2020 Budget hearing is scheduled to take place on November 6, 2019.

Almost three-quarters of funds collected from property taxes go towards support of the UW Medicine Lopez Island Clinic (UW) and Lopez Island Physical Therapy. On the same tab mentioned above, you’ll find the UW Medicine Agreement for Clinical Support and the proposed budget for fiscal year 2020, as well as the Lopez Island Physical Therapy Agreement.

The current UW Agreement runs for the three-year period beginning October 1, 2017 and ending October 1, 2020. It established annual funding caps to cover the expected operating loss, which is largely due to the size and demographics of the Lopez island population. Unlike urban areas where there is a large percentage of individuals covered by an employer plan, only 19% of Lopezians are covered by an employer. The majority of Lopezians (72%) are covered by governmental payers which include Medicare (55%) and Medicaid (17%).

The LIHD Board and Superintendent continue to work closely with our health care partners to ensure all Lopezians have access to high quality, island-appropriate care now and into the future.

Our next post will cover ways the District engages with the community, including HealthMatters 2.0.

 

 

News

The LIHD Board and Superintendent continue to compile and analyze the data gathered at the June 19th Community Conversation. We were pleased with the strong turnout and active participation from the community. Over the course of the coming weeks, we’ll be answering questions and providing data in response to questions raised at the meeting. In addition, we will be delivering the 2019 Health Care Survey results at our July 24th Regular Board meeting.

It was not surprising to hear most Lopezians are concerned about the implications of Kaiser Permanente’s increased denial rate of emergency medical air transport and their recent decision to stop offering insurance plans in the County as of January 1, 2020.

As reported in several posts earlier in the year, Superintendent Presson has been actively engaged with various County leaders, air transport operators, and the Office of the WA Insurance Commissioner (OIC) in response to the air transport denials. She has also worked with individual Lopezians to provide assistance in understanding the appeals process, and the majority of those initial denials were later overturned and paid. She continues to provides monthly reports on the status of air transport activities at the LIHD Board meetings, and you can find the recently released report from the OIC investigation on the website under the Health Care Information tab.

The Superintendent is also actively engaged with the OIC to determine the impact of LifeWise Health Plan of WA becoming the sole individual insurer in 2020. The OIC is in the process of carefully reviewing the plan filings, and expects to have more information available at the end of the summer. Superintendent Presson is in regular contact with the Deputy for Rates and Forms, and has provided input on the unique needs of the community. She is also in contact with representatives from LifeWise to ensure a smooth transition. She will continue reporting on updates, as they become available, on the website and at Regular Board meetings. If you are unable to attend Board meetings, you can read details on the discussions on the Minutes tab.

Please watch for our next post which will address the District’s annual budget process, where your property tax revenue goes, and how UW Medicine spends the subsidy provided by the LIHD.  As a reminder, the 2019 Health Care Survey will remain open until July 10th so encourage your friends to visit the 2019 Community Health Care Survey post to access the online link and have their feedback included. Finally, we encourage the community to check out the Community Engagement tab to submit your feedback, comments and suggestions. We look forward to continuing the conversation with the community.

Thank you!

2019 Community Health Care Survey

At the June 19th Community Conversation, almost 150 Lopezians completed a survey on their experience with health care on Lopez Island. If you weren’t able to attend that event, you are still able to have your feedback heard. We will be keeping the survey open through July 10th and encourage all members of the community to participate.

Please click this link to go directly to the survey.  It should take about 10 minutes to complete and the results will be presented at the July 24th Regular meeting of the LIHD Board of Commissioners.

Thank you in advance for your time and participation.

Community Conversation on Health Care – June 19th at 5:30

Lopez Island Hospital District & Lopez Island Fire and EMS invite your participation in a Community Conversation on Health Care

YOUR feedback will inform individual and joint health care strategies for those providing health care on Lopez. In small group conversations we’ll discuss:

  • What is working well
  • What needs improvement
  • How it is to navigate the health care system
  • Health care needs not being addressed
  • What else is needed for an integrated, community approach to health care

This is YOUR opportunity to help shape the future of health care as the information collected will provide valuable insights as we continue short- and long-term planning to deliver quality, island-appropriate health care on Lopez.

The following providers of health care will join the discussion, working with us to understand community needs and priorities:

Lopez Island Family Resource Center, Lopez Island Pharmacy, Lopez Island Physical Therapy, Cathy Doherty ARNP, Catherine Washburn Medical Association, UW Medicine, and the San Juan County Department of Health & Community Services.

Event to be held at Lopez Center. Snacks and beverages will be provided