Reporter John Simmons contributed to this article.

by Robert A. Duke

The PeaceHealth St. Joseph Community Health Board exists to help its namesake hospital address unmet local healthcare needs. The board’s mission is to help the hospital write its Community Health Needs Assessment (CHNA) plan as required by the Internal Revenue Service for non-profit hospitals to maintain their tax-exempt status.

Multiple requests by phone and in person in July and August 2017 by Whatcom Watch’s intern reporter, John Simmons, failed to obtain an interview with or a direct response from any of the estimated one dozen volunteer Community Health Board members.

The non-response is due, according to Bev Mayhew from St. Joseph’s Strategic Communications and Engagement office, to the board’s exemption from the state’s OpenMeetings Law, because “public volunteers are unpaid employees of a private nonprofit, their meetings are private.” The private nonprofit is PeaceHealth St. Joseph Medical Center. The public volunteers are medical doctors and citizen members of the Community Health Board of Whatcom County.

PeaceHealth St. Joseph’s current needs plan covers the period 2016 to 2019, and it details areas needing improvement in healthcare delivery. CHNA especially focuses on poor communities and children. However, the volunteer community health board responsible for the current report appears to have been disbanded and, according to a board member, has stopped meeting regularly. St. Joseph’s spokespersons said that PeaceHealth’s online description of the Community Health Board was incomplete, out-of-date and inaccurate at the site: https://www.peacehealth.org/community-health-boards/bellingham-washington as of June 27, 2017.

(Continued efforts by this reporter to contact board members have gone unanswered by the deadline for this issue of Whatcom Watch.)

Subject A Matter of Chance
Our decision to look into the Community Health Board was purely by chance, based on concerns about PeaceHealth’s performance as primary healthcare services provider in this county. As the region’s geographically dominant healthcare provider, PeaceHealth’s influence permeates the care and treatment of a wide range of health issues and treatments for a huge patient population.

How well is PeaceHealth doing its job? A random sample of any link between PeaceHealth and the community it serves might provide the answer, and what we uncovered revealed where corporate healthcare and the public interest intersect. And any doubt that a non-profit is any less corporate in its methods and values than a for-profit is unrealistic. A non-profit corporation fits the definition of corporation, mirror-like image of a for-profit.

A Puzzle Uncovered
How can a board be designated a community organization when it is unwilling or unable to communicate with the community it purports to represent? Also, how transparent are corporate operations filtered exclusively through corporate spokespersons?
Note the following emphasized statements:

“The Community Health Board is responsible for implementing processes to ensure that we’re actually meeting our quality metrics,” said Chris Phillips, St. Joseph’s Director of Community Affairs. “How are we are doing in terms of infection rates; how we are doing in terms of various procedures that point to quality of care that’s being provided on the inpatient and the outpatient side. And then, in their area of community health, we have a community collaboration committee, and that’s made up of Community Health Board members as well as community leaders.”

An explanation such as this is short on meaning, as emphasized by the vague terms in bold. As a for-instance, consider “quality metrics:”

Quality metrics are a key component of an effective quality management plan and are the measurements used in ensuring customers receive acceptable products or deliverables. Quality metrics are used to directly translate customer needs into acceptable performance measures in both products and processes, according to Project Management, an online business service to help managers be more successful. (www.projectmanagement.com)

The Centers for Medicare & Medicaid Services (CMS) says quality metrics are:

Quality measure[ment] tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care according to CMS Regulations-and-Guidance/Clinical Quality Measures.

Clearly, more words don’t deepen comprehension, but stripped to its essence: It’s really about money.

Today’s Accountable Care Organization’s (ACO) healthcare goal is to “transform care delivery by paying health systems and doctors based on their success at improving overall quality, cost and patient satisfaction with their health care experience,” states Harvard Business Press (HBP) “Redefining Healthcare,” published in 2006.

Healthcare providers are thus incentivized to measure (quantify) their performance (quality), because it is the basis of their compensation. The bottom line — for the hospital and doctor — is that reimbursement depends on acceptable measurement of the care provided. In accountable-care, if something cannot be accounted for (measured) it cannot be billed and, therefore, is not payable. Corporate values dictate that what you cannot be paid for, you must stop doing.

If you are inclined to paint the blackest possible picture, PeaceHealth appears to be enlisting a board of unpaid volunteer doctors and citizens to aid it in developing the means of increasing its billing efficiency as a way of improving corporate revenue, which reflects on executive performance, which is typically rewarded with higher salaries and bonuses.

As non-profit as it may sound, healthcare is a lucrative business. “Non-profit” is just an accounting term, another way of bookkeeping.

Unmet Local Health Needs
Health needs fluctuate, so discovering new unmet needs is routine and explains the need for the CHNA plan to identify these needs with recommendations for remedial action — it’s community healthcare fulfilling its mission. Since its mission is about public health and care, why the secrecy about this community health board? Judge for yourself whether such community health issues should remain a private matter, as PeaceHealth insists.

There are many community health boards. “Each hospital in the PeaceHealth system has its own Community Health Board and its own Community Health Needs plan,” says Bev Mayhew.

Consider the following abridged text of the CHNA plan, and see what you think. To fully appreciate the Community Health Needs Assessment 2016-2019, read it in its original form with access to references and data. Space limitation here required that it be abridged and simplified in the context of this article.

PeaceHealth St. Joseph Medical Center 2016-2019 Community Health Needs Assessment and Implementation Plan

Key health indicators were organized into the four community health pillars using primary data from Robert Wood Johnson’s 2016 County Health Rankings and other state sources. Health outcomes gaps in each area are summarized below.

Health Outcomes Gaps
The following four gaps were identified for action from the 2016 County Health Rankings:

• Healthy, Active Living: Major issues identified include the abuse of opiates and excessive adult drinking. The county ranks 3rd in negative effects from heroin abuse and 6th of 39 counties in negative effects from prescription drug use.

• Child and Family Wellbeing: Adverse childhood experiences and low vaccination completion rates are major concerns for Whatcom County. These factors put Whatcom County residents at greater risk of poor health outcomes or greater risk of serious infections.

• Health Delivery: Data show that there are significant differences in uninsured rates by race/ethnicity, and racial/ethnic differences in the quality of preventive care received by Medicare beneficiaries. Addressing these inequities is important to the health of the community.

• Equity: Affordable housing is a key component of financial wellbeing and stability, and forms the basis of good health. A high percentage of cost-burdened housing in certain areas of Whatcom County imperils the wellbeing of affected households and the community as a whole.

Implementation Plan
The following are seven strategies for filling the four health outcomes gaps identified above from the original report summary:

• Ensure effective information exchange and care coordination for particular populations (e.g. PeaceHealth Medical Group patients with complex health and psychosocial conditions who are served by multiple organizations) through the PeaceHealth Transforming Clinical Practice Initiative (TCPI) and other community collaborations.

• Increase participation in the PeaceHealth employee wellness program, particularly for caregivers at the lower end of the compensation scale.

• As part of our ongoing efforts to create an inclusive organization that exercises cultural humility, recruit for and support a workforce that reflects the changing ethnic, racial and cultural diversity of the communities that we serve.

• Advocate for and actively support the development of a comprehensive continuum of behavioral health services that includes access to crisis stabilization, transitional and long housing, substance abuse treatment services and psychiatry that is available to children and seniors.

• Work with local school districts, Head Start and others to advocate for and support the widespread availability of early learning opportunities for all children.

• Develop a Community Health Worker initiative that empowers individuals within specific communities to serve a liaison/linking/intermediary role between health/social services and the community to facilitate access and improve the quality and cultural competence of service delivery.

• Advocate for and support policies and programs geared to promoting healthy nutrition, activity and lifestyles for youth aged 8-11, with a particular focus on lower income families.

A Question for All of Us
At the end of his internship, WWU journalism intern John Simmons posed a rhetorical question about the roadblocks he encountered in getting board members to talk about their participation in the Community Health Board:

“In politics, people can bring their concerns to representatives that can properly speak for them. Why not, then, with healthcare, especially since it directly affects people in more obvious ways than politics? People should be able to communicate with their representatives and know about what their representatives are doing for them. If the board oversees quality and community needs, then why not make it easier for the community to let the board know what they want to see improved.”

The August 2017 issue of Whatcom Watch published a condensed 2017 evaluation overview of PeaceHealth St. Joseph Hospital, in the context of all Washington State hospitals, from Commonwealth Fund Scorecard on State Health System Performance 2017. Other hospital ranking services are also available online.
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Robert A. Duke is author of “Waking Up Dying: Caregiving When There Is No Tomorrow,” he lives in Bellingham. His email: boshduke@gmail.com