BHT's 2022 Year in Review
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Alison Poulsen, Executive Director, Better Health Together
A letter from the Executive Director:
It’s hard to believe we have wrapped up six years of our Medicaid Transformation Waiver. What a ride! When I think back to the early years (and our request for transformation plans that numbered 70-80 pages), I think of our stark trajectory-shifting realization that we couldn’t do transformation without getting clear about our definition of health equity. Fast forward hundreds of contracts later, we have managed to invest more than $50 million dollars in the community. We couldn’t have done without your trust, partnership, and hard work. We’re excited about the future of BHT, the possibility of Waiver 2.0, and our deep commitment to radically improving the health of the region.
Onward and upward,
Alison Poulsen
BHT by the Numbers
BHT has earned over $70 million in Medicaid Waiver funding earned since 2017.
Thru 12/31/2022 BHT had invested $50m in partners and community programs since 2012.
BHT has consistently run a lean mean administrative machine, spending Only 5% to administer the waiver.
BHT has invested Over $30 million in primary and behavioral health providers.
More than 50% of BHT’s 2022 budget came from non-Medicaid Waiver funds.
BHT currently has 150+ Community Partners under contract.
Here’s a look back at 2022, and a glimpse into some of the exciting things to come in 2023:
COVID Housing Project Offers a Supportive Hand
At the request of five community partners, Better Health Together successfully secured a $2M fund to to provide necessary support after work disruptions due to COVID-19. The Carl Maxey Center, PICA (Pacific Islander Community Organization), Spectrum Center, Health and Justice Recovery Alliance, and the American Indian Community Center have strong ties and trusted relationships with members of their community. Through their work, they identified families that have been impacted by COVID and need financial assistance to stabilize their housing situation.
The COVID housing fund paid for up to 6 total months of rent, including deposit/move-in expenses if applicable, or mortgage, Avista, and City of Spokane utilities. The partner organizations have served more than 270 households to date! Many of these households had been facing imminent eviction.
One family who was supported by this project included two young brothers, 20 and 21, who had grown up in a family filled with violence. The boys were both working but living in their car because they were unable to secure housing. Both had endured COVID and lost jobs in the last two years. They reached out to the Health and Justice Recovery Alliance for support in getting their younger sister out of foster care. With the help of the COVID housing funding and a landlord willing to work with the young men (who had no rental history), HJRA was able to fund the deposit and 6 months of rent. The three siblings were able to reunite.
The project is coming to an end as all of the funding was expended. We saw, once again, the importance of housing stability to improving health.
Equity Assessment brings New Perspective
Better Health Together (BHT) works with more than 100 organizations in Eastern Washington (Adams, Ferry, Lincoln, Pend Oreille, Spokane, and Stevens counties) to tackle health inequities throughout the region.
BHT offered our first Equity Assessment in 2019. In total, 3833 people from 81 different organizations took the assessment. We used results to inform technical assistance offerings and provided support for organizational and regional equity efforts. For example, we hosted a multipart learning series on deepening equity in HR practices as a response to a majority of “I don’t know” answers in the section on HR and equity. In 2022, over 120 Better Health Together partner organizations were invited to participate in the equity assessment, including some for whom the Assessment was required as part of a BHT contract.
The questions in the Equity Assessment represent policies and behaviors that promote equity in organizations impacting our community's health. The assessment asks members of partner organizations to evaluate whether they agree, disagree, or don’t know if certain activities are taking place.
BHT will release the 2022 Equity Assessment Regional Report later this quarter, along with organization-level reports for participating partners. BHT staff members will be available to review results with organizations, share relevant resources, and recommend the next steps. Additionally, BHT continues to grow and evolve the level and types of technical assistance we offer. We will use Assessment results to inform this work going forward.
Equity 101 Program Expands
BHT has also continued our commitment by offering equity training for our partners, supporting mission- and service-based institutions that work with the community with learning and practicing why it is essential to talk about equity and anti-racism. Participants practice engaging in and leading conversations around dominant culture, implicit bias, racism, and white supremacy culture to grow understanding and confidence around equity concepts.
More than 40 organizations from all over the region, have been trained in Health Equity 101 since BHT launched the training in 2019, with over half of those trainings happening in 2022.
Mathematica Report informs Care Coordination Systems
In the spring of 2022, Better Health Together commissioned research firms Mathematica and Comagine Health to conduct a landscape analysis of Eastern Washington’s community-based care coordination system. The project’s goal was to describe the current state of care coordination. By collecting data via surveys, interviews, focus groups, and publicly available documents, the analysis identified four current themes of care coordination in Eastern Washington and suggested promising approaches to improve whole person care and advance equity throughout the region.
Key Themes included:
There are diverse needs and considerations for providing whole-person care in Eastern Washington.
Organizations are already connected and collaborating, but lack the systems, tools, and processes to effectively coordinate care.
Care coordination relies on bi-directional information, and limits in technology and infrastructure constraints create consistency issues when sharing information back and forth.
Strong relationships, along with self-reflection, are critical elements in providing whole-person centered care.
Using this Landscape Analysis and Roadmap as a tool and a guide, Better Health Together will continue to grow and strengthen our efforts to develop a sustainable, collaborative, culturally responsive community-based care coordination system in our region.
We anticipate that investments in community-based care coordination will be an integral part of the Medicaid Waiver 2.0 renewal.
Rural Equity through Pallet Housing in Stevens County
BHT support Stevens County utilizing rural COVID equity dollars to purchase 14 temporary pallet homes. These homes will provide much-needed emergency housing for folks experiencing housing instability and homelessness during quarantine and can also be utilized by those displaced during wildfire season.
Waiver funding brings opportunities for Telehealth to Spokane Schools
Parents often need support to secure transportation to get their children to medical appointments. In Spokane Public Schools, Medicaid 1115 Waiver funding supported BHT facilitating a school-based telehealth pilot at six high-need elementary schools, one middle school, and one high school in partnership with CHAS and Unify. Each of these entities has clinics close to the schools to provide follow-up. BHT is leading the ACH charge to support school-based care, and has set aside an additional $600,000 to fund these efforts in rural counties in 2023.
Youth Action Board (YAB) stands tall to share with City Council
In 2022, BHT was chosen as the new home of the Youth Action Board to give a voice to youth and young adults impacted by homelessness. The YAB testified at a Spokane City Council meeting (watch it here) about the importance of keeping the housing levy act focused on creating more affordable housing, sharing both personal experience and the needs of youth and young adults in the community, citing the Youth Homelessness Demonstration Project Coordinated Community Plan Statement of Need, a statement created by asking youth and young adults experiencing homelessness in the community what they needed.
Creating Community partnerships via the Hub
BHT’s Hub works to connect members of the community with available supports. During COVID, BHT leveraged this network to administer Department of Health Care Connect funding, and ultimately served 3,354 individuals who needed resources due to COVID-19. The Hub connected folks to $700,000 dollars in assistance with rent, mortgage, food, and utility assistance supported by a community-based workforce. The Hub has also been leveraged to secure additional programs including a City of Spokane City of Spokane COVID Housing Assistance program for Black, Indigenous, People of Color and other impacted communities, a Department of Commerce Digital Navigator Program, and a Department of Commerce Navigator Program for BIPOC and other impacted communities.
Investing in (much-needed) Expansion of Behavioral Health Workforce Capacity
The Eastern Washington region continues to face a crisis-level workforce shortage. BHT has invested $300,000 in 2021-22 to support increasing provider capacity, including supporting licensure supervision for 72 individuals across 15 organizations. BHT has also used Integrated Managed Care (IMC) incentive funding to invest in training for 5 new supervisors and covered licensing and supervision fees to remove barriers to employment. Additionally, BHT has provided funding to train 35 newly certified peer counselors and 14 new providers who are now licensed substance-use disorder professionals.
BHT awarded a Health Resources and Services Administration (HRSA) Grant
BHT has been awarded $3 million from the Health Resources and Services Administration (HRSA) to coordinate a training and upskilling program for new and current Community Health Workers (CHWs). The program aims to strengthen the community-based workforce by providing support to lift up impacted groups and increase the distribution and diversity of CHWs throughout the region. BHT will also provide a CHW apprenticeship that will connect new CHWs with employment and support local organizations.
As a part of our convening role, BHT also facilitates the Eastern Washington CHW Network, comprised of CHWs and other health support workers from our region. The network helps build connections between different organizations and provides a space to share resources.
If you have a community health worker in your organization that would benefit from training, shared learnings and network building, please contact Community Health Worker Training Outreach Program Manager Kim Wilson at KimK@betterhealthtogether.org
WHAT TO LOOK FOR IN 2023
Community Linkages RFP
BHT is currently inviting proposals from organizations providing care coordination and services for social determinants of health (also called health-related social needs), to plan and deliver such services to Medicaid enrollees in the region. The primary goals of this funding opportunity are to strengthen Infrastructure in community-based organizations providing care coordination and health-related social needs, encourage connectivity across sectors in the care system, improve client access to care, and shift power by supporting organizations that represent the communities they serve.
A total of $3,600,000 is available under this funding opportunity for a two-year period (April 2023 – March 2025). BHT anticipates funding approximately 9 projects at $400,000 each but reserves the right to fund a larger number of smaller-budget projects, or a smaller number of larger projects.
Community Resiliency Fund RFP
In 2020, BHT adopted a Board policy acknowledging racism as a public health crisis and deepening our commitment to equity and anti-racist work. With this statement we released and funded 1.5 million dollars from our Community Resiliency Fund to address and prevent the impacts of racism as a public health crisis. To play a part in closing the gap between inequitable funding patterns, the BHT board voted to prioritize awarding dollars to organizations led by and serving Black, Indigenous, people of color, and LGBTQIA2S+ people. BHT received 34 letters of interest.
In early 2021, we funded 23 organizations. We received clear feedback from the funded partners that this kind of dedicated and flexible funding evaluated through a community process based in trust was highly needed and valued. To further support our commitment, BHT is releasing an additional $2,000,000 of our Community Resiliency Fund in a Request for Proposal process to address Racism as a Public Health crisis and prioritize awarding dollars to organizations led by and serving impacted populations.* BHT is expecting to fund up to 20 organizations, at a maximum of $100,000 per proposal for up to two years. This application was released at the end of 2022. (The application is now closed, stay tuned for more updates on funded projects coming soon!)
*BHT uses the term impacted communities to refer broadly to all groups that have been impacted by systems of oppression, such as Black, Indigenous, people of color, LGBTQA2S+, currently or formerly houseless, disabled, justice-involved, low-income, refugee/immigrant people, and more groups that face systemic inequity.
Recognizing how our intersecting identities connect, it is important to call out that while white people may experience some of these forms of oppression, this experience is not the same as racism and cannot be racialized for them. A white person experiencing discrimination because of their disability does not have to consider how their race might have influenced their treatment (although if they are doing their anti-racist work, they should). In contrast, a black person with a disability in this example does not get the privilege of separating their experience of racism and the experience of ableism.
Behavioral Health Workforce Continued Investments
The BHT Behavioral Health Forum is continuing to allocate our Integrated Managed Care earnings of$1.2 million in behavioral health workforce initiatives, with funding. This works builds on the initial $300k allocation in 2021-22 on supervision, substance use disorder (SUD) alternative certification, and Certified Peer Counselor training. Key funding areas include workforce retention & expansion, peers & community health workers (CHWs), and training/continuing education. The BH Forum is a collaborative of behavioral health, peer, & integrated organizations as well as education and workforce development orgs.