North Valley Hospital
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North Valley Hospital sends Letter of Intent to join WRHAP Pilot Program.

 NVH is choosing to join the Washington Rural Health Access Preservation pilot project to gain access to funding for care coordination and behavior health support.  This project should allow us to create a new position of a Care Coordinator and provide resources for telehealth in the ED for crisis intervention and psych consults.


About the WRHAP Program:

The threat of rural hospital closure presents a serious challenge to the health and vitality of Washington’s rural communities; especially within many of the state’s most remote or rural areas. The current CAH model is based on the delivery of acute care services, but in practice, Washington’s rural hospitals function much more like community health systems that have some combination of primary care, prevention, EMS/ambulance and long-term care services. These rural communities need a new model of care. The ideal model would deemphasize acute care, ensure core health services for all residents, and be flexible enough to meet community needs within existing resources. This may not look exactly the same in every community; however, access to a baseline of essential health services must be available.

The model discussed below represents the generally agreed upon framework, but more work is needed to refine both the delivery and payment mechanism before we can move to the testing and piloting phase.

Moving Toward a Flexible Delivery System Every community in Washington requires essential health care services, initially defined as:
• Primary Care (including basic mental health and prevention)
• Emergency Care
• EMS (including prehospital and interfacility transport)
• Pharmacy
• Lab and Diagnostics
• Observation Beds
• Care Coordination
• Long-term Care Some services may be accessed or augmented in the local community through telehealth. A set baseline of essential services may be the appropriate level of services needed in remote, extremely low volume communities. However, many rural communities need a broader set of services (e.g. labor and delivery or general surgery, long term care). The WRHAP group envisions the services as “Tier 2” services that could be provided according to community need and desire. This delivery model would ensure essential services while beginning to align local delivery with community need. Payment Models The WRHAP group proposes to explore the feasibility of multiple payment options and select those models that hold promise; WRHAP is an opportunity to use data to test payment models and see what works. While the specific payment methodology is still to be developed, the WRHAP group has proposed general principles that provide a framework for the work ahead. WRHAP proposes a payment methodology with two components: 1) a base payment that incorporates the cost of delivering essential health services and associated infrastructure, and 2) a value component. The value component of the payment model could take a variety of forms, including such approaches as quality incentives or a per-member, per-month payment. Need for Federal Action In the coming months, we will be working with HCA and CMS to get the data necessary to model and test payment options. Once a payment model has been selected, we will move forward with a few recruit sites to pilot for Medicaid. We will also work with the state to provide a regulatory framework to allow for innovation in care delivery. CMS must act to provide a pathway to design and test new models that will sustain our rural health care system. A federal demonstration program through CMMI would allow states to test ideas for a sustainable solution. WSHA is reaching out to our federal delegation and working with other state hospital associations to push CMS for action.

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