Washington Health Foundation

The washington health foundation story

The Washington Health Foundation story begins in 1962, when it was established as the education and research arm of the Washington State Hospital Association.  Registered as a not for profit organization under Section 501c3 of the Internal Revenue Service code, its primary purpose then was to allow the Association to receive grant funds from organizations where eligibility required this tax classification.  Its name was set as the Washington State Hospital Education and Research Foundation (WSHERF).

It was rarely used over the next three decades.  In 1991, it was deployed to accept grant funds for the development of a Legal Manual for Washington’s Public Hospital Districts by then Executive Director of the Public Hospital District Association Greg Vigdor.

It became an essential part of a much bigger use just a couple of years later.  In 1992, Mr. Vigdor developed a legislative proposal to save many of Washington State’s struggling rural hospitals called the Rural Hospital Assistance Program (RHAP).  RHAP used federal funding through the federal-state Medicaid program to provide subsidies to rural hospitals.   Since some of Washington’s rural hospitals were private not for profit hospitals, RHAP needed an organization that could provide relief through donations as well as government payments.

WSHERF was identified as the best organization to do this, and Greg revitalized the largely dormant organization for this purpose in 1992.  Its primary role then was to be the organizational vehicle for a Rural Initiative that would advance the full RHAP program.  At the time, it was thought this would be a three year endeavor, and certainly no more than five.  Greg Vigdor was asked to serve as President and Chief Executive Officer of the revived organization, and did so while continuing his staff role with the Washington State Hospital Association.

Two developments called on Greg and the leadership of WSHERF to expand its thinking and timeline.  First, the RHAP program became imbedded into the Washington State government and state budget as an ongoing program.  Though its funding level was set at a lower level than its first year, it became an ongoing source of funding to WSHERF for its Rural Initiative.

Second, the impressive implementation of the Rural Initiative led to requests by hospital and other constituencies to expand the Foundation’s role beyond the rural communities of the state.  While RHAP funds were limited to rural use, the Foundation developed a small general fund through investment earnings, and began to provide smaller support to suburban and urban areas of the state. 

In 1995, the Foundation was asked to take over a series of health access programs in the Seattle area formerly managed by the closing Seattle Area Hospital Council.  The Foundation agreed to this geographic and service expansion and was able to do so financially through a local health grant and payments from Seattle’s urban hospitals.

The core Seattle access program transferred to the Foundation was what was renamed the Community Health Access Program (CHAP).  This was a case management telephone service that helped people in need across the region access needed health care services.  Serving several thousand people a year, CHAP helped connect people to resources that could fill their health care needs.   The support included everything from helping obtain health coverage, to scheduling appointments with care providers, and to arranging transportation or other needs to assure a patient visit.  It was more than just advice- CHAP staff actively helped to fill these gaps hand in hand with clients.  CHAP became a core of WHF’s program activities for 15 years.

Another Seattle access program was the AIDS Care Access Project (ACAP), which provided similar case management services to clients with AIDS or HIV.  ACAP was supported by a different grant program than CHAP, and also had unique design needs given the realities of AIDS/HIV care at the time.

The other program taken over by the Foundation was a research study of whether incentives would increase childhood immunization rates- the Hospital Immunization Incentive Project.

The Foundation’s growth and successful engagement with these new programs accelerated the call for it to expand its role as a statewide health foundation.  Its rural constituencies were satisfied that the Foundation could maintain its leadership focus on rural health care and grow statewide at the same time, and supported the effort.

With this pressure to grow, and the realization that the Foundation would be active for more than 3-5 years, Greg and the Board of WSHERF began to consider how best to govern and manage the organization.  Up until then, the Board of WSHERF was the Executive Committee of the Washington State Hospital Association, and it relied greatly on management support from the Washington State Hospital Association.

The recommendation was to create a new and larger community board for the Foundation, and to grow WHF independent of the Washington State Hospital Association.  It was also recommended that the organization rename itself, and the Washington Health Foundation name was selected.

Legal documents were amended, and a new board was brought in to make this transition.  John Long, a former Chair of the Washington State Hospital Association who had a passion for the Washington Health Foundation mission, was asked to serve as the first new chair and lead the governance transition.  New mission, purpose and strategy conclusions were crafted by the Board under John’s leadership and the new Washington Health Foundation continued to incrementally grow through the 1990s.

In 1992, the Foundation had no employees, and by 1993 it had three.  The Rural Initiative and the Seattle access programs grew this number to twelve by 1996.  Over the next few years, growth in Rural Initiative and other programming raised this number to seventeen.  The Washington Health Foundation was seen as an important organization in Washington State, providing grants, programs, technical assistance and education to people in need and health care providers across the state.

An important initiative during this period was the Quality Initiative.  The Institute of Medicine had issued its groundbreaking “To Err is Human Report” and Greg saw an opportunity to create bigger change in Washington’s health care system by leveraging the Foundation’s role in assertive quality improvement projects, in partnership with the Washington State Hospital Association and its members.  WHF provided major funding, leadership and a program base to efforts to grow this new front to the Foundation’s work.

The Foundation was also growing its role around its mission of improving health- and its ability to stimulate bigger change in the health care system toward this mission.  The Foundation became an active part of a national movement called the Healthy Communities movement. Led by WHF staff member Katharine Sanders and volunteer Jeff Mero, the Foundation began to grow a base to promote health across Washington State.

The Washington Health Foundation’s next major surge of growth was built around this base of work, but funded by another creative financing program created by President Greg Vigdor.  Again seeking to save and support endangered rural health care, Greg proposed and worked with the Governor’s Office and state legislative leadership to create what was called the Proshare program.  It used public hospital district nursing homes and the Medicaid program as the means to leverage federal funds for health care purposes across the state.  Rural public hospital districts received $300,000 each in funding support.  Greg showed state leaders that more funding was available, and since the state was unwilling to provide more hospital support than this level, convinced them to approve these additional funds for use by the Washington Health Foundation.  An even larger portion of Proshare was used for state health programs.

The first year Proshare funds to WHF was $3.6 million, with $1.4 million committed to a new Rural Health Viability grant program and $2.2 million directed to statewide health programs to be determined by WHF.   In its initial year, WHF committed to key state legislative leadership to use $1.5 million to stabilize the Child Profile program in the state.

This new funding capital allowed the Foundation to begin to think bigger and longer term around its role in the state.  The new Board of the Foundation worked with Greg to identify how best to do this, and the possibilities only grew as subsequent years proved that the Proshare program would be an annual program within Washington state’s budget for a number of more years.  Over the next several years, WHF’s staff grew to over 50 employees, with an annual budget of over $8 million a year.

In addition to growing the new Rural Viability grant program and its financial investments to the strategic initiatives noted above, Greg advocated that the Washington Health Foundation grow its role to stimulate major health system change across the state.  He noted that despite the Foundation’s- and many other organization’s- efforts to fill the gaps of the health system, the gaps and needs were only growing.  Few organizations at that time were focused on leading major system change efforts, and he argued that WHF should assert leadership on this front.

The Board agreed and unanimously approved actions to support this major change intent.  Some of this related to growing the Foundation’s efforts within its then current initiatives.  For example, WHF grew its Quality Improvement efforts and began to host an annual major statewide conference on quality improvement.  The Healthy Communities efforts grew, including an annual statewide symposium on Healthy Communities and a major new Health Disparities grant program.

A January 2003 televised Town Hall was the kickoff to a year long effort to spur more extensive dialogue and, ideally, action.  The Town Hall overviewed the issue and invited Washingtonians across the state to attend one of WHF’s 40 Community Conversations on the topic.  These meetings were held in every county of the state in 2003, organized in concert with local leaders and partners, but structured and led by Foundation staff.  The aim was to produce a Values Map for Washington State and its communities on the topic.

Attendees greatly valued the meetings and the unique approach taken by the Foundation- listening and letting all sides present their views, rather than lecturing and advocacy.  The local attendees expressed their frustration with statewide leaders and told WHF that its work would be far more valuable if we could get these leaders to also listen.

In response to this request, WHF committed to a Leadership Summit in October 2003.  Our hope was that 150 might attend- almost 400 did.  The Foundation brought the results of its Community Conversations to the group, including a set of values identified by the local attendees.  The full conference prioritized the values through electronic voting.

At the end of the day, the group was asked to consider agreeing to these values as statements to pursue meaningful health system change.  The prioritized values were inserted into a draft Proclamation. WHF had secured the commitment of Governor Locke, and several candidates running to succeed him as Governor, to sign on to the Resolution.  Attendees were also asked to join this commitment by signing on.  Our hope was that 20-25 would do so- over 170 did.

This gave the Foundation great wind in its sails to press for change, and the 2004 strategic question became specifically how to vote forward.  The Foundation convened a series of leadership meetings to gauge how it might do so.  It got a broad set of worthwhile ideas, and many were practical program ideas on how to build on the set of agreements in the values.  In terms of public policy, however, it was clear that the ideologic divide was still strongly in place, with both sides arguing that WHF should advocate for its agenda in opposition to the other.

Since our core asset was agreement, in concert with public opinion, WHF needed another and creative way ahead.  The creative idea adopted was to pursue change by engaging organizations and people toward a vision that all could agree on-  that Washington can and should be the Healthiest State in the Nation.

WHF found great receptivity to the vision statement, and conceived how to turn the vision into a program.  The proposal was to create an engagement campaign around the vision, inviting organizations and people to participate in ways big and small toward this vision.  The Healthiest State in the Nation Campaign was born.

The Foundation developed a multi-level Campaign, unlike anything ever done before in Washington state, or the Nation.  The vision was grounded in metrics of state rankings and these demonstrated that Washington was the 17th healthiest state in 2004.  Over time, the Foundation grew its own unique scorecard and released regular updates on our progress.

The Campaign had a series of core messages, and used communication strategies to build these messages into the context of Washington health change efforts.   A core message was that we could only become the Healthiest State by committing to resolve both Healthy System (collective) and Healthy Living (personal) issues.  Another was that we could only become the Healthiest State by eliminating health disparities, especially among racially and ethnically diverse groups.

The energy of the Healthiest State in the Nation Campaign was engagement, however.  WHF built a series of ways to allow organizations and people to contribute to health and the Campaign.  Our research showed that many were frustrated that they were trying to do so, and didn’t feel appreciated for their effort.  An early decision was for WHF to recognize people and organizations for what they were already doing.

WHF also concluded that we wanted all to do more, even if it was just a little bit more.  The idea was for WHF to host a major event that would allow participants to do that, and to provide an easy and fun way to do so.  The Governor’s Health Bowl was conceived as a six week health improvement event.  

The 2005 Inaugural Governor’s Health Bowl became the largest health engagement event in the Nation’s history- before or after.  Over 40,000 Washingtonians participated, and several hundred organizations.  We set a goal of producing over a million miles of health and developed a tool on our website to allow recording of miles by participants.  WHF also sponsored or produced a number of specific events and sub-challenges, including a School Challenge involving hundreds of local school districts, and a Business Challenge.  Participants could record miles for not just physical activity, but also for other good personal behavior or even answering questions about our collective Healthy System commitments.

As the Healthiest State in the Nation Campaign grew, the Foundation also began to develop and bring to its constituencies a Policy and Advocacy agenda.  Some of the content of this were state issues, such as public health funding or childhood immunizations.  The Foundation also engaged nationally, in particular as the Affordable Care Act debate ensued.  We argued for a unique set of changes to the proposal, in concert with the values and areas of agreement that we had found in our work.

The Healthiest State in the Nation Campaign became the central work of WHF for the next five years.  We continued to find new ways to engage Washingtonians around health, while maintaining the successful core elements of the early Campaign, such as the Governor’s Health Bowl.  An important add on was the Foundation’s tackling of major issues that offered hope to significantly improve our health as a state- such as a collaborative tobacco cessation initiative, a college health effort, an employee wellness program for businesses, and an effort to stem prescription drug abuse.

The Healthiest State in the Nation Campaign was a huge strategic success, including especially via the state health rank, which moved into the Top Ten in just a few years. By 2010, the Foundation’s commitment to spending its capital to pursue its mission was taking its toll, however.  Funding from RHAP and Proshare had ended, and its reserves were dwindling.  In 2008, WHF began a fundraising effort to extend and grow its Campaign, and was having success- until the Great Recession hit and created a funding crisis across much of the not-for-profit community.

The Foundation was forced to begin to reduce its programs, and staff, to fit with its new financial realities.  Still, it found ways to continue its work over the next few years, and even found new opportunities to improve health for the people of the state.  A major new effort was to extend the Healthiest State Campaign by adopting a call for the redesign of health care around people.  WHF adopted design principles and convened around this notion, and developed a series of “Health Home” tools for people to use in asserting greater control of their health.

The Foundation also made one last effort to change its economic prospects.  It became a not for profit health broker that provided advice and support to people and organizations in selecting health coverage.  Available to all without regard to ability to pay, many of its clients came with commission payments from the health plans selected.  The hope was that this could generate sufficient revenue to replace lost funding.

The service provided by what was called the Healthiest State Xchange was successful.  While it generated revenue, it was not enough to stabilize the Foundation’s long term financial situation.  In 2012, WHF was forced to suspend operations.  It came back later that year, first through many of its past employees volunteering their work at the organization.  A funding award through the Attorney General’s Office provided a means to grow this interest, and the Foundation engaged around a special project supporting caregivers.

The financial problems could not be stopped, however, and in 2013, Foundation leadership decided to suspend operations.  At the same time, President and CEO Greg Vigdor had been recruited to take a position in Arizona helping to advocate for Medicaid expansion.  The decision was made to reduce the size of the Board and to effectively go into hibernation for a number of years to allow our situation to settle.  The hope was that the limited remaining resources could somehow be used to invest in a new beginning for the Washington Health Foundation.

This is where we are now.  Greg Vigdor has returned as a volunteer President of the organization and is working with former chairs of the Board Dr. Nancy Auer and Dr. Ken Isaacs to consider how best to revive WHF.  Establishing this website is an early effort to do so, and the hope is that the months and years to come will see further growth and a new age of creative health programs and leadership to improve health, for not only the people of Washington, but the entire nation.