I’m responding to the guest commentary by Elisabeth Marshall published on Feb. 3 regarding Direct Contracting Entities or DCEs. Ms. Marshall accurately states that DCEs can be offered by a range of entities. Not all DCEs are operated in the same, however, and the differences between them matter.
Since Medicare doesn’t fully cover the cost of care and largely has an arm’s length relationship with beneficiaries and their service providers, other organizations may use DCEs in the way Ms. Marshall describes. As a nonprofit, however, PeaceHealth’s foremost obligation is to the patients and communities we have served for more than 130 years. Since we don’t make profits — instead re-investing in improved care and services to the community — our motivation in starting up a DCE was to improve patient outcomes, improve access to care, and reduce the cost of care for patients and for Medicare (including the taxpayers who fund it).
From the outset, we’ve embraced the program’s simple guiding principle: Anyone participating in our DCE would have all the benefits and rights of Medicare patients not in the DCE — freedom of choice prevails. More than just freedom, however, patients who participate in PeaceHealth’s DCE also have access to enhanced benefits.
For example, we waive copays on care management for DCE participants as a way of better managing wellness and chronic diseases. We also waive the Medicare requirement for patients to be designated as “home-bound” before they can have access to home health services. And we’re piloting a program to offer at-home visits by nurses and nurse practitioners.
So, how do these things — and many others PeaceHealth is adding — get paid for? Frankly, it’s a bit of a risk. We are making the assumption that the things we’re doing will keep people out of the hospital and the Emergency Department, where the most expensive care occurs, and we’re using that “paid forward” savings — and the flexibility Medicare gives DCEs — to offer new services. We think it’s the right thing to do for patients, but since the DCE is new we don’t yet know how well it’s going to work. Time will tell.
The bottom line for Medicare beneficiaries: ask more questions of the DCE you’re thinking about, learn who the sponsoring organization is, and compare benefits and restrictions. For more information about PeaceHealth’s DCE (called the Cascadia Community Care Alliance), call 877-488-8845.
Scott Foster, MD
Chief Medical Executive, PeaceHealth Medical Group
In response to my Jan. 25 guest commentary calling for the preservation of a local forest known as Bessie, Dick Whitmore offered his own guest commentary, published on Feb. 10. I respect Mr. Whitmore’s opinion and his right to express it. This letter is in response to some of his assertions.
It was implied that natural, older forests are a forest-fire risk compared to younger, managed plantation forests. As a recent study shows, the opposite is true.
Old-growth forests, which Bessie is very near to becoming, burn less and burn cooler, and may provide important refuge for wildlife during wildfires. This is because older forests like Bessie hold much more water, have higher canopies, and are far more open than plantation forests, which are drier and packed tight with trees that have thinner bark and lower crowns, making them ripe for combustion. Our forests are burning up partly because we’ve destroyed so much of their natural character.
It was also asserted that young forests draw down more carbon than older forests. That’s been proven untrue. Trees continue to increase their drawdown throughout their life span. The bigger they get, the more they draw down. Also, when a forest is cut, almost half the carbon is left behind as stumps, roots and branches, with another 25% lost in milling. What remains continues to decay regardless. Turning trees into wood products doesn’t really sequester carbon. Old conifer forests do, however, like nowhere else on Earth.
Regarding the implication of support from “slick PR personnel, lobbyists and lawyers mostly supported by Seattle money,” I’m just an ordinary citizen and house painter. The Center for Responsible Forestry, which is leading the campaign to save older forests in Washington, is run by volunteers.
The commentary ends with the call to “start talking, and stop attacking.” I agree about the importance of talking, but don’t see where I was attacking anyone, and certainly didn’t intend to. I respect the work that goes into these assessments and the people who do it. The DNR representatives I’ve encountered all seem like fine people.
It’s the system that concerns me. We are just beginning to understand the importance of biological integrity to local and regional climates. This is no time to rush Bessie to auction, and I believe local leaders should fight for this forest on behalf of their constituents.
In Dick Whitmore’s column, Attacks on DNR’s Bessie forest sale will have long-term negative impacts, he leaves out a couple of very important points that are also of concern. I don’t think environmentalists and conservationists are arguing that our forests don’t need management.
What many people don’t like about the way that our forests are logged is the unsightly clear-cut approach that’s taken instead of thinning the old growth out. Yes, it’s more expensive, but it still helps to prevent forest fires and landslides of debris during our long, rainy seasons. A very real problem; you only need to look at Snohomish County’s disastrous landslide that occurred and killed 43 people near Darrington a few years back after a clear cut above the community of Oso.
The other problem that I personally have with his column is that it’s all about humans. It’s, ‘What can these forests do for us?’ It completely ignores the fact that thousands of animals, our neighbors in the wild, also live and survive in these forests that they call home. What is the consideration that’s given to them? When and where are their voices ever heard when it comes to good forest management?
I am extremely excited to see our community come to life with the Cascadia Daily. Your articles have already broadened my understanding of the political and social activity of our area. Thank you.
I recently read the Jan. 23 article “As Bellingham crime spikes, police acknowledge slower response times.” A few things stood out that seriously concern me as a business owner in Bellingham:
1. Aside from some very basic numbers, we have no visual/mapped data to understand where crime is happening in our city and how those numbers are changing over time. It’s time for transparency in Bellingham policing. City of Bellingham needs to join the Police Data Initiative and provide a data dashboard. If we don’t know the data, we can’t make informed decisions.
2. City of Bellingham plans to not be fully staffed until 2029–2033? What? The City has pulled the bicycle patrols, behavioral health officers, neighborhood outreach, and school-rated officers — all the positions in which the police are regularly engaged in our community. This is not acceptable. A police department that wants to serve and protect its community, needs to know its people and build relationships in the community.
3. No officers known to have been fired for racist actions in at least 25 years? I’d like to hope this is true because officers respect the boundaries of their power, but are there any citizen evaluations of police activity or investigations that are not done internally? It is time for a citizen oversight group to provide accountability and review of complaints and violations. One-third of our City budget goes to the City Police Department. It is time to make some changes with those dollars.
As a Bellingham family who tries to walk, bike, or bus as much as we can, we read the recent rush hour story and follow-up interview with Chris Comeau with great interest. Our favorite family trip is to ride our bikes around our Happy Valley neighborhood. Now that our 3-year-old is starting to ride her own bike alongside her 6-year-old sister, our trips are getting even more fun. Unfortunately, because we live on 32nd Street, they are also getting more dangerous.
While the City of Bellingham claims to champion multi-modal transportation, they have completely abandoned 32nd Street between Taylor and Fielding. This stretch of 32nd Street is home to some of the highest density in Bellingham, an assisted living facility, and is a “safe route” to school for Sehome High School. According to Mr. Comeau, “The solution is in the mirror. If people are unhappy, they need to look at their own behavior.” Based on that view, one would expect that Mr. Comeau supports development approaches that facilitate alternative transportation. Unfortunately, that’s not the story that plays out in the public record.
Consider Mr. Comeau’s 2012 Bike and Pedestrian Master Plan. The Plan recommended 32nd Street as a target for on-street parking removal, sidewalk infill and crosswalk improvements to grow a vibrant student community centered on alternative transportation. However, since 2012 none of these improvements have been made, despite the fact that 32nd Street is one of the most rapidly developing high-density areas of the city. To make matters worse, Mr. Comeau has signed off on zoning variances that push 32nd parking on street, falsely claim 32nd Street is a Whatcom Transit Center, and inappropriately rely on parking and traffic studies conducted when students are not on campus.
When these variances were brought to the attention of our city council person, he plainly stated, “Walking and biking on an arterial is generally not a good idea. I would hesitate to send kids or parents with bike trailers down 32nd Street; it’s not designed for that.” If Mr. Comeau and Bellingham City Council don’t believe that arterials are meant to be safe for walking and biking, it’s hard to believe that Bellingham is serious about doing what it takes to get cars off the road.
Galati Family — Nick, Bridget, Silvia (6), and Liana (3)
Is ranked-choice voting coming to Washington? Bellingham, Ferndale and Whatcom County are helping to bring this about.
On Feb. 7, the Bellingham City Council voted unanimously to start using ranked-choice voting (RCV) when filling a vacancy on the Council. This action followed a presentation by FairVote Washington that explained how RCV works, and some of its benefits.
The same day that the Bellingham City Council met, the Ferndale City Council adopted a resolution that urged the legislature to pass the Local Options Bill.
On Feb. 8, the Whatcom County Council heard a presentation by FairVote Washington volunteers from Bellingham and Ferndale. The presenters urged the Council to consider adopting ranked-choice voting for filling vacancies as the Bellingham City Council had just done. Other suggested actions included adopting ranked-choice voting for county elections and urging the legislature to pass the Local Options Bill. The Local Options Bill would allow local jurisdictions across the state to adopt ranked-choice voting if they chose to do that.
They took these actions to support a simple change that would make our elections better. What is ranked-choice voting? In a ranked-choice election, voters can rank more than one candidate if they choose: first choice, second choice, etc. If their first choice comes in last, their ballot gets counted for their second choice.
There are several reasons why ranked-choice elections produce better elections. Voters can vote for the candidate that they really like without fear that doing so will help elect the candidate they like least. Candidates with new ideas are encouraged to run because they don’t have to fear being “spoilers.” We would have more civil campaigns because candidates tend to do less mud-slinging when they have to appeal to the supporters of their opponents.
Our local governments are taking steps to improve the process by which we select those who govern us. Our democracy needs this simple, effective improvement.
FairVote Washington is a nonpartisan nonprofit that advocates for the adoption of ranked-choice voting across the state.