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North Sound Accountable Community of Health

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January 2024 CEO Note

January 31, 2024 by Liz Baxter Leave a Comment

January – start of a new year for us, and this first month is always filled with activity. The two-day Partner Convening, annual Board retreat, filling out our ‘year at a glance’ calendar, and staff looking at their professional development goals for the year – laying the groundwork for 2024 and more. 

For me, it’s also a month of family celebrations and remembering – birthdays (my mom, maternal grandmother, great aunt, sister, cousins, nieces and nephews), my parent’s anniversary, and one year since losing my oldest brother. It always brings to mind the word ‘bittersweet’ – that we can celebrate and mourn, laugh and grieve, because all those emotions sit inside us as humans. My nephew’s birthday brings out smiles and old pictures, and reminds the family that we lost him in a drive-by shooting almost 23 years ago, leaving my oldest brother to raise his grandson. It still feels like yesterday. Our emotions are intertwined – and this complexity of emotions surrounds so many community members every day.

The Collaborative Action Network has grown to almost 140 organizations, and the convening is just one opportunity for them to meet others who might be aligned with their work. Relationship building, collaboration building, and movement building. The network will strengthen some long held beliefs, and hopefully offer some surprises for potential new partnerships. 

Starting the year off with a two-day convening is ambitious (those who do meeting planning know what that means) and I hope you all know that it is only a teaser for what is possible. The gathering nourishes our team, and unsurprisingly makes them say things like “I wish we’d had more time for ….” Being inspired by the work you do is a nourishment to us. We thank you.

We look forward to next steps with you. We’ll be announcing dates for the August convening soon, plus communities of practice and the Learning Series. The new Medicaid waiver will support capacity building for regional care coordination and once we have that agreement in place you’ll hear more. 

Many blessings to you, your families and teams, and hope to see you all again soon.

Filed Under: newsletter, CEO Update

Connecting with our Natural World

November 1, 2023 by Liz Baxter Leave a Comment

Why does it always seem so sudden, when the hours of daylight shorten this time every year? At my house I face due west, and I can watch every day how much further south (or north after the solstice) the sun sets each day, but for some reason I don’t pay as much attention to the length of daylight until this time of year.

Each season has great significance, especially for communities that are closer to the land – tilling the soil, planting; the growth, the harvests, storing for the winter. We also know that changes in seasons can impact the well-being of community members – it is harder for people who don’t have secure housing (think colder and wetter), who work to maintain their mental health when daylight shortens are just two examples. It is critical that we keep our eyes open for those who could use our help.

When we hired our first Tribal Liaison in November 2018, one of the first conversations I had with them was about the fall season, and how ‘traditional’ holidays like Thanksgiving overshadow what fall means to Indigenous people with their unbreakable connection to the land. I think of that conversation every year, and feel gratitude that those words were shared with me. Our first liaison, Candice, also shared a quote from Billy Frank Jr. that has been on my wall ever since: 

“I don’t believe in magic. I believe in the sun and the stars, the water, the tides, the floods, the owls, the hawks flying, the rivers running, the wind talking. They’re measurements. They tell us how healthy things are. How healthy we are. Because we and they are the same. That’s what I believe in.”

Imagine if this is how we were measuring progress toward equitable well-being, instead of only relying on utilization of health care services. They – and we – are connected. And if we are after a different end, we probably need new ways of measuring well-being.

I was honored to be able to listen to the proceedings from the Centennial Accord this week, especially as Tribal leaders constantly remind the Governor and other state leaders that our well-being is connected to the health of our water, air, trees, fishing, salmon… that health care is connected to natural resources, forest land, fishing rights, education, incarceration, and more. I learn so much by sitting and learning from Tribal leaders – it’s like what I imagine listening to the United Nations must be like. 

In 2020, North Sound ACH adopted the Vital Conditions for Well-being, adding to other frameworks that guide our work. That framework also shows the intertwined relationship of our personal health with a thriving natural world. 


We’re beginning to plan our next Partner Convening, which will be in late January, and we’re imagining how we’ll lift up examples of those vital conditions, so it should be enriching (and kind of fun!) 

Members of the Collaborative Action Network will see holds pop onto your calendars for January 23-25, 2023. No, we’re not meeting for three days 😊 but it will be either Tuesday/Wednesday or Wednesday/Thursday that week. Once we confirm the location, we will update those calendar holds. 

Thank you for continuing on the learning journey with us – Tribal sovereignty, equity, targeted universalism, anti-racism, the Vital Conditions for Well-being, and now Leading with Love. It was fun presenting last month with Nicole Willis at the Washington State Public Health Association conference about our six-year journey toward leading with love. What we heard – people are hungry for ways to heal the hearts, minds, and bodies in workplaces and in their communities. You are part of that leadership, and we thank you for continuing to do what you do!

Filed Under: newsletter, CEO Update

How Can We Control Our Destiny

July 28, 2023 by Liz Baxter Leave a Comment

As a person of color, I am constantly amazed at the contradictions and inconsistencies in policy and practices in the U.S. There are days I wish I didn’t read the news, and other days I’m amazed at what can be learned with one keystroke and internet access.  

Members of our team struggle some days and are lighter on others. We provide space for expressing whatever emerges on any given day. I have had great teams over the years, but this group at North Sound ACH is really special and I’m honored to be working with them, and with you. June 30 was a hard day for our team as they reconciled the final decisions of the Supreme Court this term.

It was a strange Supreme Court month – their early decisions were surprising (‘maybe it isn’t as bad as we feared’) only to end their term with a couple of decisions that used something called the ‘major questions doctrine’ – per Wikipedia “a principle of statutory interpretation in United States administrative law which states that courts will presume that Congress does not delegate to executive agencies issues of major political or economic significance.” So this begs a serious question – does Congress pass laws without delegating responsibility to federal agencies to carry out laws? It could be an oops, or it could be intentional; either way, it seems like a major fixable flaw. 

Intersectionality was front of mind for me on June 30. As a lesbian and person of color, I was trying to understand what the court was saying to me, my children, and my family. We give the Supreme Court so much power to rule, overrule and guide the values of this country, and I wonder if we’re missing a fourth stool in this democracy – the branch of government that is looking at what we need for the future, to ensure that we have a future. 

Parts of our globe are under smoke domes, heat domes, flooding, tornados, out-of-control fires, war, famine, and violence. For several weeks now every day has broken a heat record in cities across this country. None of us are immune to these changes, no matter where we live. Which branch of government is trying to navigate our future and the impact of today’s choices on that future state?

The court can pick and choose which cases to hear – which I often think wields more power than the decisions they make. They announced on June 30 that next year they will hear a case about whether someone under a domestic violence restraining order can possess a gun. Anyone who has ever experienced domestic violence is wondering when and if the court will consider the victim’s right to ‘life, liberty, and the pursuit of happiness.’

To celebrate the 4th of July, five days after hearing that a business (regardless of whether they are actually in business) can intentionally decline to serve me because of my choice of identity, Nanc and I went with friends to see a play in Bellingham – “What the Constitution Means to Me.” I was not prepared for the scope of this small play, but I walked away with one realization. The Supreme Court has not yet made a decision that says that anyone besides white men are full and whole human beings with full rights in this country. That kind of blew my mind. 

When I graduated from high school women could not get a credit card without a spouse or father co-signing, were not entitled to a jury of their peers, and there was no such thing as sexual assault by a spouse. 

When given the opportunity to decide whether women can access contraception, the court said yes, if a doctor and their husband say yes. When deciding whether a woman and her children, who had a restraining order against an abusive husband, could count on the police to respond when her spouse abducted her children, the court said no. Even knowing that the husband killed those children. The court ruled that he had a right to take those children and the wife had no right to expect law enforcement to respond. 

In the past year, federal agencies have come together around the Vital Conditions for Health and Well-being. It is nearing 50 federal agencies who have signed onto a federal plan for equitable recovery. It’s worth checking out; it is the same framework that the North Sound ACH Board adopted in December 2020. It is time for us to find ways to control our destiny; maybe this is a strategy that will find federal agencies ready to do this work with us. Well, my fingers are crossed on this. 

Back to the play, two other tidbits – there has only been one justice from west of the Mississippi in the history of the court; doesn’t that make you want to ask “hey what???” I wonder if that can possibly be true. But then I think of the New York Times articles recently about how unhealthy air is on the east coast with all the smoke. They are right, but I’m not sure that I saw this level of national news when the smoke was covering us here on the left coast. 

The main part of the play ended with a recording of Ruth Bader Ginsburg as she was asked about women on the Supreme Court. Her response “I’m sometimes asked when will there be enough? And when I say ‘when there are nine’ people are shocked. But there’d been nine men, and nobody’s ever raised a question about that.” It was a thought-provoking way to spend the 4th of July.

Filed Under: CEO Update

Transitions and Change

April 26, 2023 by Liz Baxter 3 Comments

At work, two thoughts are top of my mind this week – creating a compassionate workplace, and hiring people with ‘lived experience.’ Both are terms that have been rising in mainstream media and both deserve some deeper discussion. 

This has been a tough couple of months for me and my family. I lost one of my sisters at the end of 2021, and lost my oldest brother in January, the day before we started our Partner Convening. This past week, I had two nephews in separate ICUs, one recovering from a stroke, and the other passing away. I’ve been struggling in some moments, and fully functional in others. I come from a large family, the fifth of six children. My parents had 22 grandchildren, and the great grandchildren list keeps growing. I grew up in poverty, and to this day I can’t imagine how my parents supported us all on my dad’s salary. (When he retired after 33 years working for the federal government, his salary was less than mine in my first year after college.) I’m trying to grapple with my older brother dying in the same time frame as one of our nephews. Our worlds and experiences are that different.   

My nephew struggled with addiction and alcohol, and yet, even as we knew he was burdening his physical self, we never imagined that his body would give out on him so young. I’m reminded of the book “The Body Keeps the Score.” My nephew carried years of accumulated physical and emotional trauma and even when he was ‘well,’ those years took a toll on his health and well-being. 

There was a recent opinion piece in the New York Times that has also been on my mind – When Someone You Love is Upset, Ask This One Question? It suggested asking “do you want to be helped, heard, or hugged?” I tried that with my team this week to see how it would play out. I shared about my two nephews, my brother facing a decision about taking his son off of life support and how that was weighing on me. I knew that they would feel sympathy for me and my family, empathy for what I’m going through, but I knew I didn’t want to tell them everything about my life and my family in that setting. They could not help me or my nephew with this pain, but they could surround me with compassion. Standing on a street corner in La Conner after a meeting, being hugged by five people who I know are also going through their own struggles, was medicine that I needed at that moment.

For our teams, I want to offer space where they can bring their whole selves to the table, but that doesn’t mean they have to share their whole stories with strangers or co-workers. Their lived experience is their own, and they get to choose if, how, and how much they want to share with others. My job is to create a space that allows them to feel safe in what they have to give on any given day. We all bring our experiences with us – family history, personal experiences, laughter, seriousness, and trauma. We don’t need a trauma-filled workspace, but we do need space that recognizes that my mood, my affect, my willingness to lean in, my attention span, my level of engagement that can and will be altered by things that my coworkers can’t see, and I may not want to bare all to them.  I want no assumptions made about why I am behaving in any certain way. Curiosity yes; judgment and assumptions no. Asking if there is anything I need, yes. Assuming I need to be fixed, no.

I share with colleagues that I’m always amazed at this emoji – 😂 – wondering if it is laughing while crying, or crying while laughing. It sounds silly, but when I am at my most vulnerable, some things can still bring me joy, or make me laugh. And when I am feeling joyful, parts of me still feel pain and tears at the underlying emotions that sit around our stories. It doesn’t mean that I am “fine” or that I’m “not fine.” I can be both at the same time. So if you stop me and ask me how I’m doing, my answer depends on how large of my own eco-system I’m responding from. “I’m doing well.” “Nanc and I are doing great.” “Our kids and their families are doing fine.” “I am grieving and suffering.” “My nephews lived really challenging lives, and we are all hurting around them.” All of those sentences can come forward at the same moment and all be true, and I never know which one will come forth first. At the same time people are being shot for knocking on doors, for pulling into a driveway, for rolling a basketball on a lawn. How can any of us be totally fine? It depends on how wide of a circle I’m responding from. 

A compassionate workplace would allow space for all of those, not because we need to pull a fire alarm, but in order to recognize that whole and amazing human beings can also be hurting, harmed, and living with things we are unaware of. Imagine a world where we can all be whole human beings and no one is trying to tell me a story with only one arc to it. It’s a lot of work, takes some trust and vulnerability, and it is totally possible.

Filed Under: CEO Update

Apple Health extended coverage to end

March 29, 2023 by North Sound ACH staff Leave a Comment

During the COVID-19 public health emergency (PHE), the Health Care Authority (HCA) extended coverage for all Apple Health (Medicaid) clients. This extension is now ending due to the Consolidated Appropriation Act (CAA) of 2023, and clients’ extended coverage will be affected. The HCA estimates 300,000 clients around the state may no longer qualify for Apple Health, but may be eligible for other insurance coverage.

HCA is resuming normal eligibility beginning April 1, 2023. Clients will receive a renewal notice prior to the end of their renewal period sometime over the next 12 months, based on a client’s renewal date.

Anticipated timeline for the end of the extended coverage:

  • Now – April 2023: clients can report a change (status, income, address, etc.)
  • April 2023 – April 2024: the HCA processes redeterminations
  • June 2023 – May 2024: some individuals and families will transition to other medical coverage.

If you receive Apple Health (Medicaid):

  • Make sure your contact information is up-to-date at www.wahealthplanfinder.org
  • Watch for renewal notices and take timely action to keep your coverage

Find a free Navigator at these locations:

  • Sea Mar Community Health Center https://www.seamar.org/open-enrollment.html
    • Skagit: Concrete Clinic and Mount Vernon Clinic
    • Snohomish: Everett, Marysville, and Monroe clinics
    • Whatcom: Bellingham and Everson Clinic
  • Skagit Valley Hospital and Cascade Valley Hospital
    • call 360-424-2613 or email exchangeinfo@skagitregionalhealth.org
  • Unity Care NW
    • Bellingham and Ferndale clinics (360) 788-2669
  • Community Health Center of Snohomish County
    • (425) 789-2060 and https://apple-health.chcsno.org/
  • Providence Health and Services (425) 261-4009
  • Resource Corporation of America (425) 263-8750

If you are a healthcare or community-based organization:

The HCA is seeking community organizations and influencers to act as volunteer Apple Health ambassadors. Ambassadors will work to ensure that Apple Health clients have the information and resources needed to maintain coverage at the end of the continuous coverage requirement period.

How can you spread the word? You can share information at work with coworkers and clients, at your next church service, community event, or school event. You can use their social media toolkit (https://www.hca.wa.gov/assets/free-or-low-cost/end-of-phe-social-media-toolkit.pdf) with approved posts you can share on platforms like Facebook and Instagram. North Sound ACH is also developing a social media tool kit that you are welcome to use.

  • March 27

The HCA is hosting monthly webinars for Ambassador updates – find dates and registration at https://www.hca.wa.gov/about-hca/programs-and-initiatives/apple-health-medicaid/apple-health-ambassador-program

Find more information at these links:

  • Search for Navigators by zip code and by language https://www.wahealthplanfinder.org/HBEWeb/Annon_DisplayBrokerNavigatorSearch.action?brokerNavigator=NAV
  • Learn more about Apple Health and the end of the public health emergency https://www.hca.wa.gov/about-hca/programs-and-initiatives/apple-health-medicaid/apple-health-and-public-health-emergency
  • Help Apple Health recipients report a change in other languages https://www.hca.wa.gov/free-or-low-cost-health-care/i-need-medical-dental-or-vision-care/update-my-income-or-address-report-change

Filed Under: Announcements, Community Engagement, COVID 19, Equity

Caring is Critical to Belonging

March 28, 2023 by Liz Baxter Leave a Comment

In mid-February, former President Jimmy Carter opted for hospice care, and the media immediately began writing eulogies and obituaries, as if entering hospice means that death is imminent. In the statement from the family, “the decision was made after a series of short hospital stays.” It reminded me of my dad, who also chose hospice after a hospital stay where he realized that for him at 96, there was no cure for what was happening with his body. He wanted to be seen as a whole human being, and not as a patient who was dying. He wanted to live the rest of his life in peace, with family, in comfort, surrounded by caring individuals. He enrolled in hospice and lived for another 16 months. Eight years earlier my mom also chose hospice, but she had to advocate for it within her health system, and was so relieved after doing so. The reason she had to fight for it: her clinical team was afraid that she would give up her will to live if hospice was presented to her as an option.

I think sometimes we forget that being inside of a medical-treatment and cure-focused system is exhausting and takes its own toll on those who want a more peaceful arc to their lives. I’ve been thinking of the Carter family a lot this week, especially with the more recent news that the former president is ‘doing well’ in hospice, and I applaud their bravery in sending these messages out publicly.

How does this relate to North Sound ACH and its themes of belonging, targeted universalism, and equity? It is about how we belong to and with another, how we provide care and nourishment to each other, and how we make each person be seen in their total humanity, leaving space for our uniqueness and our commonality.

Imagine if we could do that in all facets of our lives, not just the final days, but every day? If those themes of caring, without thinking of cures, could extend to our policies around housing, employment, food security, immigration, transportation, health, and yes – even health care. If we can bridge themes of leading with belonging, humanity and love, we can accomplish so much more than by crafting more boxes, eligibility criteria, and rules that allow some people access while denying access to others.

Our histories differ, our current situations differ, and our access to meeting our vital needs differ. What we hold in common is our humanity, the fact that we are here and part of the fabric of our communities, and we will not heal if we allow portions of that fabric to continue to fray. For us to create a space where all belong, we must truly see and welcome everyone in the common space.

Be well,

Filed Under: CEO Update

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