A Letter from Dawn Bonder

Welcome to the SWACH web site!

SWACH, the Southwest Washington Accountable Community of Heath, covering Clark, Skamania, and Klickitat Counties, is charged with convening our regional health care providers, community organizations, elected leaders, businesses, and residents to look at the health of our region using a much broader definition of HEALTH than we usually use.

Research suggests only 20% of a person's health is determined by the medical care he or she receives. The other 80% is determined by income, education, housing, zip code, race, environment, and other factors.

Our job as an Accountable Community of Health is to look at everything affecting the health of our residents and to create a system that focuses on the broad definition of HEALTH.

Our first major work in the region is planning and implementing Washington State’s Medicaid Transformation Projects in Southwest Washington. Medicaid is the program that provides health care services for the poorest and most vulnerable citizens of our state. It's jointly funded by federal and state dollars, but the state is responsible for the success of the program from both a quality and financial lens. Because the state has responsibility for the quality and finances of the program, Medicaid is an excellent starting place to make reforms.

When I ask Washingtonian’s what they think of Medicaid Transformation I usually hear one of two responses:
1 “Medicaid Transformation?”
2 “It’s not going to work.”

Medicaid Transformation is exactly what it sounds like. Research and data show us clear ways to improve medical care, lower costs, and improve outcomes. Some of these improvements are common sense – pay providers for keeping people healthy and make sure the Emergency Department isn’t being overused because there are no other options. Some improvements are emerging – how to cope with our opioid epidemic.

In some instances, we have layers of services that are duplicative and difficult to navigate. In other instances, we have gaps in necessary services. The Medicaid Transformation Project offers the opportunity to unstack those layers and reallocate those resources to fill the gaps.

We have many of the answers for how to do a better job with HEALTH, but like any large system, implementing new ways of operating is difficult. The sharing of data and collaboration across regions and states is at an unprecedented level, bringing us blueprints and toolkits for how to make the necessary changes. SWACH’s job is to work with you to fit these to our region – our residents, our health care providers, our community organizations, our employers, and OUR most pressing problems. SWACH isn’t reinventing the wheel; we are working to choose the best possible wheel for our region.

I can appreciate being reluctant to believe that we can do anything to improve our health care system. Believe me, I understand. I openly acknowledge how difficult it will be. Health care is complicated – and Medicaid is especially difficult because of limited funding. However, we have many opportunities for improvement and we intend to begin pushing this boulder up the hill before us with the knowledge of what has – and has not! – worked elsewhere. Of course it will be hard work, but nothing worthwhile comes easily!

SWACH projects aren’t “quick fix” answers. Building on decades of thoughtful research and pilot projects, SWACH solutions have WORKED. Previous efforts have also told us who to involve (everyone!) and proved the importance of transparency and an orderly, phased rollout.

Millions of hours have gone into getting us ready to roll these transformation projects out. I invite you to get involved – tell us what you think, serve on a workgroup for which you are qualified, or just sign up for our newsletter and follow our work.

Thank you for your interest in SWACH and our work – we hope you will continue to check back to see our progress.


Dawn Bonder