Are SRHD’s opioid treatment services better off privatized?

RANGE is partnering with community advocates to raise awareness and encourage dialogue about a potential change in the way opioid treatment services are administered in Spokane County. Our partners have been hosting a series of conversations with various stakeholders and the RANGE team is pitching in as well, starting with this-here explainer!

RANGE has always been committed to making sure you have the information you need to hold our institutions accountable. We hope this program really helps people connect with their leaders, and maybe become a model for future partnerships in other areas of civic life. Check the bottom of this story for all the ways you can engage in the process between now and August — Luke

The Spokane Regional Health District (SRHD) is nearing a decision that could fundamentally change the landscape of treatment services in the region, and the fundamental nature of the way public health has been practiced in the county for 30 years: Whether or not to spin off their publicly administered opioid Treatment Services Division into a separate entity that would be managed privately.

SRHD has hosted some listening sessions already, but about a month ago, advocates connected to Cool Spokane approached the RANGE team about helping spread the word a little further, through a mix of in-person and virtual conversations and a town hall. We liked the idea and, luckily, SRHD did too.

So we are all going to come together next Wednesday July 24 from 5-7 p.m. at the Central Library in downtown Spokane so the public can get its questions answered and SRHD can hear people’s thoughts, hopes and concerns. (The session will also be livestreamed on the library’s YouTube page .)

The central question is this: “Would the community be better served if the Opioid Treatment Program at SRHD was run by an independent organization instead of run by public health?”

Last week, RANGE spoke with Alicia Thompson, the health district’s new administrative officer, along with Kelli Hawkins, the Director of Public Information and Government Affairs, and April Pinckney, Associate Director of Treatment Services, to understand why SRHD is contemplating this change now, and how the organization plans to make the ultimate decision.

The July 24 listening session is privately organized to supplement the community forums that SRHD has been conducting as part of the Feasibility Study, and intended to seek input from those who would be most affected by the decision to either privatize the division or keep it as part of the public health district.

RANGE is supporting these efforts by equipping the public with all the necessary information — like this explainer story — and by spreading the word about the forum to people with a vested interest in public health — like you, our readers!

Buckle up, put on your reading glasses and get your background info on SRHD’s Treatment Services Division so you can come to the forum next week prepped with an informed opinion.

How we got here

The public phase of the process began In May, SRHD published a Feasibility Study Framework in May to start official conversations around what it would mean for the organization to decouple from its Treatment Services Division, which houses both the Opioid Treatment Program and mental health providers, and began in 1990 as a methadone clinic.

Today, SRHD is the largest opioid treatment provider in Washington. Along with prescribing methadone — a drug used to help manage withdrawal symptoms from opioids — the division also provides additional services, like behavioral health and substance use disorder outpatient services, and mental health services like individual, group and family therapy. There are approximately 1,000 actively enrolled clients in the division and a staff of 60, according to SRHD.

If the SRHD Board of Health makes the decision to privatize the division, all those services and clients would transfer to a private entity. We asked SRHD if all the employees would transfer, too, or if that would depend on which private entity acquired the division, but those details aren’t yet clear.

When SRHD started the Treatment Services Division, it was to address what the district saw as a gap in care. According to the Feasibility Study, “There was no one else in the Spokane community offering services to individuals addicted to heroin.”

However, opioid treatment was not and is still not considered a “core service,” by Washington’s Foundational Public Health Services standards (RCW 43.70.512). This means that while the district elected to begin providing it as a public service — and has continued to do so for 34 years — it is not required by state law to keep doing it.

There are a lot of details to cover, but, at a high level: the pros for privatizing mostly come down to organizational limberness — private organizations might be able to move more quickly than government. The pros for keeping it are that it’s been working for a long time and, with rare exceptions, the program pays for itself.

Why consider splitting now?

According to Alicia Thompson, the health district’s new administrative officer, conversations about privatizing the Treatment Services Division had been floating around for years, but the extent of the city’s ongoing opioid crisis added urgency to consideration of the idea.

Thompson said there is more need than ever for opioid treatment services. She said the division could use more staffing and more resources, but because of the way funding for government agencies is structured, “we can’t move fast. We can’t be nimble and quick and expand our services.”

“We know we’re in the middle of a crisis. We know that we’re not going to be able to expand our services until we have generated enough revenue to cover the cost of expanding services, because that’s the way government works,” Thompson said. “Business puts together a pro forma and says, ‘Oh, in this amount of time, we’ll recover our costs.’ Government says, ‘Where’s the money?’”

She said there could be some advantages to privatizing the division, like increased eligibility for funding opportunities, the agility to address developing community needs and theoretically conserving taxpayer dollars, should the program ever dip back into the red. The program is a huge part of SRHD’s current work, and the money to fund it comes largely from Medicaid reimbursements. However, the division has been profitable for all but two years in recent memory — 2013 and 2023 — and the majority of years since it began.

“When we have something like the Opioid Treatment Program that has a bad year, and uses $673,000 of the taxpayer dollars to backfill and cover the costs, it’s like, ‘How do we justify that to our taxpayers?’” Thompson said. “It’s not a mandatory service. It’s not a core foundational public health service.”

Though the program is back in the black so far this year, Thompson said that doesn’t necessarily quiet fears among SHRD administrators.

What’s at stake?

While splitting off the division has potential upsides, some fear that privatizing what has existed for three decades as a public health service could harm the people it’s meant to help.

One resident told The Spokesman he feared privatization could encourage patients to be treated as a revenue source, rather than a community member to be served by public health, and Thompson said she wouldn’t recommend a separation unless she could guarantee a continuation of the same standard of care. The stakes are high, though. Below are the key aspects of SRHD’s current system that are up in the air with this potential change:

ACCOUNTABILITY AND TRANSPARENCY

If SRHD were to privatize — and identified a private entity that could take on the division and maintain care — the mechanisms to hold that company to any commitments, like continuing to provide mental health services, paying employees the same wages or holding patient costs to a certain number, would be weak.

“Not being an attorney, once somebody has ownership of something, holding them to what was outlined in the contract is very hard because this would be a true separation. They would take on treatment services,” Thompson said. “SRHD would no longer have any authority over what they’re doing, and that is extremely scary.”

Privatization would also result in less transparency. Because it is maintained by a government agency, Treatment Services is subject to public records requests and accountable to the public. There are required reporting metrics and an access to information — both of which can help inform government agencies’ policy making on addiction issues — that could be lost if the division went to the private sector, which is subject to less mandated transparency.

THE SERVICES

Another piece of the puzzle is that the division doesn’t just encompass medication-assisted therapy — it also houses mental health providers. “Everything under Treatment Services would separate, if we separated,” Thompson said. “And that’s another big concern: The other opioid treatment programs that I’ve talked to aren’t licensed for mental health.”
She said the division spun up its mental health services in response to a phenomenon within the behavioral health community — some programs wouldn’t take clients that were part of a medication-assisted treatment program because they classified patients taking prescription medications for withdrawal symptoms, like methadone, as people still active in addiction, instead in recovery.

That close connection between treatment and mental health is part of what makes SRHD’s program special, and Thompson said she hasn’t yet found a potential private provider who could offer similar wraparound services. She said if the health district couldn’t find an organization able to provide mental health services in addition to opioid treatment, she said she would not make the recommendation to separate.

A point of pride for Thompson is the division’s approach to addiction, which proceeds from the core belief that addiction is a chronic disease, much like diabetes or asthma. “There are medications that can help people with chronic disease live with chronic disease much longer and healthier,” she said.

By administering the Treatment Services Division, SRHD is setting an example that addiction is a public health crisis and responsibility, and a move to privatize it amid an opioid crisis could signal to some that the government is wiping its hands of people experiencing addiction.

THE UNION

SRHD’s Treatment Services is a fully unionized workforce. Thompson said conversations she has had with potential private partners make her feel that employees would be treated well, because “treatment workers are worth their weight in gold.” Her assumption is that most of the current workforce would find new jobs with the private company and be treated well because of their value.

As for maintaining the union and the federal collective bargaining rights it has to ensure pay, benefits and working conditions stay as good as they are currently, Thompson said there wasn’t a guarantee and it’s so early in the process she hadn’t yet had those conversations.

“I personally don’t know how unions work,” Thompson said. “My belief system is that every single person that works for us, whether they’re union represented or not, is extremely valuable.”

The decision-making process

The Feasibility Study conducted by Thompson, which will be supported by the community listening session, will analyze  feedback from local community members; employee and patient impact; and financial, operational and performance data. Thompson is also in the process of talking to private opioid treatment providers to determine if an appropriate private operator for the division even exists that could maintain the same level of care.

All of this analysis will be completed by August 25. Thompson will then make a recommendation to the SRHD Board of Health on whether the Treatment Services Division should separate or not, after which it will be up to the board to make the final decision

Should Thompson recommend a separation and the BOH vote to approve it, the complex process to actually assess the regulatory hurdles of privatizing a public health service, secure a buyer and transition the division would begin.

Thompson stated her priorities throughout the whole process, whether her recommendation was to separate or not, are to make sure no one in the program would lose services or quality of services.

“The recommendation to separate will not happen if it is not in the best interest of our community,” Thompson stressed to RANGE. “And when I say ‘community,’ that’s the broad community. That means the clients, the employees, our fellow health care system, the people we collaborate with. And it won’t happen if that’s the case.”

Though there have been frequent public concerns since the firing of Bob Lutz in 2020 about the politicization of the SRHD board and public health itself, Thompson reiterated her focus is on a solution that is best for patients and added she “would be really shocked,” if the the board voted against her recommendation.

More engagement opportunities

Want to learn more? Want to make your voice heard? Here is lots of additional reading and opportunities to speak out:

Survey

You can share your thoughts on the Treatment Services Program by filling out this survey . Responses will be compiled and given to SRHD leadership to inform their recommendations to the board.

Listening session for providers

A listening session specifically for providers — folks working in health care or social determinants of health — will be held virtually on Friday, July 19 from 11:30 am to 1 pm for providers to discuss impacts to the network of care and their clients. Register here .

Reddit AMA

The RANGE team will host a modified AMA on the r/Spokane subreddit next Monday. Ask your questions and we’ll answer the ones we know live and for the ones we don’t know, we’ll bring to the listening session on Wednesday.

Read the Feasibility Study Framework here .

Read more about the Opioid Treatment Services program here .

Read The Inlander’ s story on the potential separation here .

Read about the new Treatment Services Division building they moved into last year here .

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