Community Transformation: North Sound Accountable Community of Health’s Journey

“I have an inherent belief that the more we take care of the people in our community, the better our economy and our society will be.”

—Liz Baxter, North Sound Accountable Community of Health, Thriving Together

The North Sound region of Washington State includes urban and rural areas, islands and mountains. More than one million people live in the region’s five counties: Island, San Juan, Snohomish, Skagit, and Whatcom, and eight Tribal Nations: Lummi Nation, Nooksack Tribe, Upper Skagit Tribe, Samish Indian Nation, Swinomish Indian Tribe Community, Stillaguamish Tribe of Indians, Tulalip Tribes and Sauk-Suiattle Indian Tribe.

Dedicated systems stewards, or change-makers, from across the region are working together to increase equitable well-being. In 2016, these leaders created a pathway for transformative change, launching the state’s first Accountable Community of Health (ACH).

“In 2014, a group of leaders across the North Sound region formed a planning group to explore launching an ACH. The vision was to improve community and population health, looking long term at 10- and 20-year strategies, as we knew the solutions to our most pressing problems would not happen with quick fixes. In 2015, North Sound became Washington’s first ACH, and in 2016 incorporated as a nonprofit. The state’s Medicaid Transformation Project, a five-year effort launched in 2017, allowed the ACH to build infrastructure and support regional partners as they improved care and services with Medicaid enrollees,” states Kim Williams, North Sound ACH Board Chair.

Medicaid Transformation

Medicaid transformation is not an easy undertaking, as it requires coordination of complex health plans and government regulations within and across clinic and community settings. The structure of the ACH, however, is meant to give regional leaders room to experiment and to meet the unique needs of their community members.

“The ACH is an attempt to move from federal and state decision-making to regional decision-making, to create the opportunity for the tribes, clinical partners, and community based organizations to work together to better the health of the people who live in this region,” Liz Baxter, North Sound ACH CEO explains.

The North Sound ACH Board of Directors, staff, and community members quickly found that data confirmed what they already knew to be true through lived experience: health doesn’t happen in the doctor’s office. While the type of needs have remained consistent since 2015, the demand has grown. The North Sound 2019 annual report highlights the top five non-medical needs: housing (24 percent), employment (17 percent), social support (17 percent), food and nutrition (11 percent), and transportation (10 percent).

The Medicaid Transformation Project continues in 2024, for another five-year demonstration project. Learn more here.

Well Being in the Nation Network and the Vital Conditions 


The North Sound ACH team began looking beyond medical services to understand, and address, the barriers to optimal health and well-being. “We realized fairly early that there are two different bodies of knowledge. There’s the knowledge of the professional community, and the knowledge of the people who live in the community – and the most successful care plans combine the two,” Liz Baxter states.

North Sound ACH adopted the Vital Conditions for Health and Well-Being as a framework, recognizing that our purpose is to create thriving communities, beyond basic needs and survival. Click here to listen to Liz Baxter share more about how North Sound strives to engage people with lived experiences and co-create solutions with community members.


Tribal and Equity Learning Journey

As North Sound ACH centered community transformation, North Sound leaders dedicated themselves to a learning journey. “More than three years ago the North Sound ACH team and Board made a commitment to embed equity into the work of our organization and with our partners across the region. We embarked on a Tribal and Equity Learning journey together and have been honored to learn from local, regional, and national experts who have enlightened and inspired us about the work ahead,” Liz Baxter explains.

The North Sound ACH Board of Directors launched a Tribal Alignment Committee in the fall of 2017. The committee has shaped the North Sound approach and culture, bringing the deep and rich traditions of Tribal Nations to community partners and clinical providers.

In addition, North Sound staff meetings, board meetings, and partner gatherings now begin with a land acknowledgement:

We begin by acknowledging, with humility, that the land where we are today, is the territory of the People of the Salish Sea. Their presence is imbued in the waterways, shorelines, valleys, and mountains of the traditional homelands of the Coast Salish People since Time Immemorial.

Learn more about Land Acknowledgements from this resource developed by North Sound ACH and Children of the Setting Sun Productions.  

Legacy Moment 2020

“When we remember that we need to gather ourselves in the spirit of the moment and the spirit of our ancestors, the spirit of all living things, and in the spirit of Mother Earth – then I think we have a real foundation for change.” —Darrell Hillaire, Children of the Setting Sun Productions, Thriving Together


North Sound communities, like others across America, faced the tangled threats of 2020. COVID-19 exposed the fragmentation of our systems, even as social movements for racial justice reveal the opportunity for transformation. 

By learning and growing together, leading with equity and belonging, leaning on the wisdom of Tribal Nations and people with lived experience of inequities, North Sound ACH has created a foundation for collective action – and is stepping up to demand something different and better right now.

“For North Sound, it is time to take action. … Together we are a powerful group of leaders across the North Sound region. Imagine if what happened in Minneapolis had happened in Bellingham or Everett. How would you and your organization respond? Do you feel like you have the tools to address that question? Do protests against social injustice have to be met with force? Are there other ways that those in power can respond to anger, fear, and demands for change? How do we test and develop those ‘civic muscles’? 

Across the state counties are implementing COVID-19 recovery plans. Imagine if the governor added an expectation that each county had to develop an actionable plan to denounce hate and address viral racism. Could advancing equity and wellbeing become an integral part of recovery expectations? If not now, I can’t imagine when it could happen,”  Liz Baxter shares in Calling Us to Action. Click here to listen more to North Sound’s Communities of Color Coalition leaders.

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