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Horizon Community Health Board asks for vote on integration

MORRIS – After two years of behind-the-scenes planning, five counties in west central Minnesota are poised to join forces into a single public health department.

On Tuesday, Sandy Tubbs, director of Stevens/Traverse/Grant Public Health and Douglas County Public Health, and Sharon Braaten, director of Pope County Public Health, told county commissioners from all five counties they believe the key to strong public health into the future is to officially work together.

From cooperation to integration

In January 2011, five counties merged to form the Horizon Community Health Board. The functions of each agency remained largely independent, but the five counties were recognized as a group by the state of Minnesota because community health boards are the entity for funding under the state’s Local Public Health Act.

In early 2012 the Horizon Community Health Board voted look more closely at whether full integration of the three different public health departments would result in more effective and efficient service, said Tubbs.

Over the course of the year, a restructuring committee met to take a broad look at six areas affected by integration: governance, programs and services, budgets, personnel and staff, community partnerships and facilities. At the end of the year, all five county boards reviewed the preliminary information and voted in favor of continuing to explore full integration of the three public health departments.

About the same time, the Horizon Community Health Board was awarded a $125,000 grant from the Robert Wood Johnson Foundation to explore how “cross-jurisdictional sharing” – integrating public health departments – could help the overall health of the community.

“The Robert Wood Johnson Foundation grant has really provided us with a lot of human and financial resources to be able to look at this issue the right way and work with consultants who have done this before,” said Tubbs.

Much of the grant money has been used to hire consultants to help draft a new personnel policy and position descriptions for an integrated public health system.

A move to reorganize public health organizations is not entirely uncommon. Tubbs said many in the state have had to adjust, but often because of a personnel or financial crisis.

In this case, the organizations are looking into integration without the pressures of a crisis.

“It isn’t that there is anything wrong now, it’s that we want to preserve what we have well into the future to be able to meet those needs,” said Tubbs.

This month, Tubbs and Braaten held a “mega staff meeting” to outline the proposed changes with the approximately 75 employees of the three departments and a “mega board meeting” with representatives from all five boards of commissioners.

Operating as an integrated organization

Some of the questions about how to operate as an integrated public health system are better answered than others.

The governance structure, for example, is relatively straight-forward. The integrated public health organization will be governed by a 13-member board. Each county will have two county commissioners as representatives, while the largest county, currently Douglas, will have a third representative. Two at-large representatives will also be appointed.

Thanks to work with a consulting firm, the five-county organization also has a proposed organizational structure. Under the proposal, there will be one public health administrator for the organization, plus two assistant administrators focusing on administration and finance and programs and services respectively.

The structure adds a human resources coordinator, but has the same total number of full time employees as the three departments have now

“We’ve never come and said this is so you can cut jobs,” said Braaten. “It’s not a job cutting piece. … There maybe a few situations where their exact position might be a little bit different, we don’t know because this is still really draft.”

Employees will also join the new public health organization in 2015 at the same salary they had at the end of 2014.

Estimating a budget

One of the biggest questions that still remains is how to pay for an integrated public health department. The combined expenses of all three departments is about $7.5 million dollars, which Tubbs said she expects to continue into the integration.

A preliminary budget developed for 2015 assumes the same amount of funding as 2014 and proposes a five year tax levy allocation plan.

For the first three years after integration, county tax levies will be frozen at the 2014 levels, unless they need to increase to cover health insurance costs. Over those three years, a finance committee will negotiate the terms for a population-based formula allocation for the department’s budget, Tubbs said.

“During the course of those three years, we know that we’re going to see some efficiencies,” said Tubbs. “Over the course of three years, I think we’re going to get ourselves a lot more lean.”

Tubbs said the restructuring committee will leave the transition – how to move employees from one department into the integrated department – up to individual counties. A lawyer is also drawing up the joint powers agreement, which will likely include an “out clause” for counties who may want to leave the organization.

Over the next month, all five boards will be asked to vote individually on whether to officially move forward with an integrated public health department beginning Jan. 1, 2015.

Pope and Grant Counties will vote on March 4, Stevens and Traverse Counties will vote on March 18, and Douglas County will vote on April 1.