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Five counties consider a merged public health system

MORRIS, Minn. – To ensure the long-term viability of public health in the region, three public health departments are investigating what it would take to integrate their services beginning in January 2015.

On Monday, members of the Horizon Community Health Board Restructuring Committee met with the Stevens County Board of Commissioners to discuss the integration project.

They also hoped to determine what concerns the Stevens County commissioners might have before making a final decision about participating in the new organization.

The five counties working on the project have a long history of working together on public health, said Sandy Tubbs, director of Steven Traverse Grant Public Health. Currently, the public health organizations for five counties – Stevens, Traverse, Grant, Pope, and Douglas – operate under a single community health board, the Horizon Community Health Board.

But there are still three separate public health departments underneath the umbrella of the Horizon Community Health Board. The current project is looking at combining the three departments under a single administrative structure.

“We're not trying to reinvent the wheel, we're just trying to expand it a little bit,” said Jerry Deal, Traverse County commissioner and member of the Horizon Community Health Board. “The whole idea of it, as far as I see it, is better services efficiently delivered.”

One of the reasons for exploring a five-county public health organization is size. The state of Minnesota is “making noises” that all public health organizations should serve 50,000 people, Deal said. The combined populations of the five counties is about 61,000.

In January 2012 a restructuring committee was formed to look at the implications of combining the three departments under one administrative umbrella. Shortly after, the project was awarded a $125,000 grant from the Robert Wood Johnson foundation to help explore how “cross-jurisdictional sharing” could help the five counties deliver public health services better.

“The goal of that is to really look at our initiative as well as 15 other across the nation that are looking at some level of shared services,” said Tubbs. The foundation is not interested in whether the five counties integrate or not, they just want to look at the process to see what there is to learn.

During 2012 the restructuring committee identified six areas where they needed more information: governance, program and services, staffing, community partnerships, budget and finance and facilities, said Tubbs.

After determining that there were no major obstacles that would make combining impossible, the restructuring committee asked all five county boards to pass a resolution indicating they supported the work to keep exploring a combined public health department.

On Monday, Tubbs and Pope County Public Health Director Sharon Braaten said they wanted to hear from the commissioners about their concerns so they could try to address them before a more formal joint powers agreement is presented in December 2013 or January 2014.

If the five county boards agree to move forward, the public health departments could become an integrated organization in January 2015.

One of the issues discussed during the meeting was a proposed organizational chart. The proposal includes a single public health administrator and two assistant administrators, one focusing on administration and finance and one focusing on programs and services.

Commissioner Donny Wohlers asked how the three organizations could merge without having any duplication personnel.

Tubbs said that there is some duplication in administration and support services across the three departments, so in an integrated organization some people will take on different roles. Staff who carry a caseload will continue to carry the same number of cases.

“Every position that we currently have within the three counties is represented somewhere on this chart as far as [Full Time Equivalencies],” said Braaten.

Members of the restructuring committee emphasized that the move to an integrated public health system was not designed to save money initially or cut back on staff in the short-term. Instead, it is a move to ensure the long-term viability of a public health organization in the region.

“It really is about creating a critical mass that will stabilize, I think, public health throughout the five counties into the future,” said Tubbs. “We have a system right now that is dependent on voluntary cooperation and voluntary sharing of services. … We have a system that is set up and works because we want it to work.”

Commissioner Phil Gausman said his only real concern is what happens if the counties don't decide to work together, noting that population decline in most of the counties makes it more difficult to deliver services.

“I don't look at this as being a nattempt to save money,” said Gausman. “I think it would be foolish to entertain that thought too much. What we're looking for long-term, whether there's efficiency down the road, is another story.”

Commissioner Ron Staples said that he would need more details about cost and staffing before he would be able to make a decision.

“I think overall it's a good way to go – combining is kind of the wave of the future,” said Staples.