Scramble is on to replace Tri-County health services before the agency’s end-of-year dissolution

Three counties — covering more than 1.5 million people across the metro area — are racing to find their own public health agencies before the Tri-County Health Department takes its last breath at the end of the year.

Adams, Arapahoe and Douglas counties are busy drafting budgets, securing funding streams and hiring staff—many from Tri-County—to make the historic transition from the provincial health service to county private care for the first time in more than half a century.

Trie County, torn apart last year by a mask authorization order contested by Douglas County, is set to dissolve on December 31 but has been contracted to continue providing public health services to the three counties through the end of 2022.

“There are a million moving parts,” Arapahoe County Commissioner Nancy Jackson said of the process required to work alone with public health.

Just last week, the county appointed a new five-person health board. It held its first meeting on Wednesday and selected Trey County deputy director Jennifer Ludwig as the only final candidate for executive director of the Arapahoe County Department of Public Health.

“I am so excited that we are going to the races full time,” said Arapahoe County Commissioner Nancy Sharp, chair of the new county health board.

But it’s a path full of obstacles and pitfalls, warns Glenn Mays, a professor of health policy at the Colorado School of Public Health — especially when done on such short notice.

“Most health departments receive a significant share of their budgets from federal, state, and private/charitable grants and contracts, but in this year or two, these agencies will not have time to apply for and win grants,” Maes said. “Perhaps some of the funding sources will be transferable from Tri-County to the new agencies, but this will take some time to work.”

Another big area of ​​interest, Mays said, is employment. Recruiting epidemiologists, statisticians, program managers, and interventionists in infectious disease, chronic disease, environmental health, and public health nursing is an enormous task.

“We hope that many of these jobs will be filled by former Tri-County employees, but the current labor shortages and turnover of the public health profession will make it difficult,” he said. “And in some cases, a single person cannot serve three counties at once, so it is likely that more staff will be needed than are assigned within a Tri-County.”

Kelly Weidenbach, who serves as the transitional director of public health for Adams County, is vocal about the challenges. One area of ​​focus is “ensuring that there is no gap in services” before January 1, “given that Tri-County is nearing its end and employees are looking for work elsewhere.”

But the biggest hurdle: the “time frame”.

“Establishing a health department in less than a year is really fast — and in some ways unprecedented,” Weidenbach said. “Yes, it has been and will be disabled.”

Douglas County Council members...

Helen H. Richardson, Denver Post

Douglas County Health Board members hear public comments during the Douglas County Health Board meeting on October 8, 2021 in Castle Rock.

Focus on “Health Equity”

The turmoil began late last summer when the three Douglas County commissioners became angry about Tri-County County’s decision to mandate masks at the start of the 2021-2022 school year, as Delta’s type of coronavirus was blowing up Colorado’s case numbers.

The conservative county south of Denver, which has been resisting restrictive executive and public health orders throughout the pandemic, withdrew from Tri-County in early September after being under its authority for 55 years.

The sudden withdrawal triggered a domino effect, forcing the hands of Adams and Arapahoe counties to deal with their own public health futures. While there initially grumbled — even Arapahoe County sued Douglas County over whether it had given proper notice to leave — some began to embrace the idea of ​​a health department with a narrower focus.

“I think we’re rolling up our sleeves and working together and creating an agency that is truly representative of us and that responds to the needs of our community,” Jackson said. “We have an incredibly diverse community.”

According to the 2022 Community Health Assessment released in March, 40% of Arapahoe County’s 655,000 residents are people of color — a subsection of the population that has had a lower history of access to quality health care.

The top five causes of death in 2020 in Arapahoe County: cancer, heart disease, COVID-19, accidents, and Alzheimer’s disease. Eight per cent of the children there live below the poverty level.

The report states that “the COVID-19 pandemic has highlighted the continued importance of healthcare insurance coverage and equitable access to care as an urgent necessity in our communities and that the individuals most in need of care are often those without coverage.”

Shaun Davis has worked in public health in Arapahoe County for nearly 20 years, including in the Tri County Health Department. He is also a commissioner on the Commission on Health Equality in the Colorado Department of Public Health and the Environment.

He was appointed to the Arapahoe County Board of Health last week.

“This is the best time to design a public health management — right after the pandemic,” he said. “Coming out of chaos is a great opportunity. I want us to be able to focus solely on Arapahoe County.”

Davis said more focus is needed on “health equity.”

“We have to do a better job of making sure that all of the residents’ needs are met,” he said.

In neighboring Adams County, where nearly half of the population belongs to a minority group, 12% of children live below the poverty line. Weidenbach, who served as director of health in Casper, Wyoming, said she is watching closely to ensure access to quality health care for residents.

Adams County is a little behind the other two counties in creating the official arms of the new health department. It plans to begin hiring for board members at the end of the month, with a CEO appointment expected in the fall.

“Focusing on a single county will allow resources to be directed to meet these unique county needs,” Weidenbach said.

Mays, of the Colorado School of Public Health, said how districts choose their board members matters.

“Councils benefit from having extensive experience, including health and medical expertise, and experience with other relevant sectors, such as business, education, human services and the environment,” he said. “Look for evidence of these partnerships forming with the county medical community, local hospitals, schools, the business community, mental health, community development organizations, etc.”

Looming is a lawsuit filed earlier this year by the Colorado Public Employees Retirement Association, or PERA, which has sued Tri-County and its three counties, claiming they owe them $50 million to cover ongoing benefits for employees and retirees that will It is no longer funded by Tri-County when it disappears in the new year.

Tri-County and county spokespeople declined to comment on litigation for this story.

Alicia Chacon, left, and Kate Sliver, ...

Hyung Chang, Denver Post

Elicia Chacon, left, and Kate Sliver, staff members with the Tri-County Health Department, check the schedule for hepatitis and HIV testing at Aurora last September.

Douglas County moving forward

Weidenbach admitted that critical “economies of scale” were lost with the Tri-County Health Department’s solution. Where Adams County used to contribute $3.8 million annually to services from Tri-County, Weidenbach said the county’s new independent health department will likely operate with an annual budget of $25 million.

Much of this money will come from federal, state, and local grants, as well as from foundations and other private sources. But these are the sources of income that Adams County will need to remain a top priority. Just last week, the district submitted applications for granting deadlines to the Federal Food Assistance Program for Women, Infants, and Children and the Women’s Wellness Connection Program in Colorado.

The Adams County Department of Public Health plans to bring in Tree County employees to fill the majority of the expected 170 full-time jobs. The county owns or leases all four spaces that Tri-County currently uses to house clinics and other functions, making it easier for Adams County to take control of the buildings when Tri-County finishes its job.

“We are pleased to retain these employees because they are already there to serve the customers they have been serving in Adams County,” Weidenbach said.

Arapahoe County contributed $4.8 million last year to Tri-County Health Services.

“I hope we can transfer grants that Tri-County has received when working with CDPHE to make sure government spending is sound,” said Jackson, Arapahoe County Commissioner.

She also hopes her county’s new health department will pick up a number of Tri-County employees. “Most Tri-County Department of Health staff will move to a county on January 1, 2023 when Adams and Arapahoe counties begin living with their new health departments,” Tri-County spokeswoman Becky O’Guin said.

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