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

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

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

Tri-County, which was torn asunder last year over a mask mandate order Douglas County objected to, is set to dissolve on Dec. 31 but is contracted to continue providing public health services to the three counties through the end of 2022.

“There are a million moving pieces,” Arapahoe County Commissioner Nancy Jackson said of the process required to go solo with public health.

Just last week, the county anointed a new five-person board of health. It held its first meeting on Wednesday and chose Jennifer Ludwig, Tri-County’s deputy director, as sole finalist for executive director of the Arapahoe County Public Health Department.

“I’m very excited we are off to the races full time,” said Arapahoe County Commissioner Nancy Sharpe, chair of the county’s new health board.

But it’s a path filled with hurdles and pitfalls, warns Glen Mays, a professor of health policy at the Colorado School of Public Health — especially when it’s being done on such short notice.

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

Another big area of concern, Mays said, is staffing. Hiring epidemiologists, statisticians, program managers and interventionists in communicable disease, chronic disease, environmental health and public health nursing is a formidable task.

“Hopefully, many of these positions can be filled with former Tri-county staff, but existing labor shortages and turnover in the public health profession will make it difficult,” he said. “And in some cases, one person can’t serve three counties simultaneously so there is likely to be a need for more staff than were positioned within Tri-County.”

Kelly Weidenbach, who is serving as Adams County’s public health transition director, is blunt about the challenges. One focus is “assuring no gap in services” before Jan. 1, “given that Tri-County is winding down and staff are seeking employment elsewhere.”

But the biggest hurdle: “The timeframe.”

“To set up a health department in less than a year is really pretty quick — and in some ways unprecedented,” Weidenbach said. “Yes, it has been and will be disruptive.”

Focus on “health equity”

The disruption was set off late last summer when Douglas County’s three commissioners became incensed over Tri-County’s decision to mandate masks in schools for the start of the 2021-2022 academic year, as the delta variant of the coronavirus was exploding Colorado’s case numbers.

The conservative county south of Denver, which has been resistant to restrictive executive and public health orders throughout the pandemic, pulled out of Tri-County in early September after being under its purview for 55 years.

The sudden withdrawal triggered a domino effect, forcing the hands of Adams and Arapahoe counties to grapple with their own public health futures. While there was grumbling at first — Arapahoe County even sued Douglas County over whether it had given proper notice to leave — some are beginning to embrace the idea of having a health department with a narrower focus.

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

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

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

“The COVID-19 pandemic highlighted the continued importance of health care insurance coverage and equitable access to care as a critical need in our communities and that the individuals most in need of care often are those without coverage,” the report states.

Shawn Davis has worked in public health in Arapahoe County for about 20 years, including with the Tri-County Health Department. He’s also a commissioner on the Colorado Department of Public Health and Environment’s Health Equity Commission.

He was appointed to Arapahoe County’s board of health last week.

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

Davis said there is a need for more emphasis on “health equity.”

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

In neighboring Adams County, where nearly half the population belongs to a minority group, 12% of children live below the poverty line. Weidenbach, who has served as the health department director in Casper, Wyoming, said she is keeping a close eye on ensuring good health care access for residents.

Adams County is a bit behind the other two counties in establishing the formal arms of its new health department. It plans to start recruiting for board members at the end of the month, with the naming of an executive director expected in the fall.

“A single-county focus will allow resources to be directed to address these unique county needs,” Weidenbach said.

Mays, with the Colorado School of Public Health, said how the counties choose their board members is important.

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

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

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

Douglas County moves ahead

Weidenbach acknowledged that critical “economies of scale” are lost with the dissolution of the Tri-County Health Department. Where Adams County used to contribute $3.8 million annually for services from Tri-County, Weidenbach said the county’s new standalone health department will likely operate on a $25 million annual budget.

Much of that money will come from federal, state and local grants, as well as from foundations and other private sources. But those are revenue streams that Adams County will need to stay on top of. Just last week, the county submitted deadline grant applications for the federal Women, Infants and Children food assistance program and Colorado’s Women’s Wellness Connection program.

The Adams County Public Health Department plans to bring over Tri-County employees to fill the majority of its anticipated 170 full-time positions. The county owns or leases all four of the spaces Tri-County currently uses to house clinics and other functions, making it easy for Adams County to assume control of the buildings when Tri-County ends its mission.

“We’re happy to retain those staff because they already are in place serving the clients they have been serving in Adams County,” Weidenbach said.

Arapahoe County contributed $4.8 million last year to Tri-County for health services.

“My hope is we can transition the grants that Tri-County got when working with CDPHE to make sure state spending is intact,” Jackson, the Arapahoe County commissioner, said.

She also hopes that her county’s new health department will pick up a number of Tri-County employees. Tri-County spokeswoman Becky O’Guinn said “most Tri-County Health Department employees will move to a county on Jan. 1, 2023 when Adams and Arapahoe counties go live with their new health departments.”