County re-evaluating public health services
Columbia Health Services and Columbia County are struggling to appease both sides as they redefine the two groups' contract.
The county plans to take over three programs currently operated by CHS. In April, the county's Public Health Administrator Michael Paul notified CHS that the county planned to take on the communicable disease program and the drug, alcohol and tobacco prevention and education programs.
CHS Director Sherrie Ford said that the changes presented at the April meeting were unexpected.
State legislation passed in 2015 and 2017 changed the structure of public health operations statewide. Those bills "are putting pressure on local public health authorities to make changes," Paul said.
"It all comes down to public health modernization," County Commissioner Henry Heimuller said. "As (the state has) changed their requirements, we've had to change ours."
The nonprofit now known as Columbia Health Services, formerly the Public Health Foundation of Columbia County, functioned as the county's public health authority since the Columbia Health District dissolved in 2011 following growing public dissatisfaction over a community hospital project.
But the recent legislation has led to a re-evaluation of the services the nonprofit provides for the county.
"The Legislature acknowledged that one-to-one healthcare, doctor-patient, is not really the core of public health," Paul said in an interview.
In 2017, state administrators determined that the state would only contract directly with counties, rather than including nonprofits in agreements. The county commissioners decided to hire a full-time public health administrator and begin to take a close look at which programs should be carried out by the county.
Columbia County reclaimed the local public health authority in 2018 and created an environmental health team by combining existing programs implemented by the county and CHS.
CHS is considered a safety-net clinic, meaning it provides services to patients who are not covered by insurance.
"The county is going to be doing the investigation and reporting part of communicable disease and immunization... But then they will expect us to still provide the treatment and the screening," Ford said. That means program funding from the state will go to the county instead of CHS.
"That's all well and good, but we can't provide services to all those people without funding," Ford said. "We are concerned that that's not being taken into consideration, necessarily."
At the CHS board May meeting, Paul said that the county could provide funding to offset that cost if CHS provides data on how many uninsured patients it has seen for communicable diseases in recent years.
"We have no desire or intention of providing clinical services," Heimuller noted, adding that CHS "is doing a great job" with clinical services.
The county is considering taking responsibility for two other programs: the Alcohol and Drug Prevention and Education Program (ADPEP) and the Tobacco Prevention and Education Program (TPEP). Columbia Health Services currently receives roughly $123,000 total for the two programs each year.
CHS's prevention team uses TPEP and ADPEP funding.
"When we can advocate for anything, we do," said prevention team lead Claire Catt, noting sidewalks and healthy foods as examples. "But really, the sustainability of that relies on our TPEP and ADPEP funding," Catt said.
A portion of that program funding is used in schools.
"I really need people in the schools, and my problem is, no offense, but you don't have the staff to do that... we're concerned you don't have the staff to meet the need," Rainier Schools superintendent and CHS board member Michael Carter told Paul.
"We're just trying to figure out what the community benefit is," Ford said in an interview. "If this big infrastructure change is going to benefit the community, we can get on board with that."
One of the main goals of the TPEP is to promote tobacco-free environments. "The way you do that is through ordinances," Paul said. "So it doesn't really make sense, in my mind, to contract that program out."
Creating ordinances "is considered governance, and you can't contract out governance," Paul said.
"The state wants public health to work with other departments," Paul said, noting parks, transit, and roads as examples. "Having an entity
that isn't part of the county do that work makes that part harder."
Though the county's budget has already been approved by the budget committee, funding for public health still involves consequential unknowns.
The state has proposed a tiered funding system for TPEP funding, which would require that the county self-select in one of three tiers dependent on elected officials' level of commitment to tobacco-use prevention work. At the May CHS board meeting, Paul said that the county had not yet determined if it would try to take on tier 2.
"We have to scale those programs for the funds that we get for them," Heimuller said. Current funding isn't enough for the services the county wants to provide, so the county can't afford to expand the scope of their services beyond state mandates, according to Heimuller.
The Oregon Health Authority "has an expectation that the local taxpayers will fund some of that, and sometimes that's just not possible," he added.
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