With half a year left before the dissolution of the Tri-County Health Department, Arapahoe County has announced its five-person board, and the sole finalist for executive director, to helm future health services. 

“What we’re doing is unprecedented," said Shawn Davis, a Colorado-based health care consultant who will serve on the county's new Foundational Board of Health. 

Following the breakdown of Tri-County, which for more than 50 years had been delivering health services to Adams, Arapahoe and Douglas counties, Arapahoe has been in a race against time to create its own health department by Jan. 1, a day after Tri-County's services will end. 

“We don’t have the option of delaying it or asking for an extension," Davis said. "We owe it to the county to be ready by Jan. 1."

As that deadline looms, the department's new board expressed optimism that it is on track to provide high-priority services to the county's population of just under 650,000 by the beginning of next year. 

But challenges lie ahead, especially as the department looks to finalize a budget, secure funding and attract staff. 

“Make no mistake, with this kind of transition do we think it’s going to be a smooth transition and issues won’t come up? Absolutely not," Davis said. 

The board consists of county commissioners Nancy Sharpe and Nancy Jackson as well as Davis, Bebe Kleinman — CEO of Doctors Care — and Dr. Heather N Signorelli — a pathologist and vice president and chief laboratory officer for HCA Healthcare. 

Jennifer Ludwig, Tri-County's deputy director, was named sole finalist for Arapahoe County's health department's executive director. 

Funding fallout pushed Arapahoe out

The foundation for Tri-County's demise was laid during the first year of the COVID-19 pandemic when Douglas County leaders clashed with health officials over mandatory mask mandates. 

In July 2020, Douglas County commissioners announced plans to split from Tri-County and form a new health department. In September 2021, commissioners voted unanimously to do just that. 

A month later, Adams County leaders followed suit, pledging to create their own health department. As the final county standing, Arapahoe made the decision in December 2021 to break from the health department and form its own. 

While it's been providing health services to the three counties during that time, Tri-County's operations will cease Dec. 31, leaving health decisions in each county's hands. 

Arapahoe County Commissioner Nancy Sharpe said the situation is "not something that Arapahoe County actually wanted," but — because of the financial fallout of losing two counties — had to be made. 

Still, county leaders said they see the benefits of moving towards their own health department. 

While shared funding between the three counties helped ease financial burdens, it also meant more targeted spending was less common, Sharpe said. 

“I think this gives us an opportunity to look more specifically at the needs of Arapahoe County," Sharpe said. 

Arapahoe County paid the most for Tri-County services of the three counties last year. According to a consulting firm's report, Arapahoe County paid $4.8 million. Adams paid $3.8 million while Douglas paid $2.6 million. 

Sharpe said the county's own health department will likely cost around $5 million per year, possibly even more.

"We anticipate that it will be more, we just don’t know how much more at this point," Sharpe said. 

Most of the department's budget will come from federal and state funds, according to Sharpe, while the rest will be covered by the county and private entities, such as foundations. 

Some one-off money may be used from the county's slice of the $1.9 trillion American Rescue Plan Act, a federal COVID-19 stimulus package. The county received  $127.5 million in federal funds from the law, with money so far targeted towards housing, homelessness and mental health among other priorities. 

A budget has yet to be finalized, though Sharpe said she expects one soon following Ludwig's expected confirmation as the department's executive director.

Ludwig was reached for comment but only provided a brief statement in which she said she is "honored to be named the finalist for the position."

Tight timeline, staffing shortage presents obstacles

The tight turnaround for Arapahoe County to set up its new department before Tri-County ends could cause a temporary gap in some services according to Tri-County's executive director, Dr. John Douglas. 

“It’s a real possibility and it’s a real concern," Douglas said. 

While the health department was thrust into the public spotlight for its role during the COVID-19 pandemic, Tri-County has been offering a slew of other services to county residents, including no-cost cancer screenings, overdose prevention, free nurse visits and restaurant and child care facility inspections.

Those are services that Sharpe said county residents should expect to be offered through the county's new department, but depending on staff and budget constraints, may not be at full capacity during the department's early days. 

Douglas said internal polling has shown a vast majority of current Tri-County staff have shown interest in moving to one of the new county-run health departments and expressed optimism that there would be a significant carryover. 

But Tri-County itself has become thinner as more and more health care workers leave the field following stress and burnout from the pandemic.

“Every place saw the great resignation going on, and we weren’t immune to that," Douglas said of Tri-County. “Last year, we probably were running 30% to 40% more staff choosing to leave than previous years."

Sharpe said it "would be unrealistic" for Arapahoe County to be immune to labor shortages, but was hopeful the department's salaries and benefits would be enough to hire and retain adequate staff. 

Also hovering over the county is a lawsuit from the Colorado Public Employees’ Retirement Association — or PERA — which alleges it is owed $50 million by Tri-County and the three counties.

The state organization, which provides retirement and other benefits to employees of government agencies and public entities in Colorado, said Tri-County's collapse jeopardizes the retirement benefits it promised employees. 

The lawsuit is still pending and Douglas said he would not comment on it beyond saying, "I do understand PERAs concern.” 

“We hope it’s going to get resolved and we do think a well-funded state employee pension program is important," Douglas said. 

A new way of looking at public health

Despite the uncertainty ahead, Davis, the health care consultant and Arapahoe health board member, said he sees it as a new opportunity to address long-neglected inequities in public health. 

“The county as a whole really needs to be cognizant of the different needs of the population," Davis said. 

Arapahoe County is diverse — about 40% of its population is people of color — and its demographics have faced compounding issues that traditional public health approaches have proved ill-equipped to serve, said Davis. 

Davis, who has worked with several nonprofit health care groups for more than a decade in Colorado, said health departments need to look beyond their own staff and partner with other entities, like housing and human services, to meet the needs of all county citizens. 

“You have housing, you have food security, you have social isolation," Davis said, adding that most people's health outcomes are influenced by their living environment, quality of life and access to care. 

Addressing mental health needs must also be a bigger priority, Davis said. 

“A lot of that we have to partner with therapists and community mental health centers, so some of that is slightly outside the public health system," Davis said. "But all of those areas we’re planning on providing in Arapahoe County."

For Davis, the COVID-19 pandemic showed the shortcomings of public health messaging and the need to meet people where they are. 

“We in public health really didn’t do a good job of presenting the message in a way that the constituency understood," Davis said. “The worst thing we want to do is create an environment where people think we’re doing things to them instead of in conjunction with them."

As a Black man, Davis knows the hesitancy and mistrust in Black communities around healthcare that has been cemented through decades of racist medical mistreatment, which has contributed to the racial gap in COVID vaccinations, Davis said. 

And as public health becomes more politically charged following the pandemic, Davis said it will be imperative for Arapahoe County's new health department to hear all sides of a community. 

“I don’t think you’re going to keep politics out of health … I think we live in a totally different world now," Davis said. 

Still, COVID-19 remains a "moving target," Davis said. While he understands the fatigue many may feel, it will be the job of the health department to work with and communicate to communities about where the pandemic is headed, he said.

But by reaching people where they are, be it at church or school, Davis said he is confident Arapahoe's new health department can repair trust.

“When communities are at the table I think the outcome is very different," Davis said. 

The county will be hosting a telephone town hall July 7 at 6:30 p.m. to answer questions about the new health board and department.

Citizens can go to tinyurl.com/arapahoetownhall to submit questions in advance and to listen to the event.