County considering outsourcing public health functions to Alluvion
Cascade County is exploring options for outsourcing multiple public health functions to Alluvion Health.
Alluvion was previously the Community Health Care Center and a part of the county.
Last year, the agency began splitting from the county and since Jan. 1, has operated as an independent agency.
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It remains a federal qualified healthcare center.
Alluvion took with it many county employees, including Tanya Houston, who was the health officer at the City-County Health Department.
The county posted that job vacancy and received zero applications so far, according to Commissioner Joe Briggs.
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In February, the commission approved a contract with Alluvion for interim health office services.
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Essentially, Houston will continue the duties of the county health officer for the time being.
The contract approved by commissioners runs March 1 through Aug. 31, but could be extended and pays Alluvion $3,500 monthly.
Alluvion also took over administrative duties for CCHD, including prevention services, emergency preparedness, communications, family health services, environmental health and accounting under the agreement.
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In March, Alluvion approached the county with a proposal for Alluvion to take over more health department functions, including prevention, family health and some administrative duties.
County commissioners are considering it and on May 30, met with city officials to get their feedback since the city funds a portion of CCHD’s budget.
The consensus during the meeting that it was worth pursuing, but that more details needed to be worked out before anything was finalized and a contract would need commission approval.
Commissioner Joe Briggs said they’re exploring “what’s the best model for the community.”
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Alluvion is federally funded in part and agencies like it are being directed to expand services, particularly for immunizations, emergency preparedness, family health, home visiting, STD treatment, behavior health, educational programming and more.
That will cause Alluvion and CCHD to be duplicating services, Briggs said.
Alluvion is a non-profit with a governing board.
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CCHD opened what was previously called the Community Health Care Center in 1994 to support increased access to care for the uninsured, underinsured and underserved patients. In 2012, the CHCC started operating as a separate department within the county with a long-term goal of becoming an independent agency, according to CHCC.
Alluvion offers medical, dental and behavior health services. They’ve also partnered with Gateway to provide addiction services.
Briggs said the federal government has been favoring the federally qualified healthcare center model for reimbursements by federal programs and for providing community healthcare.
Briggs said that Alluvion, as a federally qualified healthcare center, gets reimbursed for some of the same services the county health department provides but isn’t reimbursed for by other government funding programs.
So outsourcing some of those services could potentially stabilize the county cost and since Alluvion has other revenue sources, could also enhance services for county residents.
Briggs and Commissioner Jane Weber said that at this point, the county doesn’t see any duplication in the environmental health division and would retain those functions within county government. That division includes licensing and inspections for food service establishments, tattoo parlors, swimming pools, day care facilities and more, as well as septic systems, rabies and other public health issues.
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County officials said they are legally required to provide those functions and could move some of it into the county planning department, keep it as its own department or absorb those functions into county government in some other arrangement.
Weber said that similar federally qualified healthcare centers have partnered with local government in some fashion in several other Montana communities, including Custer County-Miles City; RiverStone Health in Billings; Carbon County has contracted with a hospital and Flathead County has contracted for a public health officer.
Weber said that the county has struggled to hire for prevention services division because of low wages and they don’t have a physician on staff so the county can’t recover costs for services like STD treatment.
“Alluvion has a much higher wage scale,” Weber said.
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Alluvion also has more locations throughout the location, including multiple sites in the downtown Great Falls area, school-based clinics and now a site in Belt, which allows greater access to healthcare for county residents, Weber said.
She said the agency is also free from some of the constraints of local government and could offer more services in terms of sex education and needle disposal.
Weber said that in conversations with staff at the City-County Health Department, a concern was raised about the loss of neutrality regarding community health information should the county outsource to Alluvion.
“I don’t think that’s an insurmountable thing,” Weber said.
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County government isn’t as “nimble” as a non-profit agency in managing grants either, Weber said. For example, one grant required a dietitian and the county hasn’t been able to hire one, she said.
Weber said the county would be able to transfer its health grants to Alluvion for the same services. She said the county is also allowed to outsource the WIC program, per what the Montana Department of Health and Human Services told the county.
Weber said that by contracting with Alluvion, the county believes it will be able to improve recruitment and retention of nurses and other medical staff, expand programming, increase billable services and increase accessibility.
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She said Alluvion is already handling the county’s electronic health records with their software and is handling CCHD’s billing.
Briggs said “this whole thing is not about finances.”
He said that if things remain as they are, the county will lose revenue as Alluvion expands services as well as other factors such as pharmacies offering immunizations.
Briggs said the county is envisioning that it transfers a set amount of mills annually to Alluvion for handling certain health department services.
“The county will not get a savings windfall,” Briggs said. But in the arrangement, Alluvion would also be taking on some of the county’s money losing services and the operational costs.
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Alluvion is planning to keep its footprint in the building it shares with CCHD at 115 4th St. S. Alluvion has for the past year been expanding and opening other sites around the city, including the dental clinic in Machinery Row, the school based clinics, and the temporary headquarters at 601 1st Ave. N.
The Rocky Mountain Building in downtown Great Falls. Photo by Jenn Rowell | The Electric
Alluvion pays half the operating costs for the building on 4th Street, according to Trista Besich, Alluvion’s chief executive officer.
The agency purchased the building on 1st Avenue North while the Rocky Mountain Building at the corner of Central Avenue and 6th Street is being renovated into Alluvion’s new home.
Once the move into the Rocky Mountain Building is complete, Besich said they intend to sell the building on 1st Avenue North.
City Manager Greg Doyon said it makes sense to explore the option but has concerns over the rate of Alluvion’s growth and expansion and whether they’ll have the ability to provide all of the services it’s promising.
Doyon also asked if the city would be asked to contribute more than it’s annual $250,000 toward the health department and whether Alluvion had done budget projections a few years out to see if those amounts would be adequate.
Briggs and Weber said they won’t ask the city for more.
Briggs said that the spin-off was the result of a five year plan through from the outside “it looks like magic.”
Weber said that if the city said it wouldn’t contribute under the proposed arrangement, she would have a hard time making the decision to pursue a contract with Alluvion.
The county spends about $550,000 in tax revenue for the health department. The department is also funded by fees for service and grants.
Doyon said he doesn’t plan to change the city’s allocation in the upcoming budget. He’ll be presenting the proposed budget for fiscal year 2020 to the City Commission next week.
City Commissioner Mary Moe said she was comfortable with the city’s commitment but would want to hear public comment.
Mayor Bob Kelly said he’d like the city to be involved in developing the contract but the proposal “looks like a great value opportunity for the community.”
Commissioner Bill Bronson said he’d need assurances that Alluvion could provide sufficient data to track what they were doing with the city’s contribution and see results since it’s public money.
Moe said she sees the desirability of the partnership, but was concerned with things in the public domain such as outbreaks and emergency preparedness.
She also questioned how the governance would work between the city-county Board of Health and Alluvion’s board. County Commissioner Jim Larson serves on Alluvion’s board. Weber and City Commissioner serve on the local Board of Health.
Weber said the two boards would act autonomously. The Board of Health is not involved with clinic operations but would look at community-wide issues. That board would still provide fiscal controls and oversight, so it wouldn’t be a change for the local health board.
Besich said it would be a contractual agreement and Alluvion would have to meet reporting agreements, as it does for other funding programs at the federal, state and local levels.
Doyon said that when he first got to Great Falls, there was some discussion of a mill levy to support public health and asked whether the proposed model would preclude that.
Briggs said it doesn’t preclude a levy but also doesn’t require one.
Kelly asked what would happen if Alluvion were to close in the future.
Weber said that the county is mandated to provide public health services so if they partner and Alluvion closes, the county would have to rebuild a public health program. She said they’d want to make sure the partnership would be sustainable and build terms into the contract to allow for ample notice so the county didn’t have to rebuild the health department on a moments notice should Alluvion pull out.
Houston, the former county health officer who now works for Alluvion and is under contract to provide health officer services to the county, said that emergency preparedness functions through the health department are just one component of a community’s overall emergency preparedness program.
Currently, the city fire chief is the designate emergency manager and the county recently hired a new disaster and emergency services manager.
Houston said regardless of the model between Alluvion and the county, Alluvion would continue working collaboratively and has already developing memorandums of understanding with other local agencies for emergency preparedness.
She said Alluvion is also now a third entity that could provide services in a mass casualty event.
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