County proposes public health plan

Officials say proposal will fill void left by pending departure of Western Racine County Health Department

By Ed Nadolski

Editor in Chief

Burlington and several other Western Racine County communities faced with the looming loss of their current public health service provider could see enhanced services under a new proposal that puts county government in charge of public health.

And the majority of the prospective participating communities – eight out of 14 – would see identical or lower costs than what they’re currently paying for state-mandated public health services, according to the proposal unveiled last week by county officials.

“This goes back to my central theme of government,” Racine County Executive James Ladwig said Tuesday. “People don’t care who’s delivering the services, they just want it done well in the most cost-effective manner.”

Ladwig said it makes sense for the county to step up and oversee a public health department because it is now in a unique position to realize economies of scale that individual communities or consortiums can’t.

The proposal – which was presented to representatives of the impacted communities last week – was born of necessity as Burlington and the seven other communities currently served by the Western Racine County Health Department are searching for another provider to fill that need as of Jan. 1, 2015.

Aurora Health Care, which is the current contracted provider for WRCHD announced earlier this year that it is pulling out of the public health realm mainly due to a conflict of interest that – in some cases – would require Aurora to investigate its own health care facilities.

Burlington Mayor Bob Miller said the city initially approached the Central Racine County Health Department, which is based in Caledonia, to see if that agency would consider expanding its services to the Burlington area and other western Racine County communities.

However, when officials with Central learned of the potential scope of an expansion needed to serve most of Racine County (with the exception of the City of Racine, Wind Point and Elmwood), it opened discussions with the county.

“We talked with Central and they did not want to be the fiscal agent for all those entities,” Ladwig said. “We saw this as a problem that needed a solution.

“I think this is doable for all involved.”

Decades ago, the county took an opposite approach to public health with communities banding together to offer services through a contracted provider, such as Aurora, to save money.

Now, however, reforms to collective bargaining brought about by Act 10 allow the county to again consider sponsoring the services at a more competitive cost, according to Ladwig.

“Act 10 changed the dynamics in a lot of this,” he said. “We are now more able to operate like a business than ever before.”

Previously, he said, public union bargaining over retirement and health insurance benefits made it cost prohibitive for the county to compete with private industry for many services.

More services expected

The bottom line, according to Ladwig, is that all the communities currently served by the Western or Central health departments would receive similar or expanded services and most would pay the same or less than they do now under the county proposal.

“We have a solid structure to work with now,” he said, noting that the county would adopt the services and pricing currently offered by the Central Racine County Health Department.

Burlington’s Miller, whose city would pay $363 less per year, said: “I think it’s a good deal for us. They offer some things that we don’t get now.”

Foremost on that list is restaurant inspections. Currently that task falls solely on the State of Wisconsin in the communities served by the Western Racine County Health Department. Miller said the state is not staffed sufficiently to make the inspections as regular and as effective as a county agency could.

The Western Racine County Health Department currently serves the city and town of Burlington, the villages of Rochester and Waterford, and the towns of Dover, Norway, Raymond and Yorkville.

The Central Racine County Health Department currently serves the Town of Waterford and the Village of Union Grove along with Caledonia, Mount Pleasant, North Bay and Sturtevant.

The City of Racine maintains its own public health department that also serves Wind Point and Elmwood Park. Those communities are not currently part of the county’s proposal.

What it would cost

Using the Central Racine County Health Department model, the county anticipates a charge of $6.98 per capita in each of the 14 communities served.

Ladwig said the plan is to maintain that rate without increase for a period of three years.

While the communities currently served by Central would see no change in the cost, the eight current Western communities would face varied impacts with just two paying less and the other six paying more, according to the proposal presented by the county last week.

The winners under that scenario are the City of Burlington (which would be charged $73,241 annually, a decrease of $363 from its 2011 contract) and the Town of Raymond ($27,180; -$343).

Those expected to pay more, including their estimated annual cost and the increase from their 2011 contract cost are: Town of Burlington ($45,007; +$4,384); Town of Dover ($27,899; +$1,371); Town of Norway ($55,568; +$6,203); Town of Yorkville ($21,547; +$1,464); Village of Rochester ($25,721; +$5,409); Village of Waterford ($37,413; +$4,885).

How it would work

Under the county’s proposal, the Public Health Department would become a division of the county Human Services Department.

A Board of Public Health, consisting of nine people – including representatives from some of the participating communities – would be established to oversee the service. The board would include the public health officer in charge of the service and representatives from the areas served, based on population.

However, because the board is limited to nine people by state statute, not all of the 14 individual participating communities would have a representative.

According to the county’s proposal, the board would set policy, make recommendations on funding after the first three years and regularly report activities back to the participating communities.

The county Public Health Department would operate as a Level II provider, meaning it would offer the five required Level I services plus an additional seven services that address five different priorities cited in the current Wisconsin Health Plan.

Structure of department

Ladwig said many if not all of the current Central Racine County Health Department employees would become county employees under the proposal. There would be a need to hire additional nurses and technicians to serve the added populations currently in the Western Racine Health Department County service area.

The hub of the operation would likely remain in Franksville – where Central’s office is currently located – but clinics and programs would be brought to the new areas served, namely Burlington, Waterford and Union Grove, Ladwig said.

“Services will be brought to the people,” he added, noting that there is only a small amount of “counter” traffic at the health department office.

Ladwig said the governing boards in each of the prospective participating communities will discuss the proposal and will be asked to sign a memorandum of understanding later this spring.

Based on the relative success of that effort, the county would proceed with formal planning and would prepare contracts for each of the communities to provide public health services beginning in January.