University of Wisconsin Center for Wisconsin
Rural Cooperatives, May/June 1996, pg. 32-34
Published by the Rural Business and Cooperative Development Service 

The Rural Heartbeat

Health Network Enhances Services in Mountain Community

Ry Southard

Editors Note: Southard is a partner in the Rocky Mountain Planning Group, Avon, Colo., a consulting firm that specializes in development of cooperatives and nonprofit businesses that operate on cooperative principles. 

If we believe that Rural America is the heartbeat of our nation, then most certainly a major viral infection - of Stephen King proportions - is at our doorstep. A combination of rising health care costs and cutbacks in health and social programs at both the state and federal level has left many rural communities struggling to maintain or establish needed health care facilities and related social services. When the health of our rural population is negatively affected, it increases the odds of a general economic downturn. A healthy community may be able to withstand an economic crisis, but when health services are eroding, econon-tic stress is compounded and the viability of rural communities is threatened.

    The reduction or elimination of many costly health and human services programs could have a severe impact on rural America. To plan for even the best-case scenario in this setting, rural communities need to be innovative and collaborate. They need to begin planning now, if they haven't already done so.

    Eagle County in Colorado is developing an innovative, shared-services agency that operates on cooperative principles and is surmounting these negative trends and improving the delivery of health and human services to its residents. This article discusses the needs and process that have made this possible.

The Downside of Growth

    In many rural areas, out-migration and depopulation pose a severe threat to the continued viability of communities. But many rural mountain resort communities in the West face the opposite challenge - dealing with problems brought on by rapid growth. Sustainability of some community health services is a critical issue in Eagle County, which was the second fastest growing county in Colorado in the 1980s and is now the state's fourth fastest growing county. County population increased by 51 percent from 1985-1994 and is expected to grow by another 50 percent in the next 10 years. The county's per capita birth rate has been one of the highest in the state since 1986.

    This county in the heart of Colorado's ski country is home to some of the nation's premiere ski resorts. Yet amid the wealth is a struggling underclass - usually employed in low-paying service industry jobs. One in eight Eagle County families live at or under the federal poverty level. One in four Eagle County residents is a member of a minority group, with Hispanics comprising over 15 percent of the total population.

    The high cost of living in the resort communities of Vail and Beaver Creek (Avon) compounds family financial stress for the poor. In 1994, the median price of a single family home in these towns was $235,000.

Building From a Successful Collaboration

    The Eagle Valley Family Center (Family Center) was formed to address the need for health services sustainability in Eagle County. Founded in January 1992 and spearheaded by Cherie Paller, then the director of the Resource Center of Eagle Valley, the Family Center began as a coalition of over 30 medical, educational, human and social service groups. It provided a forum to identify critical health needs and launched a collaborative effort to help eliminate duplication of services. Where gaps in services were identified, members collaborated to fill the voids. Today, it's mission is three fold: networking; consolidating and sharing resources; and improving delivery of services.

    The Family Center has effectively networked the public schools, government human service agencies, medical groups and nonprofit human services organizations. Members include: Mountain Hospice, Drug Free Eagle Valley, 4-H, Literacy Project, Catholic Charities, Family Assistance Fund and the Vail Valley Medical Center. Members have been meeting regularly on a monthly basis for four-and-a-half years.

    The Family Center is successfully identifying needs, creating solutions and implementing effective programs - building a model community-wide health and human services network. Cost savings realized as a result of sharing expenses for administrative overhead, particularly in grant applications, has helped Family Center member organizations offer new programs and continue to operate programs which were previously in danger of being lost. Examples of its accomplishments to date include implementation of

  • Headstart program
  • Healthy Babies and Families program
  • Child Care Resource & Referral program
  • Family Mediation program
  • Teen Pregnancy Prevention Taskforce
  • Eagle Care Clinic, which serves the medically under or un-insured
  • Redcliff Cooperative Preschool.
A Cooperative Model Makes Sense

    Despite these successes, the Family Center was at a crossroads in its development in 1995. The Family Center wasn't growing in scope, and member organizations wanted to take a more proactive role in community development and increase the level of vital services to low income residents. Member funding continued to be "at risk" due to the skewed nature of income demographics in this tourism and resort-based economy, where multi-million-dollar homes and incomes can raise median income levels above standards that would normally qualify area nonprofit organizations for grant assistance. The
 political climate of funding cutbacks for many health/social programs at both the state and federal levels further intensified this need. Family Center members also recognized the need to acquire more traditional business skills and to more effectively communicate information about its work to the local population.

    To determine if a new business structure would improve the effectiveness of the Family Center, a presentation on cooperatives was made to members in March 1995. Over 20 agencies were represented. The Family Center, as a group, agreed to further research this opportunity and contacted Rocky Mountain Planning Group (RMPG) to facilitate the planning process. RMPG gathered a team consisting of Jim Dean, a cooperative attorney in Denver; Allen Sparkman, a Denver tax attorney; and consulting associate Fred Kohler of Seattle, Wash. Additional support was provided by Bill Brockhouse, cooperative development specialist with the Rural Business-Cooperative Service of USDA Rural Development. National Cooperative Bank provided a $10,000 planning grant. Numerous local individuals, businesses and Family Center agencies themselves donated funds to support the planning process.

    In April, a second cooperative planning meeting was held to focus on member needs. Over 24 specific needs were identified. To help focus the initial objectives in the development of the cooperative, the following four issues (representing two major areas) were unanimously selected:

Administrative Needs
1. Create an administrative structure to provide fiscal flow-through from the coop to its member organizations.
2. Staff the co-op to facilitate "shared services" needed for fundraising, grant writing and management of new and existing projects.

Services and Delivery Needs
1. Establish a single source for information distribution.
2. Develop a physical community center with emphasis on comprehensive, single-point-of-entry Family Center services distribution.

    USDA's Brockhouse discussed ways that a cooperative can address these needs. At that point, all attendees agreed to continue the planning process. A six-member steering committee was appointed and RMPG was contracted to conduct a feasibility study, including a member survey, legal and accounting overview and alternatives.

    Between April and May, a survey of member agencies was conducted. Twenty agencies were interviewed, including: 14 nonprofit agencies; two agencies fully funded by federal grants; three Eagle County government agencies; and the Eagle County School District. The four needs previously identified were confirmed, with services and delivery being identified as the most critical need.

    Findings of note included:

  • 13 (65 percent) of the agencies work with five or more other Family Center members.
  • Interagency multi-disciplinary training and/or case management needs were cited by 65 percent of the agencies.
  • The agencies were comfortable working together and displayed a high commitment to continuing to work together.
  • The need to increase prevention programs was confirmed.
    One of the first things RMPG noticed during Family Center meetings was that the Hospice Program and the Healthy Babies and Families programs were just as important in the scope of community health as was the work of the primary care providers, i.e., the local hospital. Family Center members understood that community health could be enhanced through the synergy of a complete network. Yet they were not maximizing their return on investments made up to that point in the Family Center.

    RMPG identified an opportunity to direct the Family Center towards a business structure which would enhance the viability of its member organizations and which reflected the way member organizations were working together: one member, one vote in a shared services cooperative. The idea of a cooperative, 11 one-stop-shop" for health and human services was supported, both from an economic and sustainability perspective. Collaboration is an essential element for securing grants and - by sharing services - significant economies of scale are gained. The more economically viable a rural area's health and human services are, the more sustainable it will be in the future.

    RMPG ultimately recommended that the Family Center incorporate as a nonprofit corporation and be operated like a cooperative. This business structure reflects The Family Center's working environment, including these features:

  • The organization only exists to serve members and to achieve goals together that any individual member agency could not achieve alone.
  • Each member agency retains its unique identity, legal basis and mission.
  • It is a member-driven agency.
  • Each member has one vote.
  • Each member only collaborates on projects that make sense to that member.
  • Information, services and resources are shared.
  • All members are health and human services agencies which participate equally in cooperative programs, regardless of whether they are nonprofit, county, school, state or federal entities.
    Over the course of the summer, the network/co-op development continued at monthly meetings. Articles of incorporation and draft bylaws were prepared and a business plan was submitted last August. The 501 (C) (3) filing was prepared and approved by the Internal Revenue Service in late 1995. This administrative structure provided fiscal flow-through to member organizations. These efforts resulted in a "Smart Growth Award" from Colorado Governor Roy Romer.

    The Family Center is currently working on the creation of a single source for information distribution. This effort will focus on the establishment of a single telephone number which will provide information on any of Eagle Valley's health and human service programs. The Information Committee is further examining a broader inclusion of service providers, including recreation for special needs children and, possibly, becoming a broader community information and referral resource not only for individuals, but also for agencies or service providers. This information line may also incorporate direct "hot links" to member agencies for more information.

    Later this summer, the Family Center will begin to examine more closely the opportunity for developing a true, one-stop shop for members' service delivery. Initial thought is that this will occur in a dedicated, centrally located building that will house offices for each of the member agencies. In addition, there may be shared conference rooms, an information booth, examination/counseling space and day care facilities. Smaller satellite facilities are being considered for outlying areas.

    The Family Center is being closely watched on a state and national level as a possible proactive model for preserving and enhancing health and social services - a model which can be replicated in other communities' efforts to achieve sustainable rural development.

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