HOWARD — John Mengenhausen can tell the story of Horizon Health Care.

As the CEO of the Howard-based health care clinic system in rural South Dakota for the last 38 years, he’s been there for all of it.

But the map on his office wall tells the story as well, how the system went from two clinics and 14 staff members when he started in 1983 to nearly 300 employees, a 28,000-square mile coverage area and has 32 medical and dental clinics in 22 different communities today.

“There have been some bumps along the way, but it’s been a very rewarding career,” he said this week. “We know there’s a population in these communities that needs care and it’s gratifying to be a part of delivering that.”

Mengenhausen, 65, has worked as the CEO of what is now Horizon Health Care for the past 38 years. His final day on the job is Friday, July 2, although the transition to new leadership is underway, with current Horizon Chief Financial Officer Wade Erickson, of Howard, to take over as CEO next month.

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His path to CEO seems unlikely to be replicated today, without a medical leadership background or advanced degrees. After serving in an Army airborne unit, Mengenhausen came back to his hometown of Howard to run a bookkeeping business. In 1983, a friend involved with the local clinic board asked him if he was interested in serving as the executive director of what was then known as the Miner-Hamlin Health Care Project, which had clinics in Howard and Bryant and 14 staff members.

In that job, Mengenhausen said he did nearly everything to free up employees to take care of patients. He booked appointments, swept floors and handled ordering supplies. Mengenhausen said he learned to appreciate seeing patients feel better and improve their health, particularly among children.

"I've always had a soft spot for children and when we can make a difference for kids, that's a very special part of the job," he said.

Horizon Health Care CEO John Mengenhausen stands outside the Horizon headquarters on Wednesday, June 23 in Howard. (Marcus Traxler / Republic)
Horizon Health Care CEO John Mengenhausen stands outside the Horizon headquarters on Wednesday, June 23 in Howard. (Marcus Traxler / Republic)

Later known as East River Health Care, the clinics merged with Tri-County Health Care — which served Wessington Springs, Woonsocket and Plankinton — in 1998 to become Horizon. Today, Horizon is the state’s largest community-health center system with a budget of about $31 million annually, Mengenhausen said, with about $9 million of that coming from the federal government. It is nearly seven hours from one end of the Horizon service area to the other, from McIntosh to Elk Point, a fact that stuns Mengenhausen’s colleagues from elsewhere in the country.

As the organization grew larger, Mengenhausen said it was never tempting to move Horizon’s headquarters somewhere bigger than Howard, population 907.

“Moving somewhere else would change the outlook of our mission,” he said. “We’ve always tried to be true to who we are. I live and breathe the same things that our community does.”

As a federally qualified health center, Horizon offers a sliding scale fee program, which makes care for low-income patients more affordable, and is also part of the 340B program that requires drug manufacturers to sell outpatient drugs at a discount to providers that serve a high number of low-income patients in the Medicare and Medicaid system. That federal designation also requires having a board of directors that is comprised of at least half Horizon patients, and Mengenhausen said his entire board is served by the system.

It is not, most notably, an arm of the state’s three largest health care systems — Avera, Sanford or Monument Health — and Mengenhausen said that’s intentional. While those systems have sought to affiliate with Horizon with software or telemedicine services, Mengenhausen said that Horizon retaining its independence allows them to work easier with all three by having no other strings attached.

The primary challenge of providing clinic services in the mid-1980s and in 2021 — recruiting and retaining staff and medical providers — remains the same. He admits that his goal is for doctors and service providers to work in the system for four years, and anything longer than that is gravy. Changes in work visa rules have taken away a major talent pool for Horizon, as the system previously hired doctors on work-based exchange visitor programs.

Like every health system, Horizon was challenged by COVID-19 in ways it couldn’t expected. Among the hardest was having to lay off dental staff for two weeks and closing offices for two months before federal loans allowed Horizon to hire them back. Mengenhausen, who calls himself old-school in his management approach, said he has become more understanding of the advantages of employees working from home.

“When the pandemic first hit, the idea of locking the doors (to walk-in patients) was just not something I could wrap my head around,” Mengenhausen said. “We’re part of the community and it’s important that we’re open. But my leadership team convinced me we had to do it to protect our community.”

In other ways, Horizon was prepared. It used telemedicine in various ways for the past two decades, so those changes forced by COVID-19 were easier to handle.

He’s spent time serving on regional and national boards to advocate for community health centers. Last year, he was recognized by the Community Health Association of Mountain/Plains States, or CHAMPS, for dedicating his career toward the mission of health, poverty and human rights and health centers in the region. He also helped start the organization 35 years ago.

"John is a steadfast advocate for all patients facing access barriers and for the community health center movement," said Julie Hulstein, CHAMPS executive director in announcing the award. "He has a heart for community health and the Horizon mission; and he has a strong determination to achieve the goal of affordable health care for all."

The organization will also recognize him with a newly renamed award in his honor that recognizes a commitment to governance and leadership in CHAMPS. He also served as chairman of the National Association of Community Health Centers, which represents the 1,200 community health centers around the U.S.

“We needed to have our perspective heard. I knew that if my face wasn’t at the table, we weren’t going to get that shot,” Mengenhausen said.

Mengenhausen and his wife, Roslyn, have eight grandchildren, and while those national committees have allowed him to travel most of the U.S., they’d like to spend more time with their family and travel internationally.

As for Horizon, he has little concern that the organization he helped build will take a step back.

“I know we’re on a good, stable path,” Mengenhausen said. “I know we’ve got really good local leadership here that will take the next step forward, and move Horizon into the future in a strong way.”