"We can beat this," said Dr. Alan Ducatman, interim dean of the West Virginia University School of Public Health. "If we decide from top to bottom that we're going to do this, we can do it."
West Virginia occupies a top slot on almost every awful health ranking: diabetes, heart disease, stroke, kidney disease and others.
"There's a new feeling that it doesn't have to be that way," said Christina Mullins, director of the state Office of Maternal Child and Family Health. "There is new energy to lower these numbers. There's a sense of urgency."
One in four West Virginia fifth-graders have high blood pressure, cholesterol and obesity, well above the national average.
As millions in health reform dollars roll into West Virginia, "we have the chance of a lifetime to make it different," said Dr. Rahul Gupta, director of the Kanawha-Charleston Health
Two years from now -- if the Supreme Court doesn't strike the federal health care law down -- more than 100,000 West Virginians will get health insurance. That alone should lower the numbers, Gupta said. "People will be able to get checkups, and we'll catch a lot more diabetes and heart disease early."
"It's an exciting time to be working in health care," Mullins said. "A lot of things are possible that weren't possible before."
Federal health care reform forces agencies to cooperate, she said. "A lot of good is coming from that. People who never talked before are seeing how their pieces fit together, comparing notes, saying, 'Oh! We could work together here.'"
The state Bureau of Public Health and the state Department of Education are meeting regularly to plan for children, she said. DHHR gave the schools a half million for playgrounds. They designed a joint teen pregnancy campaign. They want to let residents of communities with no gyms use school gyms after school.
That kind of cooperation adds up to healthier communities, said Dick Wittberg, director of the Mid Ohio Valley Health Department. "Doctors or health departments can't do it alone. The schools can't do it alone. County government can't do it alone. Everyone has a part."
In 2009, Wittberg's health department got a $4.5 million federal grant to demonstrate what communities can do. They tried to choose things that would be possible without a big grant, he said.
They helped start school mountain bike and running clubs. They organized farmers markets in six counties and installed bike racks all over Parkersburg. Volunteers from the West Virginia Mountain Bike Association cut a web of biking and walking trails through six counties.
They convinced two Walmarts, three Foodlands, and now several Kroger stores to start healthy checkout aisles "so customers can have the choice of a banana instead of candy or chips."
Parkersburg is also home to the River City Runners and Walkers, a volunteer-run club with more than 1,000 members that sponsors weekly events for grownups and children. "We're making this a running town," said Sharon Marks, volunteer board president.
"Each of these things may seem small, but they add up to a community where it's easier to live a healthy life," Wittberg said.
Puzzle pieces in the air
By 2025, at the current rate, 61 percent of Americans will be diabetic or pre-diabetic, Johns Hopkins University and others estimate. An estimated 315,000 West Virginians would be diabetic, if that were to happen, and another half million would be pre-diabetic, meaning they have blood sugar close to diabetic.
Diabetes already costs West Virginia more than a billion dollars, according to the American Diabetic Association. The cost will triple in the next 10 years, the CDC estimates.
If that happens, the budget will be swamped and major new taxes or cutbacks will be needed, health care economist Ken Thorpe told the Legislature in November 2011.
His recommendation: Target diabetes. Let people know it is preventable. Diabetes leads to heart disease, stroke and other diseases and is strongly linked with obesity, he noted. "If you lower diabetes, you lower the rest."
His challenge: Help people help themselves. Set up a network of free prevention courses so any resident can get support and solid advice. Train local people to run the courses.
If West Virginians learn to prevent and control diabetes, he said, the state's longterm picture will improve.
A lot of pieces are in the air, but nobody is really keeping track, said Perry Bryant, director of West Virginians for Affordable Health Care. "They're good pieces, but nobody knows where they all are, how they're going to land or if they'll fit together when they do."
Here are a few:
- West Virginia's 28 community health centers -- the nation's strongest such network -- have expanded facilities and labs with stimulus money, getting ready for more patients.
- Eight new school-based health centers opened in 2011. Eighty schools now have centers. Ten more counties plan to add centers in 2012.
- More than 1,300 West Virginia doctors now have electronic medical records systems, which let them handle more patients and get patient records from other providers more easily.
- Three new community health centers are opening in the coalfields, where problems are greatest, but health care scarcer.
- The Benedum Foundation is pouring millions into West Virginia research projects aimed at reducing chronic disease.
- Marshall University is training dozens of people statewide to teach chronic disease management courses and has helped several counties set up diabetes coalitions.
- The School of Osteopathic Medicine in Lewisburg is training hundreds of lay people to be community outreach health workers.
- West Virginia University's CARDIAC program and Marshall are cooperating on a six-county project aimed at developing effective ways to treat obese children.
- Dozens of health research projects are running statewide. At least two are aimed at helping private doctors and schools learn better ways to help obese children.
- In Kanawha County, Keys4HealthyKids is giving grants to local communities that are creating healthier environments.
- PEIA plans to offer the national Diabetes Prevention Program to its 200,000 members. The agency hopes to set up a special program for children.
- At least two major hospitals -- Charleston Area Medical Center and Camden Clark in Parkersburg -- are exploring setting up accountable care organizations, as an alternative to traditional health insurance.
- Highmark, the state's largest private insurer, is running a major pilot project aimed at finding effective ways to reimburse prevention efforts.
State Schools Superintendent Jorea Marple is taking aim at the healthiness of school meals and the amount of physical activity in the school day.
Almost all are fledgling efforts, but the impact could be profound if they pan out," Bryant said.
Two major projects target the 5 percent of patients who cost at least 40 percent of health spending, patients with multiple chronic diseases.
West Virginia Medicaid is asking national Medicaid for permission to create care management teams to work with these patients between doctor visits. The aim: keep them healthier and out of emergency rooms and hospitals. Keep small problems from developing into big, expensive ones.
Medicaid will pay for such teams, as part of health reform. "That's a major shift toward prevention," Bryant said. "Before, they paid only after it became an expensive problem."
Second, West Virginians are in the running for $33 million in "innovation" money from the federal Centers for Disease Control, to create similar teams for the most expensive Medicare patients.
One such patient easily costs several hundred thousand a year, Thorpe said, so the teams should pay for themselves.
'Nobody's leading the charge'
All this is happening at a dizzying pace, yet nobody is keeping track statewide, much less making sure the right hand knows what the left hand is doing, Bryant said.
Don Perdue, chairman of the House Health and Human Resources Committee, worries about that. "There has to be an overseer who takes all those pieces and fits them together, even glues them together," he said. "Otherwise, we could end up with the same old thing -- a lot of services in Charleston, Morgantown and Huntington and nothing in other areas."
The Legislature created the GOHELP agency in 2005 to do that job, Perdue said, "but so far, that has never happened." For at least five months, GOHELP has been without a director.
Dr. Gupta also worries about lack of oversight. "When money on that scale comes into a state like this, someone needs to keep track of the big picture," he said.
"Nobody's leading the charge," said Renate Pore, health policy director for the West Virginia Center on Budget and Policy. "More than anything, we need central, inspirational leadership.
"We need somebody who inspires individual West Virginians to do their part," she said.
In 2011, the center surveyed 33 top health West Virginia health leaders. "They unanimously said West Virginia lacks health care leadership at the top," she said.
If West Virginia has not so far been able to lower its numbers, "it has not been for lack of interest and good-hearted people," said Kim Tieman, who represents the Benedum Foundation. "It has been for lack of coordination, leadership and clear goals."
"We have an amazing chance here," Dr. Bob Walker, West Virginia's higher education vice chancellors for health Sciences, said at a planning meeting for the $33 million CDC grant. "The people of West Virginia deserve decent health care. If we can't put politics aside and make the most of this chance, we should get out of the way and make room for people who can."