West Virginia launches huge medical project
CHARLESTON, W.Va. -- Ten thousand uninsured West Virginia workers will get almost-free, nonhospital health care for the next five years through a huge new state-sponsored demonstration project.
Each person will pay no more than $30 a year for unlimited doctor visits, immunizations and screenings, chronic disease management, and minor surgical procedures. So far, more than 2,500 people have signed up at eight participating community health centers, according to a Gazette-Mail phone survey of the centers.
Eligible people can enroll until the slots are gone, said Rick Simon, CEO of Tri-County Health Center, a participating community health center. To be eligible, a person must have a job, be between 19 and 64, and make less than $43,320 for a single person or $88,200 for a family of four. Two centers have set lower limits.
"We're signing up a lot of hardworking people who put in long hours to make a livable wage, but still don't make enough to afford health care," Simon said.
These are people, he said, who make too much for Medicaid, but not enough to afford insurance. "They tell us, 'We never get a break like this.' They can't believe it's for real."
In return, patients will let the state fold their medical data - blood pressure, blood sugar, etc. - into an anonymous 10,000-person database the state plans to use to make more informed choices as health-care reform unfolds.
"With this project, we're going to improve the state's ability to manage chronic disease and show how follow-up care between doctor visits improves people's health," said Craig Robinson, CEO of Cabin Creek Health Services. "It's an opportunity to manage the care of that group the way it should be managed, to collect data and monitor our own performance."
"It's an amazing opportunity for us to provide a true medical home for a large group of working people who need it," he said. "When people are healthier, the state saves money."
West Virginia Connect is funded by a $36 million federal Health Resources and Services Administration (HRSA) grant, which also includes funding for the state health insurance exchange and an electronic system that lets health centers, hospitals and agencies send medical records back and forth easily.
The eight centers applied to participate and were chosen in September by the state Department of Health and Human Resources, which oversees it.
"West Virginia has a wonderful, nationally-known network of community health centers, located all over the state," DHHR spokesman John Law said. "They were the logical choice."
The DHHR got its funding in August 2009 but waited almost a year to begin the project. "We were waiting to see how health reform was unfolding," Law said.
Center directors say the project is intended to:
"This is potentially a very important project," said Delegate Don Perdue, D-Wayne, chairman of the House Health and Human Resources Committee. "We need to be sure [the] DHHR is gathering the information that will help us learn as much as possible from it.
"West Virginia has a long history of setting up terrific projects, but not getting the data we need," he said.
He cited the Medicaid Redesign project, in which the DHHR failed to get baseline data needed to know if participants had improved.
West Virginia Connect is collecting baseline medical indicators like blood sugar and pressure, but center directors say the project has no uniform list of questions for new patients about previous emergency room usage, hospitalization, amount of regular health care, sociological situation, occupation, etc.
"We will get baseline information after we decide what the questions are," said Richard Brennan, project director. "This is the beginning. We're learning as we go."
The project has no advisory council yet, he said. It is governed by a steering committee of the DHHR secretary, insurance commissioner, and director of the GO HELP office. No academic institutions are involved.
Perdue wonders whether the DHHR assigned sufficient staff to the project. "[The] DHHR is badly and chronically understaffed," he said.
Brennan said no DHHR employee has been assigned full time. He was assigned the director job in July, in addition to his existing responsibilities to help complete the DHHR's federal stimulus reports and other financial reporting.
"I am devoting more than 40 hours a week to this project," he said, "and I am totally committed to seeing it succeed."
This project could help the state attack the "terrible chronic disease costs that are eating up the state budget," Perdue said. Health-care costs now eat up 35 percent of the budget, he said, "and we're told chronic disease accounts for three quarters of that."
In 2009, two state-sponsored studies predicted that, if no real changes are made, the state's health bill would double by 2018. "Everything else in the budget would be at risk," Perdue said, "so it's in everyone's interest to get a grip on this."
How will the project work?
The DHHR will pay the centers a flat $35 a month per patient, whether a patient visits 20 or zero times. That method replaces "fee for services," which many feel encourages unnecessary tests, services, and expense.
One in five West Virginians - more than 373,000 people - already get primary care at one of the state's 28 federally funded community-health centers, which charge on a sliding scale. That includes about 90,000 uninsured people - more than a third of the state's uninsured -- according to West Virginia Primary Care Association statistics.
"These centers are one of our state's saving graces," said Perry Bryant, director of West Virginians for Affordable Health Care. "They position us well for health reform."
The project staff will emphasize prevention and help patients learn how to take better care of their health, Robinson said.
Between doctor visits, staff members will help patients stop smoking, lose weight, follow a diabetic diet or manage their asthma, high blood pressure or other chronic disease. Patients can get mental-health services if needed and have access to dental care and a low-cost pharmacy. Hospitalized patients get aftercare when they go home.
Cabin Creek plans to hire "care coordinators" for the project, said education director Amber Crist. A good coordinator looks at a patient's whole situation and, with the doctor, helps the patient figure out manageable ways to do things such as daily checks on blood sugar or blood pressure, she said.
The coordinator also might connect a patient with a mortgage counselor, a diabetic cooking class or stress-management sessions. "Life is not easy for many patients we see," Crist said. "They deal with multiple problems all the time, medical and otherwise. They may be stressed out from mortgage problems, legal problems, their car broke down, whatever, and that definitely affects their health."
Coordinators help schedule specialists and check to make sure none of the patients' prescriptions interact badly. "If nobody is doing those things, it's easy for the person to end up in the hospital," Crist said.
Half have no regular doctor
About half of West Virginia's uninsured have no regular medical doctor, according to a 2007 West Virginia University study. Theoretically, the Connect project will enroll thousands and track what happens after they get regular care.
"That will be very helpful information," Delegate Perdue said.
So far, though, at least half the people enrolled were already regular patients at the centers, according to a survey of centers.
They also will be a valuable group to study, said Diane Pendleton of FamilyCare. "Many don't come in for the checkups they need because they truly can't afford the $15 co-pay. We'll be able to track what happens when they no longer have a financial block to coming in."
Each center is responsible for publicizing the program in their area. The DHHR is not helping, for now, Brennan said. "After the first go-round, we'll evaluate and see what help we can offer, if needed."
So far, most centers have enrolled fewer than 100 people, although Tri-County and Clay County's primary care systems together have signed up 1,500. About 60 percent are existing patients, according to a staff report.
Most centers plan to target small businesses. This week, Lincoln Primary Care will sign people up at a library, fire department and wellness center. Tri-County Health Center has created a website and a detailed brochure and arranged for television public service ads.
The centers are not yet sharing ideas and tools, but will do so, Brennan said.
The project probably will get an advisory board within two months, he said. The DHHR will not mandate what percentage of enrollees must be new patients or have chronic disease at this point, he said.
Many such decisions have been waiting for the new DHHR Secretary Dr. Michael Lewis, who "brings a lot of expertise," Brennan said.
Lewis has been heavily involved in North Carolina's effort to create medical homes. He started his West Virginia job this week.
"North Carolina is the state-of-the-art golden model out there," Brennan said. "They pulled a million people out of Medicaid managed care and created accountable care organizations," a combination of community health, specialist and hospital care. "They showed an initial 40 percent reduction in hospital stays, a 16 percent reduction in emergency room usage and about $530 per person per year in savings."
Each center's Connect project will be somewhat different, Brennan said, but the DHHR does not have resources to document the approaches in detail. An academic institution could, for instance, study the role of nurse practitioners, he said. "We'd welcome that."
"I have great respect for the expertise in this group," he said. "I've told the centers, 'Let's get together and make this a working group. You are the experts in your field, and we think we know what we want. How can we cooperate to get there?'"
Reach Kate Long at firstname.lastname@example.org or at 304-348-1798.