By Stephen Smoot
With the Mountain State awarded approximately $1 billion over the next five years under the Rural Healthcare Transformation program, the State of West Virginia sits poised to focus on long-term challenges and needs in rural health care.
Along the way, West Virginia Governor Patrick Morrisey has expressed the hope that this state’s experience can lead to benefits in rural areas across the nation.
West Virginia’s transformation plan is set to address six categories of need with ideas in place on how to improve outcomes.
First, the plan addresses health care access in remote areas. The Governor’s website states that “when possible, bring care to where patients are. And when that’s not possible, take patients to where the care is.” Some organizations serving the most sparsely populated counties, such as WVU Medicine and the mental health provider, Potomac Highlands Guild, have gone mobile with different testing and treatment services already. Both have vehicles taking services to the community while PHG has also pioneered a drug recovery app.
Two innovations cited for rural health transformation funding have come from both study and experience in rural health care. A “Connected Care Grid” will help build access in remote areas to telehealth services. Additionally, “community institutions such as schools and libraries will be outfitted as access points where patients with poor home broadband access can go to connect to telehealth. Those same institutions will become locations for community clinics, where healthcare providers go on a regular basis to meet patients where they are, in person.”
Furthermore, the plan will also support vehicular-based care such as WVU Medicine and PHG have established. Also, EMTs “will be trained and authorized to provide a greater range of local care.” Not mentioned in the website description, these added programs, however, will have to come with added financial support to EMS, especially volunteer services facing personnel shortfalls and rising costs of providing service.
Many, however, will need transportation to their health care provider. The “Rural Health Link” promises to bring together public transport, ride share services, and volunteers to help to get patients to appointments and serve other related needs. Currently a lot of this need falls on cash-strapped EMS systems who must respond to calls, basically, for a ride to the doctor.
In the Potomac Highlands and far Eastern Panhandle, public transit and volunteers through organizations such as the Retired Senior Volunteer Program have helped to fill those gaps.
“Allowing more patients to regularly make it to their medical appointments will directly improve health outcomes,” states the website.
Shortages in personnel do not only affect EMS, but all levels of health care in rural areas. Too many medical professionals get lured by the siren song of big city salaries without considering the reality of big city cost of living.
Rural health transformation in West Virginia will take a page from the new and successful playbook of teacher recruitment. In the Potomac Highlands, through the “Grow Your Own” program at Eastern West Virginia Community and Technical College, high school students start their teacher education program at home and can achieve their teaching certificate after only two years attending college.
The Mountain State Care Force will also work with high schools to identify students with an interest in the health care field. “The state will add healthcare faculty at regional and technical colleges to train more graduates. Financial incentives will be used to attract providers to rural areas and keep them there” while also pulling providers from other states when possible.
Those already in the health care system trying to improve their skills and credentials will receive added help in earning them.
Providers in West Virginia face an extraordinarily high cost per patient ratio, Similar to how rural broadband expansion faces higher costs per customer expansion rates in sparsely populated areas and how school systems in those regions receive vital help under the 1,400 floor plan, the State of West Virginia will work with health care providers in such areas to mitigate those high per capital costs.
According to the site, the “proposal will provide rural practices with technology and administrative support to reduce their operating expenses. And it will transition the state to a value-based care model in which providers have financial incentives to improve outcomes—and thereby decrease costs.”
Next comes a painful truth that has gradually emerged in a state that once boasted population work ethic as an economic asset. The Governor’s release states it starkly, that “West Virginia’s economic challenges are directly related to our poor healthcare outcomes. We have the lowest workforce participation rate in the country. Thousands of West Virginians who otherwise would participate in the workforce have stopped looking for work because of poor physical or mental health or addiction.”
To address this, the proposal includes developing resources under the aegis of a Health to Prosperity pipeline. Chronic conditions need not form a barrier to obtaining work that pays the bills, but does not worsen health. As the site states, “West Virginians with chronic illnesses will receive improved care coordinated with placement services to connect them to jobs that they can perform when their conditions are properly managed.”
This category includes helping those who have recovered in their drug addiction to also find gainful work. West Virginia has pioneered a number of programs, such as day report and drug court, that already serve as a strong potential foundation for such an effort.
Not always as popular as programs engineered to help people to improve their outcomes, but just as vital in overall community health, the transformation program adds an element of individual education and personal responsibility. Poor health outcomes later in life often have their origins in poor decisions made earlier.
To reverse this trend,” the Personal Health Accelerator—focuses on motivating (and incentivizing) West Virginians to eat better and move more.” Part of this involves infusing a competitive spirit between communities in state and against other states. Those that can boast the best collective improvement and outcomes will receive recognition and awards.
Resources will go to expand offerings of healthier food in rural areas, such as a program to “enhance existing food and wellness programs like local farmers’ markets and healthy hospital menus.” Also “innovative care models” will help those with chronic health conditions recover to their best potential. The proposal uses reversing Type 2 diabetes as an example.
Personal responsibility also includes “wellness and prevention education” and expanded access to computerized health care tracking systems, such as blood sugar monitors embedded in the skin or steps trackers for exercise.
Finally, the “program’s HealthTech Appalachia initiative will invest—along with private partners—in technologies that address chronic disease and addiction and that promote personal wellness.” Here again, the program links health care development with the economic, explaining that innovations can lead to the rise of businesses and jobs.
One of the benefits that West Virginia brings has lain in an honest and proactive approach to battling economic, social, and health challenges. Organizations such as the West Virginia First Foundation, Eastern Action, Potomac Highlands Guild, local farmers markets, and other entities have pioneered much of the groundwork.
The RHT provides a unique opportunity to combine these energies and build upon those efforts to make them greater than the sum of their parts.