Rural town serves as health care experiment

By DAVID A. LIEB
Associated Press

NEVADA, Mo. (AP) — Polishing off his pork and beans at the local senior center, Gentry Malcom politely passes on the peas and broccoli still sitting on his plastic food tray. He's finished eating, but not done talking about how a heart attack nearly killed him a decade ago.

Malcom is still upset about a $1,600 co-payment — that took three years to pay off — for a life-saving helicopter ride from his rural hospital to a better-equipped facility in a bigger city. He's quit smoking. But his diet hasn't changed dramatically. Exercise? "I have an excellent muscle on my clicker finger for the TV control," quips Malcom, a 69-year-old diabetic who retired after a career at a state mental hospital.

His self-assessment: "Basically, I'm pretty healthy."

His lifestyle may suggest otherwise. Though Malcom may not realize it, he and the nearly 8,400 other residents of the western Missouri city of Nevada are about to become part of an experiment testing whether a rural community that ranks near the bottom of many health indices can be transformed into a national example where the people are healthier, their doctors are more efficient and their health-care costs are lower.

In short, it's a private-sector attempt at health reform — coming as a highly-charged national debate continues to rage over the pros and cons of President Barack Obama's health care law, which seeks to expand health coverage to millions of Americans through insurance mandates and enlarged government programs.

"That's great there's a health care reform bill, but really this battle has got to be fought in a local ZIP code on the ground, and sponsored by leaders locally," said Jeff Townsend, executive vice president and chief of staff at Cerner Corp., a Kansas City-based health technology firm that is spearheading the effort in Nevada.

The Healthy Nevada project will equip the local hospital with a new $10 million electronic health records system and allow patient information to be more easily shared among the town's two dozen doctors and with medical experts in bigger cities. The city of Nevada, which recently enacted a special sales tax for parks and recreation, plans to chip in with new infrastructure such as bike lanes and improved sidewalks intended to make exercise more appealing. And an educational campaign will target residents with wellness screenings, nutrition tips and friendly competitions featuring prizes for such things as the top walkers or weight-losers.

The project seeks to improve both the health of individuals and the quality of care they receive while reducing the overall amount spent on health care.

The goal is "to develop a program that's never been done before," said Carol Branham, the executive director of the Nevada Housing Authority and one of several residents on the project's coordinating committee. "We want to be that model for the rest of the United States."

Other communities already have tried certain aspects of the plan. The federal government, for example, has awarded $250 million to 17 so-called Beacon Communities that already have made progress on developing electronic health systems that allow patient records to be shared among various medical providers.

A 2009 initiative by Minneapolis-based Blue Zones LLC set out to improve health and longevity in Albert Lea, Minn., by making it easier for residents to make healthier choices. The project emphasized walking, developed community gardens, removed candy bowls from offices and labeled nutritious items at restaurants and grocery stores. Similar Blue Zone efforts now are under way in several California cities and in Iowa, where the insurer Wellmark Blue Cross and Blue Shield has pledged to spend $25 million toward the governor's goal of making Iowans the healthiest residents in the nation by 2016.

What makes the Healthy Nevada project different is its simultaneous emphasis on healthy lifestyles and improved health care technology. Cerner, which hasn't said how much it will spend on the project, hopes the model can be adopted elsewhere and eventually even generate a profit.

In the years to come, "I think we're going to see more of this, and I think it's been encouraged," said Karen Donelan, a senior scientist at the Mongan Institute for Health Policy in Boston. "It's nice to know it's trickling down for a small town."

The city of Nevada, located near the Kansas border about 85 miles south of Kansas City and 50 miles north of Joplin, was chosen after Cerner reached out to the Missouri Department of Economic Development seeking leads on rural towns. Burned to the ground by Union militia during the Civil War, Nevada was rebuilt in the late 1800s as a railroad town and gained renown for its state mental asylum. But the county's population has fallen by a third since its peak in 1900, and the state has been closing its mental health facility. The largest local employer is now a 3M manufacturing plant.

The Robert Wood Johnson Foundation ranked Nevada's home of Vernon County near the bottom of Missouri counties in a variety of health factors, including smoking rates, obesity, physical inactivity and premature deaths. The city manager estimates that more than half the residents are eligible for the Medicaid health-care program for the poor, an indicator of the area's generational poverty.

"We're a typical rural Missouri town — not so healthy," said Donna Redburn, 49, the city's director of parks and recreation.

Yet the city is no slum. It has a new air conditioned community center where upward of125 kids play basketball and other games daily. Bright street signs point the way to "recreation districts," featuring playgrounds, lakes, walking trails, a baseball field, exercise facilities and a modern aquatic center. The senior center hosts meals, blood-pressure screenings, dances and periodic nutrition programs.

Although the town has a 72-bed hospital, including a maternity ward, many residents still travel to bigger cities for more serious health concerns. When 80-year-old Jay Borders needed a knee replacement last year, he went to a Joplin hospital — then returned again and again and again for follow-up visits. Each trip consumed at least a half a day.

Townsend, the Cerner executive, estimates that $120 million annually is spent on the health care of Vernon County residents by private insurers and government-run health care programs. His objective is to decrease the demand for medical care by 10 percent by improving people's health, and to keep an additional 10 percent of those health care costs in the local community through improved technology that reduces the need for patients to travel elsewhere.

City manager J.D. Kehrman hopes Nevada can move from the bottom tier to the top third in health rankings.

The intent is to "shift the focus here from sick care to prevention and one of health and wellness," Kehrman said. He adds: "I really like the idea that we can redefine the way people engage health care."