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 katel...@wvgazette.com or at 304-348-1798.