CAMC's most-frequent emergency room visitors came an average of 27 times in six months (once a week) in 2011. Eighty percent were Medicaid patients. The beleagured Medicaid program plans to try to reduce ER and hospital visits by improving care.

Cabin Creek health coach Karen Glazier calls elderly patients between doctor visits to check in and encourage them to do what they need for self-care: check blood pressure or sugar, take walks or "whatever they need."

Every week, Cabin Creek clinic staffers "huddle" to pool ideas on ways they can, as a team, help their most complex patients.

The care manager makes sure necessary medical steps occur. Here, Dr. Mitch Jacques checks Cabin Creek Health Center patient Louis Burgess.

"The partnership between the practitioner and the patient makes care management work," says nurse practitioner Michele Selanik, with West Virginia Health Right patient Eric Duesenberry.

"If the hospital loses money because people come to the ER unnecessarily, that means higher prices for all patients. A lot of those visits are preventable if we can get people into regular primary care." -- Bob Whitler, vice president, Charleston Area Medical Center

"We have 22,000 low-income, uninsured patients, but we have a low rate of ER and hospital usage. They get regular care from us and don't need to go to the ER as much. We help them get things like diabetes under control, and that also keeps ER usage low." -- Pat White, director, West Virginia Health Right

"Half of our Medicaid population has no care management at all, period. We're trying very hard to do something about that. We're looking to preventative models that improve health outcomes and save money." -- Nancy Atkins, W.Va. Medicaid commissioner

"We've shown that good care management reduces people's ER and hospital usage and improves their health. Part of it is, we teach people better ways to care for themselves. That's the direction we need to go in." -- Craig Robinson, CEO, Cabin Creek Health Systems

"If West Virginia can find a way to give high-risk patients intensive care management, we'll save a lot of money. The savings could be used to provide prevention for all West Virginians." -- Perry Bryant, director, West Virginians for Affordable Health Care

"One in four of our fifth-graders now has high blood pressure and cholesterol. Those children need care management as much as adults do. We have to talk about what care management means for children -- creating ways they can be more active, for instance." -- Dr. William Neal, director, West Virginia University CARDIAC program