If West Virginians learn to prevent and control diabetes, he said, the state's longterm picture will improve.
A lot of pieces are in the air, but nobody is really keeping track, said Perry Bryant, director of West Virginians for Affordable Health Care. "They're good pieces, but nobody knows where they all are, how they're going to land or if they'll fit together when they do."
Here are a few:
Almost all are fledgling efforts, but the impact could be profound if they pan out," Bryant said.
Two major projects target the 5 percent of patients who cost at least 40 percent of health spending, patients with multiple chronic diseases.
West Virginia Medicaid is asking national Medicaid for permission to create care management teams to work with these patients between doctor visits. The aim: keep them healthier and out of emergency rooms and hospitals. Keep small problems from developing into big, expensive ones.
Medicaid will pay for such teams, as part of health reform. "That's a major shift toward prevention," Bryant said. "Before, they paid only after it became an expensive problem."
Second, West Virginians are in the running for $33 million in "innovation" money from the federal Centers for Disease Control, to create similar teams for the most expensive Medicare patients.
One such patient easily costs several hundred thousand a year, Thorpe said, so the teams should pay for themselves.
'Nobody's leading the charge'
All this is happening at a dizzying pace, yet nobody is keeping track statewide, much less making sure the right hand knows what the left hand is doing, Bryant said.
Don Perdue, chairman of the House Health and Human Resources Committee, worries about that. "There has to be an overseer who takes all those pieces and fits them together, even glues them together," he said. "Otherwise, we could end up with the same old thing -- a lot of services in Charleston, Morgantown and Huntington and nothing in other areas."
The Legislature created the GOHELP agency in 2005 to do that job, Perdue said, "but so far, that has never happened." For at least five months, GOHELP has been without a director.
Dr. Gupta also worries about lack of oversight. "When money on that scale comes into a state like this, someone needs to keep track of the big picture," he said.
"Nobody's leading the charge," said Renate Pore, health policy director for the West Virginia Center on Budget and Policy. "More than anything, we need central, inspirational leadership.
"We need somebody who inspires individual West Virginians to do their part," she said.
In 2011, the center surveyed 33 top health West Virginia health leaders. "They unanimously said West Virginia lacks health care leadership at the top," she said.
If West Virginia has not so far been able to lower its numbers, "it has not been for lack of interest and good-hearted people," said Kim Tieman, who represents the Benedum Foundation. "It has been for lack of coordination, leadership and clear goals."
"We have an amazing chance here," Dr. Bob Walker, West Virginia's higher education vice chancellors for health Sciences, said at a planning meeting for the $33 million CDC grant. "The people of West Virginia deserve decent health care. If we can't put politics aside and make the most of this chance, we should get out of the way and make room for people who can."
Reach Kate Long at 304-348-1798 or katel...@wvgazette.com.
This article was written with the help of the Dennis A. Hunt Fund for Health Journalism, administered by the California Endowment Health Journalism Fellowships, at the University of Southern California's Annenberg School for Communication and Journalism.