Most people agree that prevention -- exercise, good eating, regular checkups - is a major way to reduce chronic disease and obesity. But most insurance will not pay for prevention. Some health care providers are finding creative ways to provide preventive services anyhow.
SCARBRO, W.Va. -- On a rainy November day, 12 women pile into the New River Health Clinic's recreation room for the same medical appointment. They're laughing, hugging, saying, "How've you been?"
In one corner, a nurse is giving one woman a flu shot. Off to one side, another woman is filling out a prescription refill request. Near the door, two women are getting their blood pressure taken. "My blood pressure's down, but it must be the grace of God, because this has been the month from hell," one woman says.
"Honey, maybe all that walking's keeping your blood pressure from going out the roof," another says.
Every three months, on the first Tuesday, all the women come to the Scarbro clinic to get checkups and catch up with each other. "These people are my medical group family," Gladys Shepherd says, gesturing around the room.
They are clearly comfortable together. "Some of them have been sharing appointments for years," says New River social worker Linda Stein. Ten of the 15 women have diabetes. All have a chronic disease of some kind, heart problems, arthritis, asthma. All are at least 45.
Somebody brought a curry dish. They gather in a circle of chairs, eating and trading news. Some are retired. Some take care of grandchildren. Others still work or are looking for jobs. They've been teachers, telemarketers, housewives, nurses, child care workers.
"They don't often miss," Stein said. "They know each other's medical ups and downs, and they care about each other's health. They encourage each other between meetings."
As the meeting starts, Stein hands each woman a clipboard with her blood test results. "This is all about prevention," she said. "Everyone gets their blood work done the week before the meeting. If they're due for a mammogram or other tests, we put a reminder on the clipboard."
As the women check their clipboards, Stein puts up a big grid with everyone's latest blood sugar, blood pressure, triglycerides and cholesterol. One by one, each woman talks about the past three months and her health. The stress of dying relatives, busted pipes, divorce and domestic violence get mixed in with medical details, along with "pray for me," comfortable laughing, advice and "Thank you, sisters."
Support groups are one of the most powerful ways to help people get a grip on - and prevent -- diseases like diabetes, research says, but medical providers don't often offer them because insurance won't reimburse for them. New River solved that problem by combining the support group with medical checkups.
As the women talk, nurse practitioner Tammy Campbell-Cline circulates around the room, pulling one woman after another aside for an individual checkup. She listens to heart and lungs, checks neurological response, discusses the new blood tests, and schedules further time if needed.
It's a billable intermediate care visit, Stein said. "If Tammy needs more time with a group member, we bill for an extended visit instead."