CHARLESTON, W.Va. -- In 1974, Ellen Cook had a child who could not speak or walk. "We cared for her at home for years," she said. "It was hard, very hard."
"Food can be comfort," she said. She put on serious weight.
She weighed 130 when her daughter was born. By age 45, she weighed close to 400 pounds and had developed heart problems, diabetes, thyroid problems, hypertension and gout.
For years after her daughter died, she took care of elderly people and cleaned homes. Her husband was a jack of all trades, a mechanic, a welder, a body shopper. They live "way out" in the Putnam County countryside. "We'd work several jobs at once. Sometimes there was work, sometimes not."
She didn't go to the doctor she said, "till it got bad. You put it off, because you don't want to rack up another bill you can't pay."
"Before I found Health Right nine years ago, I was in and out of hospitals and emergency rooms," Cook said. "I'd be in for congestive heart failure for two weeks, then they'd discharge me with prescriptions I couldn't afford to fill. Within days sometimes, I'd be back in. Then it would happen all over again. It was awful."
One week in the hospital with complex problems can cost more than $15,000, according to the West Virginia Health Care Authority.
But today, at 58, Cook's life is very different. "I haven't been in a hospital bed even once in nine years, thank the Lord," she said. She has been in an ER only twice in nine years, according to her medical records.
How did she do that?
"I do everything West Virginia Health Right tells me to do, one step at a time," she said with a big smile. "They've given me back my life."
"When I first came to Health Right, I couldn't walk without holding on to the walls," she said. "Within two months, they had me on my feet, moving around, doing what I needed to do."
As Medicaid begins to arrange care management for tens of thousands of West Virginians, Cook can testify to what it can do.
She and her husband and 22,000 other Health Right patients make too much money to qualify for Medicaid and too little to afford care or insurance. "Our patients have part-time jobs or are retired or laid-off," said Health Right director Pat White.
At Health Right, they get free health care and pay $2 per 90-day prescription.
"Anything they tell me to do, I'll do," Cook said. "I can't afford not to. If they tell me to do a blood lab or X-ray, I do it. They give me my glucose strips, I use them. I can get my medicine now, and I take it."
Just as important, she has learned how to improve her own health. She now tests and monitors her blood sugar and blood pressure levels. She has learned which foods send her blood sugar and blood pressure up.
"Used to be I didn't eat breakfast then mostly ate junk food the rest of the day," Cook said. "Now I eat a good breakfast and small meals after that, real food. Nothing fancy, but I like it."
"Americans think health care means take pills," White said. "We show people how to get off pills."
"I was so scared when I first came to Health Right," Cook said. "A nurse practitioner let me call her at home if my blood sugar went high. She called me sometimes at home too, to see how I was doing. That meant so much to me that she called me."
That kind of personal, face-to-face attention "inspires enormous loyalty," said Nidia Henderson, PEIA wellness director. "It's one reason why they have such success influencing patients to do what they need to do to stay healthy."
Cook has probably saved the health-care system many hundreds of thousands of dollars in nine years by being willing to follow medical directions and change her lifestyle.
"All patients don't comply, but most try," White said.
Only one of CAMC's top 36 ER users was a Health Right patient. "They don't need the ER as much," White said.
CAMC knows Health Right saves them a lot of money. They provide the clinic with a full-time pharmacist, all blood tests and more complex tests such as MRIs. They pay their utilities and provide maintenance and housekeeping. "And we save them millions a year," White said.
'Take charge of your health'
The poor economy brought in many patients who lost solid jobs with insurance, White said. Linda Pipinos, 57, of Charleston, is one. She processed claims for Wells Fargo, until one day her gallbladder ruptured. With surgery complications, she was in and out of the hospital for a year. Her employer replaced her.
By 2010, when she came to Health Right, her triglyceride levels (fat in the bloodstream) had risen to 1,316, compared with a normal level of 150. "She was a walking heart attack," said Keith Settle, patient education coordinator.
She was "staying in the apartment all day, smoking a lot. I was taking my thyroid pill every other day instead of daily, to make it stretch," she said. "I know now that put me at greater risk of a heart attack."