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Like many rural communities in the state, the town of Nevada, Missouri is struggling in more ways than one.00000178-cc7d-da8b-a77d-ec7d2f800000Nevada’s adult obesity rate has reached 30 percent; 11 percent of the population has diabetes. In 2012, nearly 20 percent of Nevada’s residents participated in government assistance programs, and in 2010 nearly 40 percent of children were eligible for a free or reduced price lunch. Improving health outcomes in Nevada will take more than convincing a few residents to adopt a healthier lifestyle.00000178-cc7d-da8b-a77d-ec7d2f7f0000According to some health policy experts, an approach that could save Nevada and other rural communities like it is a concept called population health – programs that target the health of an entire community. And now the health technology company Cerner, based in Kansas City, is looking to develop and market a population health model that could successfully improve outcomes in any rural town in America. To do this, Cerner has partnered with the town of Nevada on a new population health experiment it’s calling “Healthy Nevada.”Since 2011, Cerner has been a quiet presence in the Nevada community - supporting public works projects, sponsoring health initiatives and encouraging changes in healthy behavior. But navigating the new partnership hasn’t exactly been easy. Time and again Cerner has been met with resistance by a community slow give up the status quo, which has left some wondering whether Cerner’s investment in Healthy Nevada will have been worth it.KBIA’s Health & Wealth Desk explored Cerner’s population health initiative in a five-part series on Healthy Nevada.

Part 3: A container of ideas for Nevada’s diabetes problem

This is the third story in a series from the Health & Wealth desk on Healthy Nevada

Dr. Kristi Crymes is a family medicine doctor at the Nevada Medical Clinic. Crymes came up from Springfield three years ago to work in Vernon County, which has some of the state’s poorest health rankings. In 2010 the obesity rate in Vernon County was 30 percent. The incidence of adult diabetes has hung around 11 percent for the past 3 years. 

As we sit and chat in Crymes’ office, I’m distracted by the music that’s getting piped into the clinic through the speakers above us. The song is “I Want Candy” by Bow Wow Wow.

When I point this out Crymes laughs, a little embarrassed.

“Yeah, we should probably change the music in here.”

There is only so much one person can do, and given the complex nature of diabetes, patients need more than just a doctor telling them to eat better or exercise more. But Crymes found it was hard to bring together all the resources her patients needed.

“There are these islands of care but it’s not coordinated,” Crymes said. “It’s difficult to access and there just isn’t much in the way of diabetes education or just resources that diabetics need,” she said. “It’s all disjointed.”

Crymes had a vision for a diabetes program that connected patients to important resources, like pharmacists and dieticians. But it was just a dream. Until Cerner came to town and started Healthy Nevada.

Nevada’s high rates of obesity and diabetes, alongside high rates of smoking and cardiovascular disease, are exactly why Kansas City-based health technology company Cerner chose the town as the location for its population health experiment – to design a model that could improve the health of an entire community.

Except the blueprint for that model was essentially blank. Cerner didn’t have a plan for Nevada, Nevada was the plan.

“A community is defined by its people and history and where it wants to go,” said Erik Gallimore, the Cerner executive in charge of the Healthy Nevada project.

"I think a lot of people maybe got involved just to make sure it was authentic"

Gallimore says the goal is to make Nevada a living lab – something Cerner has done in at least six other communities with different focuses in North America. The company hopes that this experiment in Nevada will help them develop a method that can be used in any rural community.

“A core set of solutions that we could bring to other communities that we think would help,” Gallimore said.

But in order to improve the health of a rural community, Cerner first needs to understand the culture of that community. Which means that Cerner would need people on the ground - people like Crymes - to help them.

• • •

This past April, Crymes received an email from a Healthy Nevada board member. She says it was suspicion more than anything that got her to her first committee meeting.  

“This corporation coming in with a wellness plan for our city? I think a lot of people maybe got involved just to make sure it was authentic,” Crymes said.

"All these things have to happen first before we can even talk about blood sugar"

But as Crymes got more involved with Healthy Nevada, her vision of a diabetes program grew into something much bigger.  

“We realized that it’s the patients being disconnected from themselves, their self-awareness, their resilience, their problem solving,” Crymes said. “All these things have to happen first before we can even talk about blood sugar, or why they’re choosing the things they’re choosing.”

Now Crymes works with one other Healthy Nevada team member as she tries to get her diabetes program off the ground. And, like practically everything else about the Healthy Nevada project, it has cost Cerner almost nothing.

So why was none of this done sooner? Why has it taken Cerner’s presence here in Nevada to make things like the community garden, a walking trail, and cooking classes happen?

“I've asked myself that same question,” Crymes said. “Because when I moved here I was like ‘Do they have a community garden?’ And they didn’t, so I was like, ‘Shoot.’ And then you go on about your day.”

But Crymes does have one theory.

“I think shaking up the status quo and getting optimistic people with good ideas in the same room probably had a big part in it,” she said.

Now those people with good ideas for the community are connected to one another through Healthy Nevada. And the fact that Cerner came to town with absolutely no plan whatsoever? Crymes thinks that helped too.

“I think it might have to come from the inside,” she said. “Healthy Nevada has been kind of like a container for ideas and hopes for making some change.” 

Katie Hiler is a former reporter for KBIA, who left at the end of 2014.
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