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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 4: Nevada’s 'Leslie Knope' brings Cerner to the community

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

The TV show “Parks and Recreation” chronicles civic life in the small fictional town of Pawnee, Indiana. Rural Pawnee is depicted with broad brushstrokes for comedic effect – ordinary town hall meetings frequently turn violent over small issues, soft drinks come in outrageously huge sizes, and a dedicated idealistic city hall employee named Leslie Knope will stop at nothing to help her community.

But in Nevada, Missouri, that parody of a rural town isn’t too far from the truth, right on down to that idealistic, dedicated civic leader.

"It was never a competition for us, we were going to win it"

City Manager J.D. Kehrman is the Leslie Knope of Nevada. For example, when Nevada was one of five cities being considered as the location for a massive population health experiment by Kansas City-based health technology company Cerner, Kehrman admits he pulled out all the stops. 

“We parked brand new shiny grain trucks inside of some of our more derelict buildings so they wouldn’t see them when they drove through on the site visit,” Kehrman said. “And we made sure that people who were going to go to the park anyway that day went when they were in town,” he said.

“It was never a competition for us, we were going to win it.”

But what Nevada had actually won was still really unclear.

• • •


"I'm not willing to let my rural community, my rural people, my neighbors get left behind"

Cerner is looking to build a model for improving the health of an entire population that could be tailored to any rural town in America. But to do it, the company knew it needed a certain amount of buy-in from somewhere in the community. Someone on the ground who shared their vision. 

Kehrman has been in love with small towns his whole life, and is determined to make sure that high rates of obesity and diabetes in Nevada didn’t hold his community back.

  “I’m not willing to let my rural community, my rural people, my neighbors get left behind because we can only develop policy where people have money and are already on board with the message,” Kehrman said. “We have to find a way to create a model that can be replicated in other rural communities all across United States.”

Having Kehrman on their side got Cerner the buy-in they needed. But the majority of the town remained loyal to the status quo. Even when it came to something as small as enforcing Nevada’s leash law.

“We had a number of people come to the city council and say, ‘What’s next you jack-booted thugs?’ he said. “We had people from outside the city limits complaining, ‘I should be able to jog through your city and let my dog run.’”

But Kehrman wasn’t just passionate, he was crafty. When Cerner paid $70,000 for a study outlining ways Nevada could improve its infrastructure to support a healthier community, Kehrman side-stepped getting it approved by his own city council.

“That probably seemed like common sense to most people; the city is the one that’s responsible for constructing a new sidewalk. But I really felt like that was a mistake,” Kehrman said. “Because I felt like if the city owns vitality then the community doesn’t.”

Instead Kehrman took it to the planning and zoning commission, a group less subject to political trends. From then on the Healthy Nevada project did it’s best to avoid initiatives that needed official approval. They formed the Healthy Nevada board with representatives from across the community that became the projects governing body.

"We had a number of people come to the city council and say, 'What's next you jack-booted thugs?'"

  But like Cerner, Kehrman wasn’t interested in bullying Nevada residents into accepting change.  

“You don’t want them to feel threatened,” Kehrman said. “If I got in there heavy handed and said, ‘We've got to change the way this school does business,’ I’m going to lose them. But you start with that little thing, and it just gains momentum.”

Of course there is still negativity and suspicion in some corners of the community from people worried about weather a big company like Cerner really has Nevada’s best interest at heart. Even Kehrman isn’t always sure he’s done the right thing.

“When we put that site tour together we went to such great lengths to show Cerner what we can be. In many ways it was a masquerade because we weren’t there yet,” Kehrman said. “All of those amazing community leaders that were in that room, most of them had never met one another before,” he said.

“And then, yeah, there were nights when I thought, “Can we sustain this and will they stick around?’”

Kehrman is smart to ask these questions. It’s too early to really measure the impact the Healthy Nevada project is having on the community. And although Cerner has committed to five years in Nevada, things can always change.

Of course, even if they did, somebody like Leslie Knope would never give up.But what Nevada had actually won was still really unclear.

• • •

City Manager J.D. Kehrman talks about the lessons Nevada has learned from Cerner.

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