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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 5: Cerner’s strategy in Nevada gets tested

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

All this week we’ve been talking about the population health experiment that the health technology company Cerner is conducting in the town of Nevada, Missouri. But there are still a lot of unanswered questions. Will Cerner’s message and grassroots approach resonate with people in this rural community? Can small changes like new playground equipment and a community garden really have an impact on Nevada’s poor health rankings? And, more simply, will this program work?

To help forecast what may come from Cerner’s efforts in Nevada, I spoke with Dr. Keith Mueller, the Director of the Rural Policy Research Institute at the Center for Rural Health Policy Analysis. 

"[in rural areas] the challenge is: How do you bring together the assets you do have in new and creative ways?"

Note: For an extended version of this interview, please see the audio at the bottom of this story

Do you think that population health going to be the “next big thing” in healthcare?

Absolutely.  The emphasis that we’re seeing on how healthcare is paid for is to pay for value, and value really means keeping people healthy. And the best way to do that is keeping populations healthy rather than trying to do it one person at a time. This is not new and it’s exciting to see it gain some emphasis in how we do things overall.

Cerner’s approach to developing this population health model is to spend time in Nevada and understand some of the challenges rural areas face when it comes to health. Can you speak to some of the challenges as you see them through your research and work?

Well the challenge for rural areas is you don’t have that same infrastructure; you don’t have that same financial asset you do in an urban area. So the challenge is: How do you bring together the assets you do have in new and creative ways? So Cerner is right that to do that, instead of having a model that might work well in Kansas City, St. Louis or Columbia, you have to develop something that works well given the characterizes of that small or local rural community.

Cerner’s strategy for getting to know the community involves enlisting the help of local leaders to generate ideas and spread the message, as opposed to bringing in a huge marketing campaign and doing it all themselves. Is that a smart way to go about this?

Yes it is. And I’d say that would be really true no matter where you were. What you want to be able to do is understand what motivates the local population and you want the local citizens to be able to use whatever their normal network is. And you can’t do that from a distance, and you can’t do that by bringing in a blueprint and saying everybody’s going to follow this blueprint. You have to do it by meeting with people in the community and helping them develop whatever initiatives are going to work locally.

Some of these local initiatives are really, really small - like putting in a new piece of playground equipment that is more interactive. It doesn’t seem like its measureable or you could ever know how much an impact these things could have.

You may not be able to know the impact one at a time of the playground equipment, to use that example. What you can’t measure is outcome in terms of health but you could measure how many people are using the new equipment, you can do that by simple observation. That’s really where you want to start and then build momentum from that. And that’s an approach that’s not unique to what Cerner may be doing in communities in Missouri. That’s the general approach of just about any community-based, wellness, health initiative activity that I’ve seen.

Right now Cerner has a lot of support in Nevada from people who were probably already interested in building a healthier community. But I think then they’re going to reach a level of the population that were never inclined to get on board with this and it’s going to take a lot more effort to get those people on board.

There are two ways of thinking about that. One is there are ways to try to reach almost everyone to help them understand what they need to do and help them do it. But there’s likely to be a core at some level where you just can’t anymore, where the resource investment to try to change the behavior is beyond capability. But we’re not close to that core yet. And I think you’re right. You can do some things where you reach a fair number of people fairly quickly and it just gets progressively more challenging. And the other piece to that is understanding that to reach some part of the community you really need again to understand as best you can what is the social network those people have that they would rely on. So it may be that you need to find a different organization or you need to even get down to the level of “Who is the person is this neighborhood that folks listen to?” and work through that.

Do you think it’s even possible to develop a population health model that could be used in many rural communities?

Yes I do. The way to do that is to develop a model that has discrete elements. So think of it as a menu of choices. What you might do is Nevada may look at that list of elements and say “Well that one makes some sense given our community, let’s try that one first.” Cape Girardeau might say “Well no, it’s a different one that makes sense here.” Because communities are going to say “Well, we’re unique.” All the way down to the level of community organizations saying “The people we serve are unique” to providers saying “Well, my patients are sicker.” But at some point everybody’s willing to admit that we could do something better and what are some ideas out there. And the way to spread that is sharing those ideas across communities that do look alike.

The Cerner message brings economic opportunity into the equation when it comes to health. Have you seen any research that suggests that connecting economic development to health will help them be more successful in getting people on board in these rural communities?

The research is a little thin. The use of that strategy is becoming kind of prolific, and it makes sense if you’re in a community where they’re worried about the economy and that’s probably the number one worry in the community, then you do want to show there is a link between what we would do with health and the economic development of the community.

How does the fact that Cerner wants to monetize this model affect the public health research that’s happening in the public sector?

Well it certainly makes sense from a Cerner perspective. If they want to continue doing it, it has to become part of what they do. How that plays out over time, I think it will be interesting to watch. We’ve been in public-private partnership mode for at least ten years now.  I think this may be another example of feeling out what is that blend of what corporations can do to develop products to help communities and what the public investment is at the national level like the Centers for Disease Control and Prevention. That’s a little bit of a general answer because population health is not new but this kind of interest in it and willingness to invest in it is new and we’ll have to see how that plays out.

• • •

An extended version of the interview with Dr. Keith Mueller.

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