Right place, right time: Ten months in, DHHR chief focused on prevention

CHARLESTON, W.Va. -- When he was a small boy in Raleigh County, Mike Lewis often woke in the dark, choking with an asthma attack.

"I was what the old-timers called a sickly child," he said. "I almost died several times. I know what it's like."

Time and again, a doctor who lived a mile down the road came to their house in the middle of the night to help the little boy breathe. "I never forgot that," he said. 

West Virginia's top health official was raised near Marsh Fork, mothered by his great-aunt. His father, an accountant, died of a heart attack when Lewis was 21 months old.

"My dad was sedentary and overweight," he said. "My grandfather said I used to reach my arms up for him, like little kids do, and say 'Daddy, carry me,' and my dad used to carry me a few feet, then say, 'Dad, can you take Mike? My chest hurts.' "

After his dad's death, his mother took him back to her family home in Raleigh County. "I grew up there fishing, playing baseball, pretty normal stuff. Working in the garden. Digging potatoes."

As he grew older, Lewis says he was dogged with a deep desire to learn all he could about the causes of heart problems, poor blood chemistry and cholesterol. He went into chemistry first, got a Ph.D. in chemical engineering at Virginia Tech, then started medical school at West Virginia University.

"At some point, I realized that, at heart, I had always wanted to be a doctor, to help people live healthier and happier lives."

The sickly child grew into a country doctor and public health officer, then dean of WVU's School of  Family Medicine and director of WVU's Charleston medical school. Later, he led heart, dental and public health programs at East Carolina University's medical school, as vice-chancellor. He has seen thousands of patients and trained hundreds of doctors.

"I loved my patients," he said. "I used to buy common drugs like penicillin to give people who couldn't afford them."

In late 2010, Michael J. Lewis agreed to come home to West Virginia to run the huge, troubled state Department of Health and Human Resources.

More than 65 years after his dad died, he finds himself in the position to affect the health of more than 400,000 West Virginians enrolled in Medicaid, DHHR's biggest program.

More than half of them are children. Another 25 percent are elderly.

To help those children and adults, Lewis wants to move the DHHR -- with its 6,000-plus employees -- toward prevention. Specifically, he wants the agency to use its enormous reach to prevent chronic diseases such as diabetes, heart disease and asthma and promote active lifestyles.

"We need to help people be healthy, not just pay to fix problems," he said.

"God bless him, he took on the toughest job around," said Don Perdue, D-Wayne, chairman of the House Health and Human Resources Committee. "Getting the DHHR to change direction is like moving an oil tanker."

Lewis oversees a $4.5 billion budget and dozens of programs, from sanitation to the $2 billion Medicaid bureau.

"He's a visionary with an engineer's mind," said Sen. Ron Stollings, chairman of the Senate Health and Human Resources Committee.

Stollings met Lewis in the 1980s when Lewis was head of Family Medicine at WVU and Stollings was a young Boone County doctor. "He had his fingerprints on a lot of things that helped rural doctors."

Lewis helped set up telemedicine networks, Stollings said, so rural doctors could consult with specialists. "He helped create a program that brought rural doctors to Morgantown to meet with specialists and teach medical students," he said.

Lewis also traveled the southern coalfields to help set up screening programs for schoolchildren and create teen pregnancy and nutrition programs. "I saw how enormous the need was," he said.

Saving hundreds of millions

Today, 20-some years later, he is tackling similar problems that are, in some ways, quantum leaps bigger.

His home state now leads the nation in a fearsome list of chronic conditions: Heart disease, diabetes, asthma, arthritis, depression, obesity, and toothlessness, to name a few. 

The sedentary lifestyle and heart problems that contributed to his father's death are rampant, pushing state rates of diabetes and other chronic diseases ever higher. 

Lewis says he came home in part because he wants to help lower those high numbers. "It's a challenge," he said. "I feel I have something to offer."

North Carolina, where he worked for more than a decade, improved patient health and saved more than $1.6 billion in Medicaid money between 2003 and 2008, according to independent evaluations by Mercer Consultants. The state did so by creating a statewide preventive care system, Community Care of North Carolina.

"Any figure with that many zeroes behind it is interesting to me," Delegate Perdue said. "A number of people want to look at the North Carolina program in regard to how we can use it."

Lewis' was familiar with Community Care as a medical school administrator. More than 95 percent of North Carolina's medical offices -- public and private -- participate, according to the program Web site.

The basic idea: Between office visits, mostly by phone, nurses and assistants help patients make lifestyle changes that improve their chronic illness. With healthy patients, they promote active lifestyle habits to keep them healthy.

The savings are mostly in reduced hospital and emergency room visits.

West Virginia can do it, too. "But it can't happen in a day," Lewis said.

West Virginia should create a version that suits this state, he said. If West Virginia had about the same rate of success as North Carolina, the state could save about $200 million over five years.

"We desperately need something like that," Perdue said.

Chronic disease costs eat up 75 percent of West Virginia's health care spending, according to actuarial reports. Health care spending takes a huge chunk of the state budget. As chronic disease spreads, the cost of treating people squeezes everything else in the budget.

"Dr. Lewis is the right person in the right place at the right time," Perdue said. "He knows the North Carolina system, he knows what the feds are doing, and he knows the players in the West Virginia system."

A troubled agency

"Things are starting to move" toward prevention at DHHR, Lewis said:

* In August, the DHHR applied for a $50 million federal preventive health grant.

* Medicaid plans to ask the feds for permission to create a program similar to North Carolina's Community Care for Medicaid recipients with chronic diseases. DHHR is deciding which diseases to include.

* Lewis and new state Superintendent of Schools Jorea Marple have formed an alliance, recently announcing a joint teenage pregnancy project. Lewis has his eye on school-based health centers. "We will announce more collaborations later this year," he said.

* He has hired a new commissioner of the Bureau for Public Health, Dr. Marian L. Swinker, who he says is committed to active prevention.

These days, Dr. Lewis doesn't get much time for doctoring, but a few times a month, he sheds his suit jacket, drives across Charleston to West Virginia Health Right, and slips into a white coat and stethoscope. He examines patients in the clinic for those who have no health insurance.

He introduces himself to patients simply as Dr. Mike Lewis.

"Mike Lewis has volunteered at Health Right for years, long before he was DHHR Secretary," said Pat White, clinic founder. "He never draws attention to himself. That's his style."

"When I leave there, I may be tired, but I'm happy," he said.

"I could spend all my time on health policy," he said, "but there's an agency to run."

In Lewis' first month on the job, Sen. Brooks McCabe, D-Kanawha, challenged him during a Senate Finance meeting. "My gut is, DHHR needs a major systems overhaul," McCabe said.

The personnel challenges are considerable in the sprawling, understaffed department. Many DHHR employees make less than $18,000 a year. Turnover and retraining costs are high.

"So many employees qualify for food stamps that DHHR developed a policy that employees have to apply in another county, so their co-workers won't know," said Gordon Simmons, United Electrical Workers organizer.

Many frontline administrators are also poorly paid, Simmons said.

In late 2010, 25 Kanawha County employees filed a grievance because only 26 of 47 budgeted economic service jobs were filled, and no empty jobs were posted. Existing workers had caseloads over 900 and compulsory overtime, employees complained.

"That department has been fractured for a long time," Perdue said. "The Manchin administration was very neglectful of DHHR in terms of its staffing. It's refreshing to see somebody trying to do something about that."

McCabe asked Lewis to root out inefficiencies, then use savings to raise the lowest salaries. In his first year, Lewis has worked with the National Governors Association to audit efficiency. He plans to announce results in January.

DHHR has started to fill vacant positions, Lewis said. Acting Governor Earl Ray Tomblin lifted the Manchin administration's unofficial hiring freeze. "Let's just say, it's a lot easier to hire people now," said DHHR spokesman John Law.

"We need to fill all budgeted positions," Lewis said.

He is reshuffling top officials and visiting programs in person. "I came in for a staff meeting, and there sat Dr. Lewis," one employee said. "He said he'd come to learn. I've been here since the 1990s, and never before has a secretary come to anything we're doing."

"I like to talk to the front line troops," Lewis said. "They know what's going on."

A new respect

Some past DHHR critics are waiting to see what happens. "He's thoughtful and knowledgeable, but the question is: Can he prevail in West Virginia's political environment?" said Renate Pore, health policy director of West Virginia Center for Budget and Policy.

Others are not waiting. Earlier this week, the Union of Electrical Workers held a press conference to protest low wages, understaffing and mandatory overtime at DHHR.

"If they do fill the budgeted positions, that would be great, but we'll believe it when we see it," Simmons said. "We haven't seen a lot of it yet, except when there's legal action involved."

Others worry that Lewis moves too slowly. Dr. Rahul Gupta, director of the Kanawha Charleston Health Department, praised Lewis, but said he had hoped Lewis would quickly create a Kanawha County chemical plant safety program, as recommended by the U.S. Chemical Safety Board. Instead, Lewis is asking for consultants to do a study.

"Dr. Lewis thinks like an engineer, so he tends to be careful," Sen. Stollings said. "But make no mistake, once he has a plan, he moves."

Stollings is not sure what Lewis plans for the year ahead, "but I have confidence in him."

Morale is up at DHHR, said spokesman John Law. "We are extremely busy with Dr. Lewis being here, but I think all of the employees, including me, feel a new respect for the agency."

"[DHHR] is a great big ball," he added, "so it rolls ahead slowly. But it's rolling ahead. We see that."

"You had a losing team for awhile, and now a new, vital coach, and the team is starting to feel better about itself," Delegate Perdue said.

Lewis is carefully watching the Washington deficit talks. The uncertainty makes it difficult to plan.

"If they cut Medicaid funding, we are in real trouble," he said.

If Washington doesn't cut the funding dramatically, he says, "I'm optimistic."

Lewis says he is here for the long haul.

"My family is here. My grandchildren are here. This is my chance to do something for West Virginia."