Few states plow as much money per capita into healthcare as West Virginia, but you wouldn't know it from the results.
A new report urges major changes in health services and the government department that helps provide them.
"West Virginia is in the midst of a healthcare crisis," the report concluded. "These facts are not due to a lack of effort to address West Virginia's healthcare challenges." Gov. Earl Ray Tomblin ordered the audit.
The 116-page report (PDF) details 78 recommendations for revamping the Department of Health and Human Resources at a potential savings of nearly $284 million over five years.
Despite West Virginia's spending—it ranks fourth among states for public healthcare funding per person, and residents have the 10th-highest private health insurance premiums—it has among the worst outcomes in the nation.
Only two states have a higher share of adults who are obese or have diabetes, while just one has more adult smokers, the audit's review of 2012 statistics found. Only five states see more residents die of heart disease. West Virginia ranks 49th for avoiding preventable accidents or ailments that land seniors in the hospital. For overall health outcomes last year, West Virginia ranked 48th among states.
The report outlines a range of steps for healthcare providers to reduce unnecessary and even harmful services and procedures while improving preventive care, nutrition and physical fitness. But with a nearly $4 billion annual budget and more than 5,700 full-time employees, the department's role in the system receives most of the audit's focus.
Finding some agencies overburdened and others underused, the audit recommends reorganizing most into two divisions each led by a deputy secretary while shutting down or combining several.
The Bureau of Medical Services, for instance, oversees the $3 billion Medicaid program but has only 62 employees—1.4% of the department's workforce to handle nearly 72% of its budget. The Bureau for Behavioral Health and Health Facilities accounts for 68% of the department's overtime, even though it receives less than 10% of its funding, the audit found.
Compared to a national average of 3.3%, department turnover is 30%, according to the audit. With a cumbersome, months-long process for filling jobs, more than 600 positions remain vacant at any given time. Overtime spending grew from $5.2 million in 2010 to $7.1 million last year.
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