Starting in the second half of the 19th century with the rise of industrialization, one of West Virginia's greatest natural resources, coal, helped change the world. Coal industry peaks and valleys have shaped the fortunes of the state's people ever since.
During parts of the 20th century, the coal industry employed more than 100,000 West Virginians, but that number has now dropped to about 14,000 according to the U.S. Energy Information Administration. A related intersection of social and economic pressures has had near-catastrophic impact on the region, including on people's health.
"We have been a transitioning economy for years, and it's been difficult," says Jason Landers, president, Highmark Health Options West Virginia. "The industries that people my age grew up with I'm a coal miner's kid from the southern coal mines are gone, which greatly impacts the places where those businesses operated. We've lost thousands of jobs and thousands of people. The resources supporting those jobs and people are just not there anymore."
Social determinants of health where people are born, grow, live, work and age can impact up to 80% of an individual's health outcomes before any health care intervention occurs. The demise of the coal industry has created or exacerbated a unique set of challenges for West Virginia that negatively impact social determinants of health for its people, especially at-risk populations:
Addressing social determinants of health can be especially important in removing barriers and improving health for Medicaid populations. Landers says there are huge benefits to Highmark Health Options West Virginia being able to tap into an organization-wide strategy and resources to address social determinants of health, but an understanding of West Virginia's specific challenges is equally vital to achieving success.
"We have deep understanding of addressing social determinants of health, and we also know what it's like to be West Virginians," he says. "I grew up in this state. The people here are my family not in a figurative way, but literally."
Landers points to population decline, transportation, and economic transition all of which are intertwined as significant factors shaping West Virginia's social determinants of health landscape.
"Population decline can also result in aging state populations," he says, noting that West Virginia has the nation's third highest percentage of state population age 65 and older. "That can become a drain on the workforce that feeds many other issues. It's hard to support businesses if you don't have people with discretionary income, so the economy goes sideways."
The geographic footprint of the state makes the scarcity of local resources more difficult to address than in many other states, according to Landers.
"West Virginia is a state where transportation is incredibly difficult once you are on the margins," he says. "West Virginia is not like a lot of places. It may not look far on a map, but it can take hours to get from one place to another. This in turn makes it difficult for people to access things like healthy food, health care services, and jobs."
While meeting the challenges of economic transition go far beyond any one company, Landers says there are logical ways for Highmark Health Options West Virginia to get involved. Specifically, he and his team are spending considerable time and resources on workforce development and food insecurity throughout the state.
The end of a pandemic-driven federal program that funded states to maintain continuous enrollment of Medicaid beneficiaries has increased the urgency of their efforts. The federal program began a 12-month phase-out on April 1, 2023. With the return of pre-pandemic renewal, or redetermination, guidelines in each state, millions of Americans, including approximately 200,000 West Virginians, are at risk of losing Medicaid coverage, most of whom are still eligible but will get tripped up by re-enrollment paperwork.
"With many people on Medicaid potentially being redetermined out of coverage, we owe it to the population to exert efforts to ease the transition," Landers says. "We are going to hire West Virginians to serve West Virginians. I have the third floor of our Parkersburg headquarters to fill. Everything that can be provided in West Virginia will be provided in West Virginia, but we need to do more."
Landers points out that hiring is just part of the solution. "It's our responsibility as an organization to develop a West Virginia workforce," he says. "Workforce development will improve the ability of Medicaid members to ease the transition off the program should they no longer qualify. Workforce development starts with life mentoring. People don't always understand how important it is to show up. They may not know how to write a resume or how to interview for a job."
Highmark Health has prioritized a "food as health" approach as a first step to better health and management of chronic conditions and eventually even reducing their prevalence.
Food insecurity efforts across the organization include close relationships with food banks, mobile food pantries, churches, and similar community organizations, a high-performing social care network, and related grant funding. This support makes food distribution, healthy eating mentorship, and other resources a reality for families across multiple communities in Pennsylvania, New York and Delaware.
In West Virginia, food insecurity efforts include grant money from the West Virginia Charitable Fund for Health to finance Healthy Neighborhood, a transformational pilot food program with Dollar General, West Virginia Health Network, and InComm Healthcare.
"Our focus on food insecurity includes committing resources to our Dollar General initiative," Landers explains. "Dollar Generals are ubiquitous in West Virginia. They recently built one a mile from my dad's house. He’s approaching 80 years old, so driving to a store 20 miles away is a journey for him. Now he can shop at a nearby Dollar General to get fresh fruits and vegetables."
In 2021, the U.S. Department of Agriculture ranked West Virginia as the fourth worst state for household food insecurity. The Healthy Neighborhood pilot program works with healthcare providers to address food insecurity and improve health outcomes by providing a prefunded, restricted-use debit card to individuals with a qualifying need to purchase healthy and nutritious food in Dollar General stores.
"Getting healthy food into people's hands can be complicated," Landers says. "We need to help people make the right decision. If you have a family of three, do you buy the snack chips because they're a dollar or do you buy healthier foods? How do we get people to say, 'I want the healthy food?' Providing vouchers for members to get fresh food is just part of the commitment Highmark Health Options West Virginia is making to help tackle large, complicated problems like food insecurity. We want to provide access to food and access to hope."
Often, helping individuals and families overcome that first barrier, like access to food, can establish the trust and forward moment to start on the longer journey to better overall health.
Highmark Health works with health plans that have served Medicaid beneficiaries for four decades and now include more than half a million members. Across its footprint, the organization has shown a commitment to designing, implementing and measuring programs to address the social determinants of health challenges of its Medicaid members. As Landers points out, many programs are tailored to specific challenges and regions, including addressing social isolation by partnering with Papa Pals in Pennsylvania, and working with the YMCA in Delaware on a diabetes prevention program.
"Medicaid in West Virginia has financial challenges in helping our people reenter the workforce and reenter life," Landers says. "It's such a large problem. There are opportunities for the state to seek out innovation in Medicaid."
He adds that Highmark Health Options West Virginia combines an innovative mindset with decades of experience providing health coverage in West Virginia.
"I have 30 years' experience addressing these unique West Virginia challenges," he says. "Experience informs everything we do. It's not just West Virginia experience. It's the experience of managing health coverage in West Virginia. You need only look at the commitment Highmark has made to this state and its people over the years to see how much that means."