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CHARLESTON -- Gov. Jim Justice and West Virginia Department of Health and Human Resources Cabinet Secretary Bill Crouch said they'll quickly implement recommended changes to the agency, but if one thinks they've heard that before, they'd be right.
Speaking earlier this week during a virtual press briefing from the Capitol, Justice and Crouch said they will put in place recommendations from an organizational assessment and strategic plan for DHHR conducted by the Virginia-based McChrystal Group.
"Let's get moving," Justice said. "Some things are going to have to have legislative approval, but some things we can do now. We need to move on that … we're moving."
"We are moving very quickly," Crouch said. "I understand the need to move quickly and had planned to move quickly … most of these we do not need legislation for. We think we will be up and running here with some new folks and new positions. I'm glad to have the help."
Among the recommendations made by the McChrystal Group, the report's authors recommend adding three new deputy secretary positions: a deputy secretary for child welfare who will oversee the bureaus for Child Support Enforcement and Social Services, a deputy secretary for access and eligibility who will oversee the bureaus for Family Assistance and Medical Services and a deputy secretary for substance use disorders who will oversee the Office of Drug Control Policy and the Bureau for Behavioral Health.
The report recommends creating integration teams to help coordinate between the new deputy secretaries and existing bureaus. The report recommends retaining the State Health Officer with the Bureau for Public Health continuing to report to the State Health Office. The director for the Center for Threat Preparedness and the Chief Operating Officer roles would remain mostly unchanged.
The McChrystal report, which took 17 weeks to complete and cost the state more than $1 million, did not make lawmakers happy, several of whom vented over last weekend during legislative interim meetings at Cacapon Resort State Park in Berkeley Springs. The Legislature passed a bill earlier this year that would have split DHHR into two, but Justice vetoed that bill in favor of a top-to-bottom review of DHHR.
"We've tried all of those things in the past," said House Majority Leader Amy Summers, R-Taylor, after hearing a presentation of the report last Sunday by the McChrystal Group. "We've had three deputy secretaries. We had integrated teams. That's where I'm worried about the crux of the report … we're disappointed in the meat of the report."
It turns out that McChrystal report recommendations for new deputy DHHR secretaries is similar to a proposal from a previous DHHR cabinet secretary in response to a nearly decade-old study that also recommended splitting DHHR into two.
DEJA VU
Former Gov. Earl Ray Tomblin commissioned a study of DHHR in 2012, which was completed by Pennsylvania-based government strategy group Public Works in 2013. That report, which cost taxpayers more than $330,000, one-third of the cost of the McCrystal Group report, had two goals: making recommendations to reduce Medicaid costs and reviewing DHHR efficiency and capacity.
The Public Works report included 78 recommendations that would have resulted in $56.7 million in savings or new revenue in year one and $283.8 million in savings or revenue after five years. One of the findings in the Public Works report was a need for re-alignment of services within DHHR, such as dividing services between two deputy secretaries -- one who focuses on healthcare services and one who focuses on social services.
"Our findings indicate that West Virginia's health care system is fraught with systemic challenges involving rising health care costs, poor health outcomes, and lack of access to appropriate care," The report's authors wrote. "However, West Virginia's Department of Health and Human Resources and other health care agencies, rather than working together to mitigate these problems, are beset by fragmentation, an insufficient workforce, and the lack of an overarching strategic vision and a sustained mechanism for accountability.
"Agency reorganizations alone do not necessarily save money," the report continued. "However, over the long run, it is critical that West Virginia's health care agencies be structured in such a way that they can continuously focus on strategic opportunities to contain health care costs and improve quality."
DHHR under former cabinet secretary Karen Bowling implemented several of Public Works' recommendations, but she did not agree with splitting DHHR into separate divisions. Instead Bowling created three new deputy secretary positions for health services, human services, and public insurance and strategic planning. According to a 2014 article in the Charleston Gazette-Mail, Bowling said the positions would streamline decision-making.
"If you were to look at the prior organizational chart, what you would see is a very large organization, with everyone reporting to the cabinet secretary," Bowling said. "The idea behind the vision is to ensure that, from an accountability standpoint, there is a good outcome for all of our bureaus. We really need to be able to make quick decisions and good decisions, and if the cabinet secretary is the only reporting entity, that can really delay those decisions.
It's unclear when the new deputy secretary positions went away, but by the time of the McCrystal Group report, only two deputy secretary positions were on the organizational chart. According to the DHHR website, the agency only has one deputy secretary as of Saturday, Russell Crane.
BREAKING THE CYCLE
Kelli Caseman, the executive director and founder of Think Kids, has seen all of this before. An advocate for children's health for more than 18 years, Caseman founded Think Kids in 2020.
In an interview on the Mountain State Views podcast recorded Wednesday, Caseman wondered whether the McChrystal report's recommendations would make a dent in the state's poor healthcare rankings.
"It's not our first report," Caseman said. "I feel as if we've been here before, so I don't hold a lot of faith in seeing major implementation of what we got from that report."
West Virginia's health issues have a major effect on children in the state. According to West Virginia Kids Count, in a hypothetical classroom of 30 children, five are born exposed to drugs, seven live below the poverty line, and of the 18 who are covered by Medicaid, three would be in the foster care system.
DHHR'S budget for the current fiscal year includes $7.5 billion in state and federal funds. The federal funding, which makes up the majority of DHHR's budget, comes with specific requirements depending on where the money is coming from.
"If we're still around 68% federal, that's money that comes with very concrete goals and objectives of what you need to do. If you have a strategic plan with goals and objectives, and 68% of your money already has goals and objectives, are you creating more efficiencies or are you creating more work on top of a system that we know has high vacancies and high turnover?"
Justice said Wednesday he trusted Crouch to implement the McChrystal Group recommendations. Justice compared the situation to what he inherited with the Department of Transportation. After the Roads to Prosperity road bond program, additional funding for secondary road maintenance, and the purchase of new road repair vehicles, the DOT was able to make progress on maintenance and new construction projects.
"I expect great, great performance," Justice said. "We've got a lot of issues, but DHHR has always had tons of issues … We've got a lot of holes in the dike that we need to absolutely plug, and we're on it … If we take time to breathe just a little bit and let our people get their feet underneath them and absolutely be able to address the recommendations of this report, you'll see the same exact level of progress go on."