KANSAS CITY — Cerner Corp. employees started visiting the western Missouri city of Nevada in 2011, looking to adopt a community as a testing ground for theories to control skyrocketing medical costs.
At the outset, "our discussions were marked by a lot of confusion," recalled City Manager John David Kehrman. "We thought of Cerner as a data company. We didn't understand what they wanted."
The North Kansas City-based company, grown to global prominence by selling health care information technology to hospitals and doctors, aimed to reach a broader audience with a message: You have to take more responsibility for your own health.
Now, nearly all Nevada residents know that Cerner wants them to practice healthier habits, from welfare recipients who get advice about healthier food to students at Benton Elementary School who have walking time built into their lunch breaks.
The message certainly reached Kehrman's kindergarten daughter, who got in the car one day after school and announced, "I have to limit my screen time."
It's all part of Cerner's business-development model. The Healthy Nevada prototype may expand and eventually produce consulting revenue for Cerner.
But the company's bigger evolution is that it's investing millions in its next-generation software, dubbed Healthe Intent, which tracks individual and group health and treatment results. It re-imagines jobs in the health care industry and eventually will reach into patients' homes.
If the initiatives blossom, Cerner executives believe they will boost the company's revenue by billions of dollars a year.
"It's in the DNA of our company to have the vision and passion to fix what's broken in health care," said Matthew Swindells, Cerner's head of population health and global strategy. "We've solved the data problem. Now, it's not about what the doctor does. It's about what the individual does."
It's also forward thinking. The market for the major health IT systems that fueled Cerner's growth is maturing — Cerner actually envisions "paperless hospitals" soon. Future growth requires new markets.
That means Cerner intends to reach out and touch you — through hospitals, workplaces and where you live. Like earlier software, Healthe Intent is marketed to care providers, but it expects to link your home into the system.
You might, for instance, be identified as an at-risk heart patient who's asked to step on a wireless scale so that care providers can monitor daily weight changes. If the vision takes hold, you may one day have a personal case manager who flags problems, maybe before you know you have them.
And you won't just be discharged from the hospital with a prescription; you'll be tracked to make sure you follow instructions. The system will send computer or phone reminders about medications, schedule doctor's appointments, remind you to exercise and even help a relative keep tabs on you.
It's a vision that faces tough competitors and some skepticism, but it's embedded in a concept called "population health." The discipline, a big part of the Affordable Care Act, says we've focused too much on paying doctors and hospitals for providing expensive care for acute illnesses.
Instead, to really get a grip on health care costs, experts say we need to keep the U.S. population healthier in the first place and pay better rates to caregivers who produce the best health outcomes. Population health emphasizes: Stay out of the hospital to avoid expensive care.
Thirty-five years ago, when Cerner's founders started the company, they wanted to tame medical costs by improving the efficiency and accuracy of health care through better record-keeping.
The company's technology is now in more than 14,000 hospitals, doctors' offices and other health care facilities worldwide. Cerner logs nearly $3 billion a year in revenue, employs more than 14,000 and has become one of the Kansas City area's premier corporate citizens.
But digitizing health records hasn't cured medical cost inflation. And that hasn't set well at Cerner.
"Cerner's founders never saw themselves being a health care IT company," Swindells asserted. "They saw themselves fixing health care."
One health care IT industry analyst, Eric Coldwell at R. W. Baird, agrees with many stock traders that Cerner is an industry leader. He's impressed with "their diverse business model, their execution, their financials," and thinks the company will continue to take market share in its basic IT business.
Healthy Nevada is a long-term project for the town of 8,300, the county seat of Vernon County.
Efforts in subsequent towns are unlikely to get the same capital investment from Cerner, which spent $750,000 to remodel the top floor of the town's public library as Healthy Nevada headquarters. A half-dozen Cerner employees work there, building partnerships with employers, churches and social service providers.
Cerner also financed a pedestrian and transportation study. It found that residents didn't walk or ride bikes because Nevada's sidewalk and trail system was poor, and scary dogs ran free. In short order, some sidewalks and trails were improved, a leash law was adopted, the City Council passed a "PedNet" plan, and every zoning or development decision in Nevada now must consider pedestrians and cyclists.
"Dollars didn't flood the community, but our focus changed," City Manager Kehrman said. "Healthy Nevada created an interaction between public policy and personal behavior."
That meant adapting police work to better deal with mental health problems and creating a mental health court. It meant using city and county health departments to not just give free flu shots but educate about healthy diets. It meant school kids exercising and vegetables growing in the downtown garden.
"Sure, we hear pushback," Kerhman admitted. "The status quo is easy. This can't be about forcing change."
Indeed, smokers pushed back when they heard that smoking might be restricted in public places. Change has to include something people want, Kerhman acknowledged. But he said Cerner's prototype project has taught the town that "if we're not thinking about hypertension, diabetes and our ability to get and keep good employees, we're setting our population up for failure."