Assessing the Effectiveness of Policies to Improve Access to Primary Care for Underserved Populations, Case Study Analysis: Kanawha County, West Virginia

Focus Area:
Primary Care Transformation
Health Equity

Funding for this project was provided by the National Institute for Health Care Reform. Read a related report reviewing the evidence on the effectiveness of these policies.


This case study of Kanawha County, West Virginia, the fifth in a series, assesses the effectiveness of various policy initiatives to expand access to primary care in the region, particularly for underserved populations. Kanawha County is designated by the federal government as a primary care health professional shortage area for low-income residents, and a variety of policy initiatives have been implemented to make primary care more accessible. They have met with mixed success.

The state government has been particularly proactive in efforts to improve the recruitment and retention of primary care clinicians in the state. More specifically, the state funds several loan repayment and scholarship programs for health professions students, and closely monitors the effectiveness of these programs. However, retaining those professionals has been challenging, and the county continues to experience a shortage of clinicians who serve low-income populations. The state has also made efforts to expand access to affordable health insurance for low-income populations. The decision to expand Medicaid has been especially beneficial.

On the other hand, the state and local governments have taken a hands-off approach toward the federally qualified health centers (FQHCs) and school-based health centers (SBHCs) that provide vital safety net services to the county. State resources and leadership could help them deploy their services to more effectively meet the population health needs of the county.

Like many other rural areas, Kanawha County residents also struggle with lack of access to transportation and barriers to the use of telehealth. While state leaders have taken an interest in dedicating resources to fix the latter, local safety net providers have been left to cobble together their own fixes for the former. State and local leadership could also be leveraged more effectively to help build and sustain trust between underserved communities and the providers who serve them. For example, community health workers (CHWs) have the ability to serve as liaisons between patients and providers and improve health outcomes, but the state has not yet invested in the CHW workforce.

Read the Kanawha County, West Virginia Case Study

Read the  Detroit case study

Read the Columbia County case study




Kona M. Clark J. Walsh-Alker E. Houston M.Assessing the Effectiveness of Policies to Improve Access to Primary Care for Underserved Populations, Case Study Analysis: Kanawha County, West Virginia. The Milbank Memorial Fund. June 20, 2023.

 Case Study

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