Health-care reform is a topic of debate and discussion by a joint interim committee of the West Virginia Legislature as well as by a statewide task force involving the public. For many West Virginians, particularly employers who are struggling with rising health-care costs, this issue is one of the highest concerns here in the Mountain State.

Here are 10 pragmatic recommendations on areas where the West Virginia Chamber of Commerce thinks there are opportunities for consensus and advancement:

1. Health insurance. We must come up with ways to provide greater availability of health insurance, especially for small groups and entrepreneurs. These must be created through tax incentives, changes in state and federal laws to allow small group coverage and innovative creation of insurance pools of people with mutual interests. We also must find ways to provide greater insurance coverage options, without high costs or severe restrictions, for individuals and entrepreneurs.

2. Electronic medical records. Electronic medical record systems can avoid medical errors, eliminate costly, burdensome and time-consuming management of paper records and improve health services and outcomes. Implementation of electronic medical records also will simplify the burden that patients and their families have in managing their care. The state should explore a "public utility model" of deployment, which would eliminate a key deterrent to EMR adoption by physicians -- the upfront cost of purchasing and implementing an EMR system.

3. Cost-shift. We must continue responsible measures regarding the amount of state funding for governmental health care programs in order to cover the "true" costs of those health care coverage and to prevent further cost shift to the private sector. Continuing the cost shifting practices of the past is detrimental for private-sector employers in West Virginia who provide health care coverage to employees because employers -- and employees -- end up paying for the cost-shift.

4. Personal responsibility. We should expand public health education and create incentives that will produce better personal health conditions through diet, exercise and health management, which must be adopted by all of us now. No waiting; no exceptions. Spurring preventative measures and reducing the incidence of obesity, type 2 diabetes, high blood pressure and heart disease through diet and exercise will improve people's health and can cut costs significantly. Our citizens both young and old also must exercise more, smoke less and eat better.

5. More medical education. We need more doctors, nurses, physician assistants, health technicians and researchers. Colleges and universities need more funding to help train students for these fields. The Legislature can and must act now to increase funding for medical education and medical research. This potentially represents an as yet unexploited opportunity for West Virginia to provide national leadership in preparing more of our graduates for a health career and making important medical discoveries.

6. Medical home. In keeping with nationally recognized professional groups that support the model of care that promotes personal responsibility and prevention, the development of a network of "medical homes" will promote a more pro-active approach to health care. A "medical home" is more than a usual place of care; it is a continuous health care relationship among the patient, the patient's family and his or her primary health-care team. It is designed to foster and promote healthy lifestyles, improve interaction between doctor and patient and use technology and care processes to integrate and coordinate health-care services more timely, appropriately and cost-effectively. We also need to adopt effective reimbursement strategies to encourage and facilitate the development and widespread use of medical homes.

7. Community care clinics. We need to expand the resources and capabilities of community-based and rural clinics in our state. These clinics serve as the "medical home" of so many of our citizens, where preventive practices, telehealth applications and community-based health education can enhance overall access to health care and improve the health conditions of so many of our citizens. These centers must serve as the front lines in our efforts to combat rural health-care problems.

8. Oral health initiative. Science has shown that preventative care and better dental/oral care produces dramatic results in overall health. In West Virginia too many citizens lack basic dental care and, as a result, end up with poor overall health. Our rural neighbors have challenges finding local dentists and specialists. Solutions are available; we just need to put them in place and provide the necessary levels of funding.

9. Worksite wellness. We need to develop a worksite wellness initiative in West Virginia that would involve the creation of a new statewide wellness network of business groups and certified "wellness" health centers and clinics. Also, this network could work with at-risk employees to create specialized intervention programs to help them migrate to low-risk status. These may involve setting up contractual relationships with reputable vendors to provide at-risk employees with personalized services through means such as telephonic counseling, nutritional services and exercise programs.

10. End-of-life care. Generally, a very high proportion of total health-care costs is devoted to the last six months of a person's life. We need better planning and more understanding about the options available during severe illnesses and a person's final journey.

The above represent solid proposals for serious-minded people to discuss, refine, add to and, we hope, find near-term opportunities for action. The West Virginia Chamber of Commerce believes our state's health-care problems, while daunting, can and should be addressed.

Roberts is president of the West Virginia Chamber of Commerce.

Here are 10 pragmatic recommendations on areas where the West Virginia Chamber of Commerce thinks there are opportunities for consensus and advancement:

1. Health insurance. We must come up with ways to provide greater availability of health insurance, especially for small groups and entrepreneurs. These must be created through tax incentives, changes in state and federal laws to allow small group coverage and innovative creation of insurance pools of people with mutual interests. We also must find ways to provide greater insurance coverage options, without high costs or severe restrictions, for individuals and entrepreneurs.

2. Electronic medical records. Electronic medical record systems can avoid medical errors, eliminate costly, burdensome and time-consuming management of paper records and improve health services and outcomes. Implementation of electronic medical records also will simplify the burden that patients and their families have in managing their care. The state should explore a "public utility model" of deployment, which would eliminate a key deterrent to EMR adoption by physicians -- the upfront cost of purchasing and implementing an EMR system.

3. Cost-shift. We must continue responsible measures regarding the amount of state funding for governmental health care programs in order to cover the "true" costs of those health care coverage and to prevent further cost shift to the private sector. Continuing the cost shifting practices of the past is detrimental for private-sector employers in West Virginia who provide health care coverage to employees because employers -- and employees -- end up paying for the cost-shift.

4. Personal responsibility. We should expand public health education and create incentives that will produce better personal health conditions through diet, exercise and health management, which must be adopted by all of us now. No waiting; no exceptions. Spurring preventative measures and reducing the incidence of obesity, type 2 diabetes, high blood pressure and heart disease through diet and exercise will improve people's health and can cut costs significantly. Our citizens both young and old also must exercise more, smoke less and eat better.

5. More medical education. We need more doctors, nurses, physician assistants, health technicians and researchers. Colleges and universities need more funding to help train students for these fields. The Legislature can and must act now to increase funding for medical education and medical research. This potentially represents an as yet unexploited opportunity for West Virginia to provide national leadership in preparing more of our graduates for a health career and making important medical discoveries.

6. Medical home. In keeping with nationally recognized professional groups that support the model of care that promotes personal responsibility and prevention, the development of a network of "medical homes" will promote a more pro-active approach to health care. A "medical home" is more than a usual place of care; it is a continuous health care relationship among the patient, the patient's family and his or her primary health-care team. It is designed to foster and promote healthy lifestyles, improve interaction between doctor and patient and use technology and care processes to integrate and coordinate health-care services more timely, appropriately and cost-effectively. We also need to adopt effective reimbursement strategies to encourage and facilitate the development and widespread use of medical homes.

7. Community care clinics. We need to expand the resources and capabilities of community-based and rural clinics in our state. These clinics serve as the "medical home" of so many of our citizens, where preventive practices, telehealth applications and community-based health education can enhance overall access to health care and improve the health conditions of so many of our citizens. These centers must serve as the front lines in our efforts to combat rural health-care problems.

8. Oral health initiative. Science has shown that preventative care and better dental/oral care produces dramatic results in overall health. In West Virginia too many citizens lack basic dental care and, as a result, end up with poor overall health. Our rural neighbors have challenges finding local dentists and specialists. Solutions are available; we just need to put them in place and provide the necessary levels of funding.

9. Worksite wellness. We need to develop a worksite wellness initiative in West Virginia that would involve the creation of a new statewide wellness network of business groups and certified "wellness" health centers and clinics. Also, this network could work with at-risk employees to create specialized intervention programs to help them migrate to low-risk status. These may involve setting up contractual relationships with reputable vendors to provide at-risk employees with personalized services through means such as telephonic counseling, nutritional services and exercise programs.

10. End-of-life care. Generally, a very high proportion of total health-care costs is devoted to the last six months of a person's life. We need better planning and more understanding about the options available during severe illnesses and a person's final journey.

The above represent solid proposals for serious-minded people to discuss, refine, add to and, we hope, find near-term opportunities for action. The West Virginia Chamber of Commerce believes our state's health-care problems, while daunting, can and should be addressed.

Roberts is president of the West Virginia Chamber of Commerce.