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byline: Robert Burke

Caution ahead

This year was expected to be a rough one for employers, following predictions of a coming tidal wave of costly employee lawsuits and labor complaints powered by the and last year’s racial justice protests.

So far, though, that onslaught of litigation hasn’t materialized. Why not? Partly because the pandemic itself closed courts for months last year in Virginia, so there is a backlog of litigation to work through, say employment attorneys. And lawyers for employers and employees are waiting to see how the courts rule in any active employment-related lawsuits to help them figure out legal strategies. Plus, there are new state and federal laws to sort out.

A wave is likely still coming, though, say employment attorneys, so businesses shouldn’t let their guard down. “While the sky is not falling, I still think there’s a lot of risk for employers,” says Todd Leeson, a partner at Roanoke-based Gentry Locke Attorneys.

For one thing, many employers have gone from offering incentives for vaccinations to mandating that their employees get vaccinated. And while courts have generally been upholding an employer’s right to issue employee mandates, Leeson says, there are legitimate exceptions that can be carved out for health issues and religious beliefs and that can create some room for disputes around a hot button issue that can trigger strong emotions.

“While the sky is not falling, I still think there's a lot of risk for employers,” says Todd Leeson, a partner at Roanoke-based Gentry Locke Attorneys. Photo courtesy Gentry Locke Attorneys
“While the sky is not falling, I still think there’s a lot of risk for employers,” says Todd Leeson, a partner at Roanoke-based Gentry Locke Attorneys. Photo courtesy Gentry Locke Attorneys

“I do think the folks who are not vaccinated who perceive that they’re being singled out unfairly are going to challenge that if they end up getting fired,” says Leeson, who represents companies and employers in labor and employment cases.

Another reason businesses haven’t yet seen the predicted wave of litigation is Virginia’s particular business and legal culture, says Alexandra Cunningham, a Richmond-based partner with Hunton Andrews Kurth, who co-heads the firm’s products liability and mass tort litigation practice group. Virginia juries generally aren’t that tort-friendly, she says, and the state’s purple-shaded politics means less chance of conflict between courts and state policymakers. Virginia also has a less vulnerable than other states, offering more white collar jobs that allowed work-from-home options, she says.

“I also think frankly we had a pretty strong [state] response to the virus, so we don’t have some of the issues that states like New York had,” she says, adding that better control over the pandemic generally means fewer lawsuits. “And we were late to have a surge and the guidance was already in place.”

According to a national database maintained by Hunton Andrews Kurth that tracks state and federal litigation involving COVID-19 claims, the most litigious state, California, had 2,018 pandemic-related legal complaints from January 2020 through July 2021. New York was second, with 1,743 pieces of litigation. During the same period, Virginia tallied just 135 pandemic-related complaints.

Even nationwide, the pandemic litigation count shows no surge in 2021, according to the Hunton database. Nationwide last year there were 7,734 lawsuits related to the pandemic. Through July of this year, there are 3,767 complaints.

Nevertheless, employment attorneys say they haven’t lacked for work amid the pandemic. “Firms have been incredibly busy over the past year,” Cunningham says. “Like the rest of the world, businesses have had to drink from a fire hose to figure out the obligations they have to respond to [in regards to] protecting employees and following mandates — especially at the [pandemic’s] beginning, when those mandates were changing constantly.”

Expected boom is quiet

A major development for employers is the Virginia Values Act, which went into effect in July 2020. It expands the scope of the Virginia Human Rights Act to prohibit discrimination in employment and housing based on sexual orientation and gender identity. Leeson says when the act was approved, defense attorneys predicted disaster for corporate defendants, while plaintiff’s lawyers were saying, “This is a new day in Virginia and we’re anxious to start filing these claims.” But “lo and behold,” Leeson says, “there have been very few cases” related to the act.

That’s partly because of the timing — the Virginia Values Act took effect during the pandemic — and partly because of the administrative processes the new includes. This January, Virginia Attorney General Mark Herring created the Office of Civil Rights, which expanded and reorganized his office’s previous Division of Human Rights. Prior to the Virginia Values Act, discrimination claims based on race or gender identity would have been handled exclusively in federal courts. Now there’s a state court option with different rules and an investigation phase that can take months to complete. “There’s probably not a smooth-running machine in trying to process these complaints,” Leeson says. That could push potential litigation even farther down the road, as attorneys for both employers and workers study what the law requires and watch to see how courts respond.

Recent developments such as vaccine mandates, remote work and marijuana legalization may lead to litigation against employers, says University of Richmond law professor Henry Chambers Jr. Photo courtesy University of Richmond
Recent developments such as mandates, remote work and marijuana legalization may lead to litigation against employers, says University of Richmond law professor Henry Chambers Jr. Photo courtesy University of Richmond

There are plenty of issues that might result in litigation against employers, says Henry Chambers Jr., a professor with the University of Richmond School of Law who teaches constitutional law and employment discrimination. There are vaccine rules, the treatment of remote and in-office workers, and marijuana policies now that recreational marijuana use is legal in Virginia.

Given the social protests related to civil rights that erupted last year following the murder of George Floyd by a Minneapolis police officer, Chambers predicts workers returning to the workplace will have “shorter fuses, and they will feel freer to discuss issues in the office” that they previously might have avoided.

“It’s difficult because our workplaces can become kind of our second homes, which can be a plus and a minus,” he says. As people return to commuting and to sharing a workplace again, “there are a whole host of issues that might turn into litigation.”

Compliance confusion

There also continues to be considerable confusion among businesses over pandemic-related state and federal requirements. And providing compliance advice is driving a lot of business for law firms. “It’s been that way the entire time,” says Karen Doner, founding partner of Tysons-based Doner Law, which specializes in employment law and commercial litigation.

Virginia, for example, was the first state to pass a workplace safety standard specific to COVID-19, she says. The Virginia Department of Labor and Industry’s “Final Permanent Standard for Infectious Disease Prevention of the SARS-CoV-2 Virus That Causes COVID-19” went into effect in January. Before that, Virginia employers were expected to operate under a “Temporary Permanent Standard” implemented in July 2020.

Depending on the types of tasks employees perform, state workplace requirements for employers to control and prevent the spread of COVID-19 can include a range of requirements for training, protective equipment, and reporting and notification. Virginia employers failing to comply with the state standard are subject to fines up to $12,726 for serious violations and $127,254 for willful violations.

“Many employers are under the impression that the Final Permanent Standard is no longer in effect, but it is,” Doner says. “It’s troubling that the guidance has not been clearer.”

There also continues to be considerable confusion among businesses over pandemic-related state and federal requirements, says Karen Doner with Tysons-based Doner Law. Photo by Will Schermerhorn
There also continues to be considerable confusion among businesses over pandemic-related state and federal requirements, says Karen Doner with Tysons-based Doner Law. Photo by Will Schermerhorn

Additionally, employers who provide health care services or support services must comply with the federal OSHA COVID-19 Emergency Temporary Standard, which went into effect in June.

Employers remain perplexed over which of the layers of state and federal rules apply to them. Mask requirements, for example, have been hard to follow, Doner says, with differing requirements for certain work settings and rule changes from federal, state and local authorities.

With the rising threat of the COVID-19 delta variant interfering with planned returns to offices, employers can count on uncertainty to continue. And for attorneys who guide employers through the changing legal terrain, there is much to learn. The past year is “the most challenged I’ve been in my whole career,” Doner says.

Much of what’s happening now for businesses and their legal counsel is based around preventing legal liability. Jeremy Schneider, principal with the Washington, D.C., office of Jackson Lewis, represents businesses facing workplace litigation, and his firm also conducts corporate trainings to help businesses avoid litigation in a range of areas, such as diversity in hiring related to age, race, gender, religion, sexual orientation or other characteristics unrelated to job performance. “We have a lot of employers asking us to do unconscious bias training,” he says. “Now more than ever, employers need to be vigilant and aware of the problems that can arise.”

As courts work through any legal challenges to the new laws, employment attorneys are paying close attention to how courts are interpreting new laws and regulations. “It’s been fun to watch a new area develop,” says Cunningham with Hunton Andrews Kurth. “There’s a lot of new law being developed right now, so it’s interesting.”

A distinct vision for students

The University of Mary Washington isn’t a very big school, and it doesn’t really want to be. The university has about 4,400 undergraduates, way below enrollment giants like Virginia Tech (34,950) or James Madison University (22,686).

UMW will likely never reach those totals. Its main campus in downtown Fredericksburg is just 3-by-10 blocks, not including some nearby athletic fields and university-owned apartments.

“Students walk a lot farther at Virginia Tech or U.Va. to get to anything,” says Jeffrey McClurken, a 1994 UMW graduate who has taught at his alma mater since 1999. He also serves as special adviser to UMW President Troy Paino, who arrived in 2016 after six years as president of Truman State University in Kirksville, Mo.

“Part of what we sell [to prospective students] is that compact experience,” McClurken says.

The approach seems to work. That’s not to say the school is static —  it grows, rebuilds and adjusts academic programs pretty much every year. UMW just has its own vision about the undergraduate experience, McClurken says. “I know my students,” he says. “But it’s not so small that you literally know everyone, which is also a good thing.”

Serving STEM students
The university’s biggest project underway now is expansion and renovation of the Jepson Science Center, which holds several of the university’s key STEM-related departments. The new space, which opens this fall, will be three stories tall and have nearly 42,000 square feet. Two departments — physics and earth and environmental sciences — will move there. Biology and chemistry departments will stay in the existing building but that space — 28,000 square feet — is being renovated and will be ready next spring.

This project is a big deal for the school’s goal of attracting STEM-focused students. Jodie Hayob, chair of the Department of Earth and Environmental Sciences, notes that when the original Jepson building opened in 1998 “we pretty much outgrew it on the day we moved in.”

The new project brings bigger classrooms, more faculty offices “and a whole lot of research lab space,” says Hayob. “In my department, those are teaching laboratories. We’re probably getting 100 percent more.”

One selling point for STEM majors is that the new space will be populated by undergraduates working directly with faculty. That’s generally always been true at UMW. There are no graduate students to compete with for lab space or faculty time. But this is new equipment and more space.

“The professors do all of the teaching and all the grading. We don’t have equipment that undergrads aren’t allowed to use,” she says. “The STEM fields are important and popular and … more engaged learning leads to students being better prepared,” Hayob says.

Digital fluency
UMW is continuing its push to teach students digital communications skills no matter their field of study, says McClurken. In 2015 the school created a major, communication and digital studies. This year 172 students were pursuing that major with 44 students minoring in the field.

Plus, the school just adopted a set of general education requirements that now includes a “digital intensive” course requirement with the goal of developing digital fluency. That term is defined as “the ability to consume and produce digital knowledge critically, ethically and responsibly, as well as to creatively adapt to emerging technology,” according to the school.

Virginia and the mid-Atlantic represent a competitive region in attracting students, McClurken says. Other schools are growing and adding facilities and pitching themselves as the best bang for the buck. “We’re focused on a particular type of undergraduate education … integrating digital technology into a liberal-arts experience,” says McClurken. “That’s been our argument.”

Building the
The UMW main campus is focused on undergraduates, but the school’s two other locations target the region’s adult workforce. UMW’s Continuing and Professional Studies program, located at a small campus in neighboring Stafford County, focuses on helping professionals pursue training or degrees to further their careers.

And to the east in King George County near the Naval Surface Warfare Center is a center focused mostly on science and engineering studies, for graduate and undergraduates, but its main emphasis is continuing education for Dahlgren-related workers, local government employees and private-sector workers. UMW shares that space with educators from other Virginia schools.

A major new initiative is coming. UMW is launching a cybersecurity certification prep course next year, supported by the region’s community colleges and business development groups. The 12-week, 40-hour program is expected to begin in spring 2020. In March, the state’s GO Virginia program awarded a $110,000 grant to help start the program, which is intended to ease the shortage of certified cybersecurity workers in the region.

The Stafford center also offers a bachelor of liberal studies degree for  people who have done some college work but haven’t completed their undergraduate degrees. “Many start school, then stop, then life happens along the way,” interrupting their degree pursuit, says Kimberly Young, executive director of UMW’s Continuing and Professional Studies program.

Evening classes and some online work is part of the program, but UMW advisers are keen to make sure the project feels like a true degree program. “It’s important for the Mary Washington brand that we’re not pushing them through something just to get to the finish line, but really taking a look at what they want to do,” Young says.

Planning a bigger UMW
Even if UMW doesn’t aim to be a lot bigger, under Paino’s leadership it is going to grow and renovate. And for this modest-size campus, there are many new things planned or underway. In 2016 the school opened its massive University Center, which houses dining facilities and offices of university programs such as the James Farmer Multicultural Center. The former dining center, Seacobeck Hall, will soon be renovated and reopened as home to the school’s College of Education. Plus, renovations are planned or underway in several of the school’s older residence halls.

Farther down the road, Paino is talking up proposals to build a new theater at the southeast corner of the campus and a parking garage across the street on an existing surface parking lot. The existing theater, Klein Theatre, and the adjacent fine arts buildings would be renovated. Plus, the new theater space potentially would also be used by the city of Fredericksburg.

Paino is also pursuing plans to demolish and rebuild the UMW Apartments on William Street at the south end of campus. The complex houses about 350 students but would be expanded and possibly include some mixed-use development.

For now most of the activity is at the other end of the campus, extending across U.S. 1 to the Eagle Village shopping center, which has residence halls and some of UMW’s administrative offices. That property is owned by the UMW Foundation. “Our vision is really to create some activity and space on this side as well,” Paino says. He wants the school to provide “21st-century living and learning.”

In five years the estimate is that UMW will see modest growth to around 5,000 students across all its programs. “The direction I’m trying to take the university is [to become] an anchor for the entire region and Fredericksburg in particular,” Paino says. “There’s a lot going on here.”

Making connections

One challenge of being a CEO with a new technology is finding investors who believe in it as much as you do.

“Raising money is a full-time job,” says Mike Blue, CEO of Michigan-based HistoSonics Inc., which is trying to bring to market a new kind of focused-ultrasound technology that destroys targeted tissue such as tumors using pulsed sound waves. “It takes constant effort to try to get in front of the right people.”

Lucky for Blue, the Charlottes­­­­­­ville-based Focused Ultrasound Foundation already had the right people: its wealthy donors and an all-star board of directors.

Foundation leaders told them about Blue’s need for money, and, in about 10 days, the entrepreneur had what he needed: a $5 million convertible note from a group of investors led by an ultrasound foundation board member.

That money is helping to keep HistoSonics going as it works on its C-round funding, which Blue hopes to close by the end of this year. The goal is $30 million. He’s grateful for the foundation’s role in helping the $5 million deal happen. “I can’t overstate the power of an introduction to an audience who is already familiar with and believes in the potential of focused ultrasound,” he says.

The ultrasound foundation would like to see a lot more deals like that one. So, earlier this year it launched a formal effort, called FUS Partners, to make more connections — not just for financing but other initiatives such as collaborative partnerships or academic-research opportunities, all with the goal of advancing the development and adoption of focused ultrasound technology.

“The field of focused ultrasound is at a tipping point, where it’s transitioning from a research and development activity to a commercial activity,” says Dr. Neal Kassell, who started the Focused Ultrasound Foundation in 2006 and is its chairman.

Focused ultrasound is a noninvasive therapy using ultrasound waves to generate heat and destroy targeted tissue. It also has potential in drug delivery. Kassell began the foundation to speed development of the technology.

FUS Partners program is a logical next step for the foundation, Kassell says. “Ten years ago, there were five manufacturers in the field. Today, there are about 65,” he says. That’s a good trend, but those companies are relatively small and not making money, he says. “So, the first step that we see is to get these companies to be successful. The next step is to effect some consolidation.”

Kassell came to Charlottes­ville in 1984 as a professor of neurosurgery at the University of Virginia School of Medicine. He co-chaired the neurosurgery department there for 22 years.

Partnering with experts
The person leading the partners program is Dr. Emily White, who joined the foundation as director of operations in 2016. Besides her training in general surgery — she’s a U.Va. School of Medicine graduate — White also has experience on the business side, having held leadership roles with several startup companies.

The first step was going to investors already involved in focused ultrasound to test their willingness to continue investing, White says. Then she started asking ultrasound-related startups about their growth plans and what help they need.

“Our first phase was to go to incumbent investors and say, ‘Can we talk to you about why you decided to invest in this space? And do you have an appetite for more?’” she says. “The companies were obviously already out there knocking on doors trying to get meetings with investors. I think what we brought to the table is some efficiency.”

White also tries to make other contacts. “I want to introduce companies to whoever is the world expert in whatever they’re trying to do,” she says. For example, a researcher trying to use ultrasound to create a drug delivery therapy for bladder cancer would benefit from talking with a company trying the same thing. In its 12 years, the foundation has helped fund research efforts in the U.S. and abroad, and its leaders know a lot of people. “Yes, they need money, but sometimes they need strategic partnerships,” White says.

The key hurdle is winning approval of focused ultrasound treatments from the U.S. Food and Drug Administration. So far the leaders in winning FDA approval are ultrasound-based thermal ablation applications that use heat to destroy targeted tissue such as tumors. HistoSonics is developing a system without heat. Its pulse technology destroys tissue, the company says, without generating heat that can damage surrounding tissue.

Another approach is to use focused ultrasound to deliver drugs. That use “is still in its infancy” in terms of development and FDA approval, White says.

Immunotherapy for treating cancer is another application, with research in one area of that field showing that ultrasound treatment actually was stimulating the immune system. White says a researcher in Italy, using ultrasound for palliative care for pancreatic cancer, found that, somehow, leaving part of the tumor in place produced a stronger anti-tumor immune response. Research shows that approach works on about 30 percent of patients, but they don’t yet know which 30 percent, White says.

So, the foundation works with every kind of stakeholder — drug companies, startups, researchers and the rest. “If your whole thing is to accelerate the adoption of the technology, then all of that matters,” she says.

A board of heavyweights
A key resource for White’s efforts is the expertise of the foundation’s 14-member board. There are plenty of heavyweights. Among them are William Hawkins III, retired chairman and CEO of Medtronic; Stephen Rusckowski, chairman, president and CEO of Quest Diagnostics; Andrew von Eschenbach, a former FDA commissioner and former director of the National Cancer Institute; and Dr. Frederic Moll, chairman and CEO of Auris Health, a medical robotics company that he founded. When White has questions she can’t answer about technology or financial issues, she can turn to a bevy of experts. “This is the genius behind the way Neal put this together,” she says.

Moll is the board member who led the round of investment for HistoSonics. His interest with that supporting technology — called histotripsy — goes back a few years to when it was being developed at the University of Michigan. After Moll learned that Histo­Sonics was having a hard time raising money, he met with the company’s leaders at a J.P. Morgan conference in San Francisco and agreed to help. “It’s something I’m personally excited about, both as someone in the field who wants to see focused ultrasound get as far as it can go, and I thought it was a great investment opportunity,” he says.

It’s a tough fundraising environment for young companies, Moll says. “Most people don’t have the time or the background or interest to really understand the nuances of a technology like this.”

In late October, the foundation held its sixth International Symposium on Focused Ultrasound in Reston. The four-day event, which included some of the top researchers in the field from the U.S. and abroad, covered the latest advances in the treatment of a number of conditions in fields such as oncology, neurology and women’s health. The conference also explored the technology gaps and commercialization efforts needed to bring wider use to focused ultrasound.

White went into that meeting with plans to gather all the CEOs into a room and ask them what they need from the partners program. She’s having those talks with other stakeholders, too, and wants next year to produce a more detailed picture of the state of focused ultrasound. “We want to be market responsive,” she says.

Getting connected

The places in Virginia without broadband aren’t hard to find. Just look for mountains or two-lane roads or lots of trees, any place without rooftops. Southwest Virginia, definitely. Big swaths of Central and Southern Virginia and the counties west of the Hampton Roads region, along with parts of Virginia’s Eastern Shore.

It’s been clear for years that the telecoms aren’t going to build there because they could never find enough customers to make a profit. So, now the hunt is on, with some success, to find just enough public dollars to get these places wired. It’s a big deal for local economies, which can’t recruit or grow companies without internet access. Schools and hospitals also suffer in isolation.

Gov. Ralph Northam has launched an effort to make broadband service available to all who want it. But the details — the amount of funding and how it will be spent — aren’t yet known. In the meantime, localities and private-sector businesses are working what deals they can.

There is progress being made, such as the Central Virginia Electric Cooperative’s (CVEC) project to build a broadband network in its 14-county region. Co-ops in Virginia and around the U.S. have been getting a lot of traction in expanding broadband into unserved areas because the co-ops already have built and maintained infrastructure. Oftentimes, providing broadband service is just a matter of adding new fiber.

“We’re used to being out here in the terrain in low-population areas,” says Gary Wood, CVEC’s president. “And we’re used to low margins.  We don’t have to return a 20 percent margin.”

A good match
Wood says electric co-ops are a good match for rural broadband projects. For one, co-ops have been building and maintaining utility infrastructures in rural areas for decades. The same poles that carry electric wires also can carry broadband. “So, it works for us, where it’s more difficult for the investor-owned, private companies,” Wood says.

Plus, the co-ops have a need for a broadband network, too. CVEC has substations and pieces of equipment in areas without cellphone service. “If we had communication with them, it would improve our reliability and efficiency,” he says.

CVEC has 37,000 customer accounts — 90 percent of which are residential —  in the counties it serves. The co-op has 4,600 miles of overhead and underground lines.

Co-ops aren’t allowed to sell internet services, Wood says, but they can create subsidiaries to do that. CVEC’s subsidiary is called Firefly Broadband.

CVEC’s service area stretches from around Appomattox and Farmville at its southern boundary north into Orange County. The co-op will build the fiber network and then lease it to its subsidiary. Those lease payments will cover the cost of the network.

So, customers who buy broadband services will be providing the revenue for those lease payments, while co-op members won’t bear the cost, Wood says.

Getting outside support — grants and so on — is part of the formula. A feasibility study for the $110 million project showed it would take 11 years for the subsidiary to break even. “You really can’t ask a Verizon or Comcast to wait 11 years to turn a profit,” Wood says.

Developing a plan
In July, Northam announced the appointment of Evan Feinman, executive director of the Virginia Tobacco Region Revitalization Commission, as chief broadband adviser. Feinman is assigned to “develop a plan to get broadband to every single Virginian as soon as possible,” said Northam in announcing the project at the Laurel Grove Volunteer Fire and Rescue in Pittsylvania County’s Sutherlin community. Courtney Dozier, chief deputy with the Virginia Department of Housing and Community Development (DHCD), was named deputy adviser.

“We’ve been working on this since the beginning of the administration,” Feinman says. In announcing his plan, Northam framed the problem as quite serious but said it could take up to 10 years to make broadband available to everyone who wants it. Feinman says that’s “an achievable goal, provided the General Assembly steps up and shows the political will to get it done. And we have confidence that they will.”

One funding increase happened in this year’s session, when the General Assembly increased funding over the next two years for expanding broadband from a total of $2 million to $8 million.

That grant money, handled by the DHCD through a program called the Virginia Telecommunication Initiative (VATI), is intended to help private-sector providers and local government entities with the cost of constructing broadband infrastructure in unserved areas. Priority is given to projects that will be owned and operated by a private-sector co-applicant.

Over the years, the tobacco commission has put money up as well. In March, it approved grants totaling more than  $11 million for nine projects. The biggest grant is $3.5 million to a project involving Comcast and Bedford County.

The project began after a survey of residents and businesses in the southern part of the county showed an appetite for broadband access, according to DHCD. Comcast said it couldn’t afford the project on its own, so the county and the company sought the grant, originally asking for $4 million.

Trade group’s position
The Virginia Cable Telecommunications Association (VCTA) supports this approach, using grant money to enable private-sector providers to offer service in rural areas.

Ray LaMura, the trade group’s president, says cost is an issue for private- and public-sector efforts, and the risk of financial failure is high, too. “It’s expensive to deploy broadband. It’s not like water and sewer; not everyone has to take the service,” he says.

Another VCTA argument is that the public sector isn’t very good at running these kinds of networks. That’s why partnerships are best, LaMura says. “Localities or co-ops have the infrastructure, but then you have us with the expertise.”

There are good examples of where these partnerships are working, he says. Gloucester County, for example, got a $193,000 grant from the VATI fund and partnered with Cox Communications to expand its fiber-optic network. Cox said it invested $140,000 in the extension. There also is a partnership launched in 2016 between Harrisonburg and Shentel, a telecommunications company based in Edinburg.

LaMura says the VATI fund and private-sector expertise also help localities deal with hurdles that are unfamiliar and expensive, such as laying fiber across railroad lines or over bridges. “We understand that there is a cost to do that,” he says. “We just don’t want excessive cost that kills a project. Because that’s what this fund is for, to make a project doable when previously it was not.”

What VCTA especially dislikes is municipal networks, such as the Bristol Virginia Utilities Authority (BVU) effort, begun in 2001 to build and operate a broadband network, called OptiNet. It’s one of LaMura’s favorite examples of what not to do. “It’s a sad situation,” he says.

A 2016 review by Virginia’s Auditor of Public Accounts found that,  “The BVU Authority’s OptiNet Division has a potential going concern issue, as it appears that they do not have the resources to continue operating without cross-subsidization [with revenue from other BVU services], which the Code of Virginia prohibits.” That review came after a U.S. Department of Justice corruption investigation, begun in 2013, resulted in the convictions of several senior managers at BVU, including its former CEO.

In 2016, Sunset Digital Communications announced it was buying OptiNet from the BVU for $50 million. The deal wasn’t finalized until this summer.

LaMura’s criticism of public-sector efforts, however, isn’t limited to examples of mismanagement. He objects to any public effort to compete with the private sector. Roanoke launched a regional network in 2016 with support from other municipalities, LaMura notes. “It is very frustrating,” he says.

More state funding?
So, VCTA will push for public subsidies that support private-sector expansions into unserved areas. But others say the rural areas have waited long enough. The Virginia Association of Counties (VACo) is joining the discussion. Sherrin C. Alsop, VACo’s president, is a member of the King and Queen County Board of Supervisors. The county grew tired of waiting for private-sector investment, she says. “That’s why we said, if we want it, we’re going to have to do it ourselves.”

The county spent its own money to install broadband access, building on top of its existing public safety radio communications network, she says. But VACo supports more funding for the VATI fund and a new revolving loan fund with no local-match requirements. VACo sent a 27-page plan to the governor in May.

One of the key voices in the General Assembly on broadband legislation is Del. Kathy Byron, R-Bedford. She supports more funding for the VATI grant program, noting that it directs that money to unserved areas. “Nobody has a crystal ball on what’s going to come out of the General Assembly this session,” she says. “I think this should be a priority just like any other economic development project and that we should continue to increase funding to public-private partnerships.”
FCC grants

The federal government has made a change in one of its funding programs and now is pumping a lot of new money into broadband. In August, the Federal Communications Commission announced nearly $1.5 billion for projects around the country with the goal of expanding broadband access. The money comes from the FCC’s Connect America Fund auction. The money will be distributed over a 10-year period. Among the recipients are four electric cooperatives from Virginia, including the CVEC. The others are BARC Electric Cooperative, Prince George Electric Cooperative and Mecklenburg Electric Cooperative.

Sunset Digital, the purchaser of the OptiNet system, will get $29.5 million over 10 years from the FCC, says Paul Elswick, the company’s president and CEO. The FCC has long subsidized rural telephone service, and this time the agency is devoting funds from that same funding program to rural broadband, he says.

Sunset bought the OptiNet system “because we wanted to grow the company.” Elswick estimates Sunset will hire another 50 people in the next 12 months, bringing total company employment up to around 160 people.

Elswick raises an interesting argument. If state and federal dollars start propping up private-sector projects — this rural broadband effort might find some traction.

“We’re in a paradigm shift for broadband in the nation,” he says. “People have always wanted to provide broadband in urban areas, and rural areas are the next market. We felt like this was a growth opportunity.”

Not just for humans

Here’s another reason why dogs are man’s best friend. A research effort now underway at Virginia Tech’s Virginia-Maryland College of Veterinary Medicine is testing a new technology — focused ultrasound — as a way to treat soft-tissue cancers in dogs.

Besides helping animals recover from tumors, the lessons learned during these treatments might help improve the use of focused ultrasound for human patients.

Both dogs and humans get these kinds of sarcomas, says Dr. Jeff Ruth, assistant professor in the school’s Department of Small Animal Clinical Sciences. “So, the things we learn from these dogs could translate to people,” he says.

The research is made possible through a partnership with the Charlottesville-based Focused Ultrasound Foundation, which was founded in 2006. Since then, the foundation pushed this technology forward by supporting the research, development and the commercialization of focused ultrasound technology.

More than 100 conditions
Dr. Neal Kassell, the foundation’s chairman and founder, says there are now more than 100 conditions being studied for focused ultrasound treatment, among them Alzheimer’s disease, essential tremor, Parkinson’s disease and metastatic breast cancer. These efforts are underway around the U.S. and in nearly 60 other nations.

Focused ultrasound is a noninvasive treatment that uses sound waves to destroy tissue. Most of the research still is in the early stages, though knowledge of its possible uses is growing “exponentially,” Kassell says. “The foundation is in a position to influence that trajectory” and accelerate the use of focused ultrasound.

The technology is being used to treat an ever-increasing number of people: 15,000 in 2014, rising to more than 50,000 in 2016. The total for last year isn’t available yet, but Kassell hopes it will be around 100,000 patients.

The foundation has an annual budget of $8 million to $10 million, with about 35 full-time and seven part-time employees. Five physicians help lead the foundation, including Dr. Suzanne LeBlang, the chief medical officer, who has more than 10 years clinical experience with focused ultrasound for uterine fibroids and bone metastases. Kassell is a former co-chair of neurosurgery at the University of Virginia.

$10 million donation
The foundation depends on donors, and Kassell is pretty good at fundraising. Last fall, the foundation received an anonymous $10 million donation, which is to be matched by 2022. Kassell thinks the matching funds will be in place this year or next.

Private-sector investors also are interested in the technology. In December, Koch Disruptive Technologies, a subsidiary of Koch Industries, invested $150 million in Israel-based Insightec, a commercial-stage, medical-device company that uses MRI-guided focused ultrasound.

The veterinary research is something of an outlier, because pretty much all the other efforts involve human illnesses. The Virginia Tech study itself is just beginning. The foundation grant is for up to $170,000, which will cover almost all stages of treatment for up to 20 dogs. That includes scans and the lab work and the surgery itself, which happens after the ultrasound treatment.

Cocker spaniel treated
So far, just one dog has been treated — a cocker spaniel — and the first indications are that focused ultrasound treatment has caused the dog’s own immune system to respond to the cancer, Ruth says.

“The reason cancer survives and thrives in the body is basically it disguises itself to look like just any other cell,” which means the immune system won’t know to attack it, Ruth says. “However, if you take these cancer cells and break them apart, it breaks down the cell membrane and exposes the proteins inside the cancer cells to the immune system.”

In October, the foundation will host its sixth International Symposium on Focused Ultrasound, this time in Reston. About 400 people are expected to attend.

There’s still a lot of work to do, Kassell says. Almost too much. “The foundation’s been more successful than anybody anticipated,” he says. The challenge now is, how to focus its resources “in areas where we can be most effective. We spend a lot of time trying to figure out which can translate into treatments.”

A health-care access challenge

During Virginia’s long debate on expanding Medicaid, the siren song for supporters has been “access to health care.” Pass the bill, they said, and thousands of uninsured finally will get to see doctors and nurses.

If only it was that easy. Getting a Medicaid card doesn’t necessarily mean you have a doctor at hand. Plenty of places in Virginia — especially rural areas — already are short of health-care providers. Oftentimes, people there depend on nonprofit community health centers or free clinics (both of which are chronically underfunded) scattered around the state, or they just go without. This is the true access challenge.

And, even with new money to help recruit providers, the whole health-care network, public and private, has to figure out how many new enrollees they’ll need to care for. So, it would take some time to see the full effect.

Deborah Oswalt, executive director of the Virginia Health Care Foundation, says the health-care sector will rise to the challenge of treating the newly insured. “I’ll tell you why. Because every one of [the new Medicaid enrollees] will go into managed care.

They’ll become patients of managed-care organizations. And those organizations will have contracts with DMAS [Virginia’s Department of Medical Assistance Services] that require them to ensure” they have enough providers.

The foundation would work to enroll newly eligible Medicaid recipients. “The thing that we’ve learned over 20 years is that it is a slower process than one imagines. It’s not as if a switch is going to flip, and all of the sudden these 300,000 people are going to be enrolled. It will take years.”

Doug Gray, executive director of the Virginia Association of Health Plans, agrees. “Of course, they won’t all enroll right away,” he says. “It’s more than an ‘if you build it, they will come’ situation. In some places, the capacity exists; in other places, it does not. Providers will hire more people, and the qualified centers may increase their capacity. We have the flexibility to change, but just like any change in a program, you’re going to have to see where the demand is. That takes a little bit of time.”

The new population of patients created under expanded Medicaid still would have to identify itself. There is, for example, the “woodwork effect,” a phrase generally used to describe a rise in enrollment when a program is changed or expanded. It means people who already were eligible hear about the change and come forward to enroll, resulting in more new applicants than just those newly eligible.

‘More boots on the ground’
Places like Southwest Virginia and Southern Virginia have some of the highest numbers of uninsured. In fact, an annual free clinic conducted for the past 18 years at the Wise County Fairgrounds by Tennessee-based Remote Area Medical has drawn national attention.

Last year, the three-day event, which is staffed by health-care volunteers, provided medical, dental and vision care to more than 2,000 people from Virginia and other states. The clinic returns to Wise County on July 20.

Teresa Gardner Tyson has firsthand knowledge of the needs of the uninsured. She is executive director of The Health Wagon, a nonprofit group that provides health-care services in Southwest Virginia. Because of the large number of uninsured people in the region, she says, “Medicaid expansion would be favorable for the people I treat.” The region, however, needs more doctors and mental-health professionals. “So, anything we can do to put more boots on the ground here in Southwest Virginia is favorable.”

Health Wagon is a free clinic. With expansion, it could become an official Medicaid provider, which would be ironic. “Because, right now, we do have Medicaid patients. We’re not getting any reimbursements; sometimes they can’t get in with a provider” and have to turn to the free clinic.

About five years ago, Health Wagon hired a consultant to run the numbers on how best to take advantage of Medicaid dollars if they started flowing. “We’d have to go back and look at those numbers again” and see whether becoming a Medicaid provider makes sense, Tyson says. “We’re sustained by donations and grants, and at the end of the day, though, we do give free care, [but] the care that we give is not free.”

Tyson’s organization is trying with some success to lure health-care professionals by promoting a “medical tourism” concept. “We do live in a very beautiful region, and people on the other end of the state come here, and they love it,” she says. A physician recently came to Health Wagon for a two-week stint, and a week earlier a cardiologist and radiologist visited. “We try to leverage every resource,” Tyson says.

Patient estimates vary
The Virginia Community Healthcare Association (VCHA), which has 29 member organizations at 147 sites, serves about 100,000 uninsured people every year. Neal Graham, its CEO, estimates that of that number, about 70,000 would be eligible for Medicaid under expansion. “So, that’s 70,000 people who are currently in our health-care system who would be eligible.” VCHA already is the largest Medicaid provider in the state, Graham says, and after expansion it could wind up enrolling an additional 100,000 new Medicaid patients.

Estimates of how many people statewide would be newly eligible vary, to say the least. “Everybody’s got a different number,” Graham says. There were estimates of 400,000 eligible people; then the estimate dropped to 300,000, based on an expectation that not all eligible people would enroll. “But about 100,000 are expected to come to community health centers, so, as you can imagine, that’s a large impact.

“Each health center would look in their area to see how many people are eligible,” Graham says. And if the expansion follows the existing model that uses managed-care plans provided by private-sector insurers then “we’re all in those networks now. We would work with those insurers to make sure those people are in proximity to health centers.” That would be a first step, determining where these people would go. “With that in mind, you would look at allocating the number of providers and the types of providers.”

The group has been anticipating these changes to the VCHA network. “We’ve been looking at this for five years now. We’ve got the models in place, and we’ve got a fairly good idea of where these people live and what centers they would go to. If it does happen, we can be operational in whatever time they require,” Graham says.

Making it work financially is “all about volume.” More patients would result in more revenue and distribution of costs. “You have to have a payer mix that will help cover some of the cost of nonpaying patients,” Graham says. “You just have to adjust your business model accordingly. So, that’s a capacity need that we’re struggling with, that other providers don’t have to worry about.”

Oral-health problems
A problem that could well exist, even with Medicaid expansion, is the lack of oral health care. People need dentists. “Right now, oral health is very limited in the Medicaid system, and that will not change,” Graham says. (Dental benefits for adult Medicaid recipients in Virginia are limited to medically necessary oral surgery and associated diagnostic services.) But once a person is enrolled as a primary-care patient, “we’re obligated to provide [more-routine oral health care] to you, but there’s no reimbursement,” he says.

It’s certainly not a problem unique to Virginia. Rural areas across the country struggle to recruit health-care providers. That includes primary-care, dental and mental-health professionals. “You really have to work harder to recruit providers who are willing to stay in those communities,” he says. “Where do you get enough providers? Where do you get enough mental-health providers?”

Graham says his group works with community-service boards around the state, which are a main point of contact for the state’s public mental-health system. “Anything beyond that, we simply cannot recruit the providers,” he says. “It makes a real challenge that we have to deal with on a daily basis.”

Typically, a health-care employer would lure people with higher wages. That’s not an option for the community-health centers or free clinics. As for Graham’s group, “it’s not like we’re a cash cow that can afford to pay extensive amounts of money” to help lure health-care providers. Offering housing sometimes helps, or when it comes to providing mental-health services, there are options with telemedicine. “You’ve got to be creative with these things. You’ve got to make sure some payment mechanism exists to make it possible. It does no good to then run out of money and have to close your doors.”

Safety-net grants
Organizations like the Virginia Health Care Foundation are one source. In early March the group announced $1.5 million in grants to 18 “health safety-net organizations,” the largest being a $235,000 grant to expand dental services at the new Family Dental & Specialty Center of the VCU Health Community Memorial Hospital in South Hill. The center is expected to open in mid-2018 serving patients in South Hill and Mecklenburg County.

The money doesn’t go just to rural areas; the second-largest grant was $220,000 to the Arlington Free Clinic. That funding is also for dental services for the county’s low-income and uninsured residents.

Finding money is an unending task. “You’re constantly looking for new resources. It cannot be just reimbursements to a provider,” Graham says. “Every day, the health-center executives and their boards wake up knowing this is the challenge, to provide quality, competent care to a population that can’t afford it. That’s why we exist.”

Kay Crane is CEO of Piedmont Access to Health Services, known as PATHS, which has five health centers in Southern Virginia. She says Medicaid expansion would have a good effect on federally qualified health centers (FQHCs), which would receive “enhanced reimbursements” — more money — because of their status. That means they could hire more providers, Crane says.

Crane says about 3,500 of her current patients would qualify for Medicaid under expansion. “That’s a big deal for us. Right now, about 22 percent of our patients are Medicaid eligible; children and adults with disabilities.” The group has hired two new providers recently, but that wasn’t done in anticipation of an expanded Medicaid program. “We just knew there was a need in our area.” In most communities, there is about one health-care provider for every 1,200 to 1,500 patients. “In our area, it’s like one provider for every 6,000 patients,” Crane says. “That’s what it means to be medically underserved.”

Legislation passed by the General Assembly this year could help the situation. The reduces requirements on licensed nurse practitioners (LPNs) regarding what level of oversight they need to have from physicians. The change likely means more LPNs can be hired to work in underserved areas.

A learning curve
There’s likely to be a learning curve under expanded Medicaid. Oswalt notes that, if there is a work requirement included in Medicaid expansion, “that’s a whole other layer of bureaucracy that we have to teach everybody and learn ourselves.”

Some confusion among the eligible state residents is likely, too, Oswalt says. “One of the things we saw when the ACA passed is that everybody automatically thought that everybody was insured. I’m afraid the same thing will happen here.” It’s bound to affect the process. “I think it would be wonderful in the first year if we could hit 100,000 people enrolled,” she says. “I’m going to be really happy if we do have Medicaid expansion, but we’ll still need a safety net.”

Much of the health-care debate since the 2010 passage of the Affordable Care Act has been about money and politics, that the federal government is getting too big, and that the law is costing too much. Both are legitimate topics, but on the front lines, people see the health-care issue differently. “Your life is shortened by living here in the mountains,” says Tyson. “Your longevity should not be dictated by your ZIP code.”

A ranking spanking

It is fun to be No. 1. Virginia had a taste of life at the top back in 2007 when CNBC named Virginia the “Top State for Business.” That was the first year the business-news network conducted such rankings.

Nowadays there are a lot of annual rankings of the best states for business. Virginia’s top-ranked performance has slipped lately for many reasons, including its cost of living and the effects of federal budget cuts. The 2017 CNBC ranking, for example, ranked Virginia seventh among the 50 states. That actually was an improvement. The year before, the commonwealth was No. 13.

In an effort to get Virginia back to the top of these rankings, the Virginia Economic Development Partnership and the Virginia Chamber of Commerce asked for a study by Virginia Tech’s Pamplin College of Business.

The study’s mission is partly a marketing effort. The commonwealth wants to regain its bragging rights as a top-ranked state. But officials also want to use the rankings to learn how Virginia stacks up to other states on many measurements so they can address its weaknesses. “You need to be competitive with what other states are doing, at least in your region,” says Robert Sumichrast, Pamplin’s dean.

Pamplin has been working on the study since 2016. Stephen Moret, VEDP’s president and CEO, says Pamplin’s first report calls for the state to create a custom -training system, invest in infrastructure such as broadband and do a better job of economic development marketing. Moret says VEDP may ask Pamplin for more analysis this year or next.

None of these findings are groundbreaking, but they offer confirmation that advocates of these goals are on the right track. The ranking study “is focused on laying out what it would take to get Virginia back to the top,” Moret says.

Barry DuVal, president and CEO of the Virginia Chamber of Commerce, says the study is not about “chasing the rankings. We are allowing the rankings to identify any deficiencies and then working to improve those deficiencies.” For example, Virginia once ranked among the top 10 states for its legal climate, but the commonwealth has since fallen out of that elite group, DuVal says.

And location matters in these rankings: This year Forbes ranked Virginia fifth in the nation — at first glance, a pretty good showing, until you notice that the top-ranked state was neighboring North Carolina.

U.S. News & World Report has its list, too, currently ranking Virginia No. 11. Virginia generally gets high marks for its workforce and quality of life, but lower marks for cost of living, infrastructure and a generally weaker economy in recent years.

The CNBC ranking is more transparent than most, says Kevin Carlson, associate dean for research and faculty affairs at Pamplin. The network website shows how a state ranks in each of 10 categories and how it performed in previous years. One of the reasons that Virginia climbed to seventh in the CNBC ranking is its improving economy, which jumped from 30th to 20th in the nation.

These rankings efforts generally use the same data — CNBC, for example, uses information from the U.S. Census Bureau, U.S. Bureau of Economic Analysis, U.S. Bureau of Labor Statistics and Moody’s Investor Service.

Understanding the rankings is helpful, but there are limits to what state leaders can do. “There are very few things that the state does directly; what it is trying to do is influence investment and other kinds of things,” Carlson says. “They’ve got to be able to signal effectively” to businesses “and try help when they can help. It’s a very complex job, and it’s always changing.”  

Two Virginias

Let’s revisit some recent economic misery. By March 2010, the Great Recession was over and a recovery was underway nationwide. But it surely didn’t feel that way in some parts of Virginia.

Southern Virginia, Southwest Virginia and other rural areas had lost jobs for years before the recession, as manufacturing and textile companies folded or left town for cheaper factories overseas. Coal and tobacco had long been fading, too. The 2007-09 recession only added insult to injury.

Eight years ago, for example, Henry County’s unemployment rate was 16.1 percent, with 3,910 people out of work, according to Virginia Employment Commission figures. The jobless rate in Martinsville was 18.9 percent. That’s 1,172 people looking for jobs.

A surging national economic recovery and new economic development projects have helped the Martinsville area in recent years. By last December, Henry County’s unemployment rate had dropped to 4.4 percent while Martinsville was down to 6.1 percent. That improving employment trend is happening in a lot of other rural areas of the state, too.

But it’s not enough. Compared with eight years ago, many rural communities are doing better, yet in important ways they’re still facing an uphill fight. The problem is not unique to Virginia — rural regions around the country are searching for ways to attract businesses and to keep their youth from going somewhere else to work.

There’s a renewed effort underway to reverse this trend. Under the direction of Stephen Moret, its president and CEO since January last year, the Virginia Economic Development Partnership has put a high priority on helping economically weaker parts of the state. Likewise, GO Virginia, a new statewide program, is focused on economic strategies developed at the local and regional level. And the Virginia Chamber of Commerce has drafted its Virginia Blueprint 2025 economic development plan that aligns with the goals of VEDP and GO Virginia. There is some fairly serious money and resources behind all these efforts.

Why the extra attention? Maybe it’s because many rural residents spoke loudly in the 2016 presidential election about being forgotten. Plus, the gap between the rising wealth of people living in Virginia’s urban crescent and the lagging fortunes of those in rural Virginia just keeps growing. There really are two Virginias, and one is chronically struggling.

On the same page
Barry DuVal, president and CEO of the Virginia Chamber of Commerce, says that when it comes to which strategies are best for improving the Virginia economy, the state’s business community “is the most aligned today than it has ever been in the past 20 years.” The chamber’s Blueprint plan, for example, pushes four main points — marketing the state as a prime business site, expanding broadband access, developing business-ready sites and customizing training for business prospects — that line up with the VEDP’s goals.

Virginia had a slower recovery from the recession than did many parts of the country. That situation — and a general sense that Virginia, a one-time frontrunner, now was trailing the competition — got peoples’ attention. “Frankly, the business community saw the fall in our international rankings, the drop in our per-capita income and the impact of sequestration,” DuVal says. “Out of crisis comes motivation.”

A top priority for these groups in the 2018 General Assembly session (which was still in session as this issue went to press) was developing “customized” workforce recruitment and training programs. So, if a business wants to expand, it can get quick help in finding and training workers with support from the state’s community colleges and workforce training centers.

A local example of this concept is the Commonwealth Centre for Advanced Training (CCAT), a 26,000-square-foot facility being built in Henry County’s Commonwealth Crossing Industrial Park near the North Carolina line. CCAT will serve businesses moving into the park. A company can place its equipment in the facility and begin training new employees while its plant is under construction. By the time the plant is ready, its workers are thoroughly prepared and ready to begin operations.

A model for statewide programs is Georgia’s Quick Start program, which is offered through its system of 23 technical colleges. Area Development magazine, a trade publication for site consultants, named Quick Start the top workforce training program in the country last year.

Little marketing money
Another goal is creating a stronger marketing program. A recent VEDP report says that, in comparison with competing states such as Georgia, Florida and Ohio, “Virginia has an economic development marketing budget of approximately zero.” The report goes on to say that Virginia is considered “a quiet state by many corporate executives and site-selection consultants … In particular, the story and potential of rural Virginia is not being shared.” The marketing plan VEDP and other groups were proposing would require at least $3 million a year.

There were a couple of other budget proposals VEDP and others were pushing. One is expanding the number of “certified” business-ready sites. Virginia has fewer of these sites than many of its competitors, especially sites of 100-plus acres, according to VEDP. In fact, the top reason that Virginia loses manufacturing and distribution projects to other states is the lack of development-ready sites. VEDP says that expanding this effort will help rural and economically distressed regions, which generally don’t have the money to create certified sites.

A fourth proposal was expanding the state’s international trade programs, at a cost of at least $1.8 million more per year. VEDP claims that increasing the number of companies enrolled in its programs from about 320 to roughly 500 a year would translate into 5,000 to 10,000 trade-supported jobs annually during the next 10 years.

Moret is blunt about the challenge the state faces in boosting the economic health of its rural regions. “When we look at the challenges of Southside and Southwest, they are largely similar to the challenges faced by rural areas” around the country, he says. “Metro areas are heavily advantaged, and that’s where companies want to go.”

He also says the state’s incentive program is weak. “Virginia is really a very low incentive state. Most of the time, other states are willing to offer considerably more,” Moret says. “Can we be willing to step up a little bit to compete with these other Southern states?”

And, rural areas need more broadband access. “If people can’t get broadband in their homes, we can’t retain the talent that we really need.”

GO Virginia
The newest entity in this effort is GO Virginia, shorthand for Virginia Initiative for Growth & Opportunity in Each Region.The program takes a regional approach, aiming to develop growth strategies for each section of the commonwealth based on its particular needs. The program has nine regions, each headed by a council of local leaders.

Charles Majors, chairman of the board of Danville-based American National Bankshares, heads the GO  Vir­­ginia council in the organization’s Region 3. The region, which has a population of 372,000, includes the cities of Danville and Martinsville and 13 counties: Amelia, Brunswick, Buckingham, Charlotte, Cumberland, Halifax, Henry, Lunenburg, Mecklenburg, Nottoway, Patrick, Pittsylvania and Prince Edward.

Regional councils develop projects for which they seek state funding. In December, the GO Virginia state board approved a handful of grant requests, most of which were for projects in Northern Virginia or Hampton Roads.

Region 3 didn’t seek any grants in the first round of funding but will submit proposals later this year. “We’re not far enough along in the GO Virginia process to tell you how much this is going to help us. We’re really at the beginning stages. But I’m really optimistic,” Majors says.

Region 3 is a good place to measure the needs of rural economies. It is the smallest of GO Virginia’s regions in population, has the highest unemployment rate (5.3 percent) and the second-lowest level of per-capita income ($33,480). Those are all GO Virginia figures.

Majors says the sheer geographic size of the region makes it tough for the council to develop a cohesive plan. Nonetheless, the arrangement offers the region’s localities a big-picture perspective. They aren’t really competing against each other. “We used to fight among ourselves” when the localities in Region 3 were trying to organize. “Now we’re realizing, if we’re Danville, our competition isn’t really Martinsville. It’s another state, another country,” Majors says.

Aging population
But regional cooperation may not be able to fix perhaps the biggest challenge for rural towns, cities and counties. “Our greatest gap is that we have an aging and shrinking population,” says a guiding document for the region that was presented last summer by GO Virginia. Here’s the recommended cure: Get young people to stay at or near home and give them training and then attract companies that will give them jobs.

The region is putting some serious muscle into keeping its young workforce at home, but the latest figures reveal that it is not working yet. Numbers released in late January show that between 2010 and 2017, Henry County lost 4 percent of its population, Lunenburg County lost 4.1 percent, and Brunswick County lost 5 percent.

During the same timeframe, urban areas gained a lot of people, especially the suburbs around Washington, D.C. Arlington’s population, for example, rose 15.1 percent, and its December unemployment rate was 2.2 percent, the lowest in the state. Outside of Northern Virginia, Albemarle County, anchored by Charlottesville and the University of Virginia, saw its population rise 8.8 percent to 107,697.

The people who are leaving are generally younger, with fewer economic ties to their home regions. Localities that want to keep them have to provide jobs. Henry County and the city of Martinsville have had recent success doing so. VEDP lists 11 economic development announcements in Martinsville and Henry County since the beginning of 2016, which were expected to generate a total of 333 jobs and and investments of $43.7 million.

In addition, the Martinsville-Henry County effort has the support from the Martinsville-based Harvest Foundation, which was formed in 2002 and funded by money from the sale of Memorial Hospital of Martinsville and Henry County. The foundation last year provided a three-year grant totaling $3.1 million to pay tuition for the first two years of college at Patrick Henry Community College for all qualified spring 2018 graduates at high schools in Martinsville and Henry County. The foundation also provided a $5 million grant to support development of the CCAT training center.

But good news in one area doesn’t necessarily tell the story for the whole region. Of the 493 manufacturing firms in the region, only 67 are in sectors like advanced  materials manufacturing. And of those companies, 93 percent are in four localities: Henry County, Halifax County, Danville and Martinsville. It’s to their credit that those clusters exist, but, in a way, it is the exception that proves the rule, which is that most of the rural region is struggling. The Region 3 group produced a development plan last August that put it this way: “While certain parts of Region 3 are positioned for a strategy to build on existing clusters, much of the region is not.”

Some of the strategies for fixing that include targeting specific sectors — advanced manufacturing, health care, IT (including cybersecurity and data centers) and education. The development plan says 30,000 people leave the region every day to work in jobs elsewhere, so recruiting companies that would employ them in their hometown makes sense. It also calls for recruiting workers from outside the region and offering cash incentives. Other localities offer to pay off student loans, give cash rebates for new home construction and provide free tuition for the children of workers.

It’s impressive to hear how many tactics regions around the country are trying to keep workers at home and attract new ones in the right sectors. Of course, there’s a downside to offering all these incentives; these training programs can end up creating skilled workers who still go somewhere else.

The trick is tying these training programs directly to the targeted sectors a region identifies. In a sense it’s all about timing and having the skilled workers available, or at least in the pipeline, when businesses come looking. That’s a tough task. “I think historically the sense was, there wasn’t enough attention” paid to rural areas, Moret says. “For us to help rural areas to grow, we have to actually succeed where other states have failed.”

What’s working?

In the roiling debate about what to do with the nation’s health care, it would seem a good idea to find out which practices work and which ones don’t.

But that knowledge can be hard to come by. Toward that end, five of Virginia’s major health plans are taking part in a new pilot program led by the Catalyst for Payment Reform (CPR), a nonprofit group that seeks to measure “which strategies are having the desired impact in the market,” according to its website.

Virginia will be one of three states taking part in the CPR project, says Beth Bortz, president and CEO of the Richmond-based Virginia Center for Health Innovation (VCHI), which is responsible for getting the state’s health plans involved. New Jersey is the second state, and a third is so far unnamed. The VCHI and the Virginia Association of Health Plans are co-sponsoring the effort here.

The health plans participating in the project are Aetna, Anthem, Optima, UnitedHealthcare and Virginia Premier. Each has agreed to provide data to CPR about health-care spending during a one-year period, reaching back through 2016 or the most recent 12 months. Not all the state’s major health plans are participating. CareFirst in Northern Virginia and Cigna, which operates statewide, might participate but haven’t yet agreed to do so.

The key goal is to identify health-care payments in commercial and Medicaid sectors that are “value oriented,” which CPR defines as effective treatments combined with a reduction in unnecessary spending. That means the project’s intent isn’t just to find effective treatment. “We’ve been about advancing value,” Bortz says. “It’s not quality at any cost.”

Funding for CPR’s work comes largely from the Robert Wood Johnson Foundation and the Laura and John Arnold Foundation. Results are expected by next August.

There are a couple of reasons Virginia is involved in the project. First, Bortz wanted VCHI to take a step back from trying to guess which direction health-care policy will go — in Virginia and nationwide. “In the world of health-care reform and innovation, there is great uncertainty these days,” she says. “I made a decision last November that … we were going to pull back a little bit and focus on how we prepare ourselves for whatever reality emerges.”

And secondly, Bortz says, pretty much every part of health-care policy will be, or should be, backed by data. “All of that is going to require more sophisticated data, more actionable data, more timely data than we have had in the past,” she says.

Bortz says the CPR’s work is the closest she’s seen to the kind of product she wants to pursue. Plus, she says, “They have resources and analytics I don’t have in Virginia.”

Health Value Dashboard
Involvement with CPR will help a project VHCI has already begun. It is a data-based measurement of health care called the Virginia Health Value Dashboard. Its purpose “is to prompt action for improving the value of health-care services,” says VHCI.

Examples of “low-value” care that the dashboard project is targeting include: avoidable emergency-room visits, hospital readmissions and the use of high-cost service sites when less expensive options are available. The “high-value” care examples include: up-to-date vaccinations, smoking cessation programs, better screening for cancer and improved management of chronic conditions such as diabetes.

The goal is to have in place by January a dashboard tool for groups that provide, buy or fund health-care services to use in evaluating various costs. Being part of the CPR’s project is a big step toward that goal. “It costs money to get good data,” Bortz says.

Good information is being collected about health-care spending, but it’s generally held by private entities like hospital groups or commercial health plans, and they don’t share that information. “The challenge is: They’re all going in different directions” serving their own competitive interests, Bortz says.

VCHI wants to act as a neutral entity — a challenging task in a national policy debate that has “gotten to a pretty toxic place,” she says. But the problem shouldn’t affect these data projects. “It doesn’t matter which side of the aisle you’re on,” she says. “Whatever you want to do will be helped by better data.”

Mediocre health rankings
Bortz notes that Virginia ranks high among the 50 states for its “business-friendly” environment and per-capita income, but its rankings fall to the middle of the pack or lower on national health scorecards. For example, Virginia is 21st in the nation on Gallup-Share­care’s Well-Being Index and is ranked 42nd by Mental Health America, a nonprofit group based in Alexandria.

A 2016 state-by-state analysis conducted by America’s Health Rankings, which examines a wide range of health issues, ranks Virginia 19th in the nation overall but 43rd in health-care policy.

One of the big obstacles to better data is technology. “Technology in the health-care world is decades behind every other industry,” says Doug Gray, executive director of the Virginia Association of Health Plans. So there’s no agreed-upon methodology for sharing data, even if the various entities were willing to do so. “We’re in the beginnings of trying to … see the connection between the standard of care and what’s happening in the real world.”

Money is at stake, and the health-care industry tends to pit one revenue-hungry entity against another. Say a medical practice gets big enough to set up its own lab instead of sending those tests out. Then it has an incentive to order more tests. Insurance plans might smell wasteful spending, but is it really wasteful? There are not enough reliable measures, just arguments. “You can’t talk about the standard of care and its value without getting to the cost,” Gray says. “This is not easy stuff to manage.”

Shared data key to project
The willingness of the state’s health plans to share data was a key factor in Virginia being invited to the CPR project. Without their help, the project won’t happen.

Andréa E. Caballero, program director for CPR, says health plans have good reason for keeping secrets. “We’ve been very fortunate,” she says. “For individual health plans, sharing information is when they get very nervous.”

The data that health plans share with CPR will be measured in aggregate so that no secrets will be spilled. “This is to be used by Virginia for its strategic purposes,” she says.

In fact CPR would like to do similar studies in every state, or at least see some entity, private or public, do the studies. In a best-case scenario, the report can be done every year. The results of this year’s analysis “will be a snapshot” of what’s going on in Virginia’s market, Caballero says.

The goal isn’t to compare Virginia’s health-care spending with New Jersey or any other state, “but the more states we have information on, the more we can determine what are the market impacts of health-care spending decisions,” she says.

Welcome to the neighborhood

You might not think the Fredericksburg region has any link to Boston, but it does.

Boston is the northern end of what urban scholars call the Northeast Megalopolis, a string of cities and dense suburbs along the Interstate 95 corridor that is home to about 55 million people, all living in about 2 percent of the U.S. land area.

Experts used to define this 500-mile corridor as ending in Washington, D.C. Nowadays, however, the end point is 50 miles south, in the Fredericksburg area, which has been growing rapidly for decades. Workers keep moving to the area, with most of them commuting to jobs north.

The Fredericksburg region includes the city of Fredericksburg and the counties of Stafford, Spotsylvania, Caroline and King George. Here’s how fast the region’s population is expected to grow, according to forecasts from the University of Virginia’s Weldon Cooper Center for Public Service: between 2016 and 2040, Virginia will grow by about 21 percent, to 10.2 million people. The Fredericksburg region, however, will grow more than twice that rate — up 43 percent, adding about 151,000 people and topping half a million total residents. See detailed growth patterns for the region.

In raw numbers, most of these new residents are settling in Stafford and Spotsylvania counties. Those two counties make up 77 percent of today’s population and will have pretty much the same share in 2040, according to the Weldon Cooper Center. That means that out of the 151,000 new residents, nearly 119,000 will live in these two counties.

It’s not hard to figure out where many of these new residents will live. Developers and the local governments generally are steering development to where the roads or rails are, or where they will be.
Development along I-95

Interstate 95 dominates everything when it comes to development in the region. Spotsylvania’s most active growth is around the interstate exit at mile 126, its northernmost interchange, and that’s what the county wants. “If you look at the past comprehensive plan and the growth patterns we’re now seeing, we’ve done a good job” of guiding development, says Leon Hughes, the county’s assistant director of planning.

Among the developments is Jackson Village, which hasn’t been built yet. Plans call for 2,270 residential units on 241 acres along U.S. 1 near I-95. It is a mix of apartments and condos and single-family homes. That project was approved in 2015, along with the Alexander’s Crossing, a 701-acre mixed-use development. The two developments will be linked by a four-lane bridge over the interstate if all goes as planned. Also on the books in this part of the county is the 1,060-home Heritage Woods subdivision, on 378 acres along U.S. 1.

Hughes says the bigger, single-family detached housing developments are not making much progress now, but apartment projects are. Apartments have been a hot trend in real estate in a lot of urban areas in Virginia in recent years, and Spotsylvania is seeing that trend, too. A few miles east of I-95 is the southernmost station of the Virginia Railway Express, which opened in 2015.

There are new apartment homes being built on land between the VRE station and the interstate, many of them projects of the Silver Cos., a major local developer. They’re pretty fancy, and a short drive to either the interstate or the VRE station. There’s also plenty of shopping and restaurants nearby, and a hospital, Spotsylvania Medical Center, which is attracting medical office projects.

Buffalo Bills fans
The sense among county planning staff is that many new residents have left parts of the country that have been hurting economically for years. Jacob Pastwik, a planner for Spotsylvania, is from Buffalo, N. Y., and says he’s found a lot of former Buffalo residents here, looking for work.

“There’s a lot of people here who are not from here,” Pastwik says. The presence of military personnel drives up demand, too, for temporary housing along with young adults who need rental space they can afford. During football season, Pastwik helps organize a weekly gathering of Buffalo Bills fans to watch the team’s games on television. “Every Sunday there’s a whole community” of Bills fans with roots up north, he says.

In general, a lot of these newcomers are coming for jobs in the region, which had an unemployment rate of 3.9 percent in July. But, many will commute north to jobs in the Washington, D.C., region. So, in an important way, the new transportation improvements in the Fredericksburg region only make it easier for its residents to commute.

Here are details on three transportation projects. The new VRE station in Spotsylvania has been open since late 2015, and the two-mile extension of the Express Lanes on I-95, now under construction, will bring those lanes into central Stafford County. That project is expected to be complete next year. Plus, work has begun on a new $150 million interchange on I-95 in central Stafford. That’s a big deal because it will create much better access to land that the county and the private sector want to develop. The project is supposed to be finished in 2020.

That interchange and a second one about five miles away near the county’s northern boundary will welcome a lot of the region’s new residents. The Embrey Mill community is an 831-acre development on the west side of I-95 between those two interchanges. At build-out, the development could have up to 1,800 homes.

1,200 residential units
Also adjacent to the new interchange is a proposed project by Stafford-based Garrett Development. The company has about 1,000 acres on the west side of I-95 and has been seeking county approval for a development called George Washington Village. It’s planned as a mixed-use development that Andy Garrett, the company’s founder and president, says would have 1,200 residential units, including single-family homes, townhouses and apartments, along with commercial space.

“George Washington Village could be an absolute winner for Stafford County,” Garrett says. He’s been working with the county for several years to win approval. Garrett also says that, with the road improvements in his project and in the Embrey Mill development, county residents would have a major north-south route parallel to I-95 on the west side of the interstate. Currently the county has U.S. 1, on the east side of I-95, as its only other north-south corridor.

While the big counties of Stafford and Spotsylvania plan for big population growth, the region’s three other localities are expecting growth, too, but at a much lower level. King George County to the east has just fewer than 25,000 residents today and is expected to grow 41 percent by 2040. And Caroline County at the region’s southern end is expected to remain significantly smaller than its northern neighbors. It is also going to grow more slowly, according to Weldon Cooper projections. Its current population of about 30,000 will rise 35 percent by 2040 to 40,000. Neighboring Spotsylvania, by comparison, is expected to have 181,000 residents by 2040.

In the middle is Fredericksburg, which has experienced a building boom of sorts. Several downtown condominium projects are either completed or under construction. The city’s population is expected to rise more than 43 percent by 2040.

Another prediction supported by the Weldon Cooper data is that the megalopolis likely will not get longer during the next 20 years. Shonel Sen, a research and policy analyst at the Weldon Cooper Center, agrees that this giant corridor now extends to the Fredericksburg region, but it might stop there for awhile.

Between the relatively rural Caroline and the city of Richmond is Hanover County, which is expected to grow by about 20,000 people in the next 20 years, to 127,000. That’s substantial growth, but not on par with what the Fredericksburg region is going to see. “Richmond is further away and does not have a population size high enough to include it [in the megalopolis] and stretch it all the way to the Hampton Roads region,” Sen says.