Dr. Bob Moser knows western Kansas and the family physicians who care for its residents about as well as anyone.

He's been both himself.  

The Tribune, Kansas, native and KU School of Medicine graduate will use his background to lead a $12.5 million effort to reduce deaths from heart disease and stroke in northwest Kansas.  

"We have to raise awareness about early recognition of heart attack and stroke symptoms and calling 911," Moser said. "The culture out there is that they don't want to bother anyone," Moser added of the area's residents, particularly older citizens.  

Physicians and other providers are well-trained but don't have all the resources or the expertise of specialists. Among other goals, the project Moser now oversees will make that knowledge available in their clinics and emergency rooms via the technology of telemedicine.  

Moser brings more than a bit of relevant experience to running a government-funded program: from 2011 to 2014 he ran one of the state's largest agencies, the Kansas Department of Health and Environment.

"Bob's always had a good head for policy and looking at things in broad strokes, which is different from most physicians," said Dr. Rick Kellerman, chair of the Department of Family and Community Medicine at KU School of Medicine-Wichita, who's known Moser since the latter was a resident.  

Moser, 57, grew up in Greeley County, as far west as you can go and still be in Kansas. His father owned a garage and body shop in Tribune (pop. 740) and his mother was the bookkeeper. He didn't give much thought to a career in medicine until a sixth grade teacher asked him what he wanted to do in life.  

"I chose architect," Moser recalled with a smile. "She said 'No, you should become a doctor.' It got me thinking."  

Moser gave up junior college scholarship offers in track and golf to attend the University of Kansas, earning a pharmacy degree and then enrolling in medical school. He worked part-time for a pharmacy during his first two years of medical school.  

When it came time to apply for a residency, Moser's choice was the Wichita campus' Smoky Hill Family Medicine program, located in Salina. "I wanted a program where I got to do everything," Moser said, adding that Salina didn't let him down. With only four residents a year entering the program, there was more than enough training in obstetrics, minor surgery and all the other aspects of family medicine to go around.  

Moser's plan had been to pay off his student loans by serving in a critically underserved community, then find a spot that would allow him to teach medicine as well as practice it.  

But about a year after returning to Tribune, the town's other physician left and Moser found himself the only doctor in Greeley, as well as adjacent Wallace County. Moser saw patients in the clinic, hospital and long-term care facilities; at one point, he had 7,300 active patients on the rolls. He was the county health officer and coroner. Rather than leave, he built up the area's medical service. By the time he left 22 years later, he was one of five family physicians serving Greeley, Wallace and Hamilton counties.  

"The community did a great job of really supporting our health care system," said Moser, who was named Kansas Family Physician of the Year in 2006.  

Moser had kept in touch with Kellerman, who brought him to KU School of Medicine-Wichita in 2010 as an associate clinical professor in the Department of Family and Community Medicine and director of the Rural Health and Outreach program.  

Moser seems almost sheepish as he recalls what led him to leave that post and Wichita after just five months (long enough to buy a house, he notes). Gov. Sam Brownback, then about to start his first term, was considering naming a physician as secretary of the Kansas Department of Health and Environment for the first time in that agency's history. When a member of Brownback's transition team called seeking input, Moser said, "I opened my big mouth and said 'What a great idea!'" Moser accepted Brownback's offer to head the agency himself.  

"I spent four years recruiting him and had him for four months and it took Sam Brownback 20 seconds to recruit him," Kellerman joked. The appointment wasn't as surprising as it might have looked: Moser had long been active in governmental advocacy work on behalf of the Kansas Academy of Family Physicians.  

In Tribune, Moser "really focused his work on setting up a system with the physicians, the hospitals, the long-term care facility, and pharmacy and everybody being on the same page," Kellerman said. As health secretary, he added, Moser kept up the pace. "He read voraciously and learned about health-related issues from pig farms to coal plants to runoff in lakes. He did a good job on the environmental side. I think because of his rural background, he kind of had an understanding of that."  

Moser describes his four-year run at the health department as a period of intense work alleviated only by the mundane task of affixing his signature to many official documents. His tenure wasn't without controversy as he carried out the governor's vision for what health care in the state should look like.  

"I learned a ton," he said. In general, he said, "I'm glad I had the chance to do that."  

In December, immediately after resigning as health secretary, Moser was named executive director of the Kansas Heart and Stroke Collaborative at the University of Kansas Hospital. Funded by a three-year, $12.5 million award from the Center for Medicare and Medicaid Innovation, the project is designed to reduce two of the state's five leading causes of death, which have higher rates of mortality in rural areas. In 2013, 5,331 Kansans died of heart disease and 1,306 of stroke.  

The KU Hospital is partnering with Hays Medical Center, the First Care Clinic in Hays, and 11 critical access hospitals: Cheyenne County Hospital, Citizens Medical Center, Gove Medical Center, Ness County Hospital, Norton County Hospital, Pawnee Valley Community Hospital, Phillips County Hospital, Russell Regional Hospital, Rooks County Health Center, Sheridan County Health Complex, and Trego County-Lemke Memorial Hospital.

The program will use telemedicine, health data exchanges, preventive health screenings and community health "coaches" to reduce deaths from heart disease and stroke as well as the cost of treating them. A key component is standardizing treatment, including using the same criteria to decide when patients need to be transported to receive a higher degree of care.  

"I thought this position would not require I wear as many hats, but I'm not sure I've gotten away from that," Moser said.  

On a personal level, the job brings a big reduction in travel. While Moser was in Topeka, his wife Dalene had remained in Tribune, working as a respiratory therapist and medical lab technician, and keeping an eye on the home they used to run as a bed and breakfast. Moser notes that he still covered an occasional weekend shift at the Greeley County Hospital during that period.  

"If she was going to be on call, I was going to be on call," he said.  

Now they are both at their Lawrence home, letting Moser catch more of the games of his beloved Jayhawks. It's an arrangement Moser thinks will last longer than the life of the three-year grant. The Center for Medicare and Medicaid Innovation will evaluate the collaborative's work to see if it can be replicated elsewhere.  

"I don't see this job ending because we've accomplished what we want to do," Moser said. "It's been best described by the program operations director, Jodi Schmidt, as 'venture capital' the federal government has given us to prove our theory."