Building a Healthier Hawaii Island-- Together

Hawaii Community College Community Economic Development Strategies,

April 27 2012

Sharon Vitousek MD, North Hawaii Outcomes Project , www.nhop.org

Hawaii Island Healthcare Alliancewww.hawaiihealthcarealliance.org

How can HCC support economic growth of the Health sector?

• What health careers are expected to grow?

• [What additional training is needed for existing health professions?]

• [What partnerships/ resources can help answer these questions?]

Why should we collaborate to grow the health sector on Hawaii Island ?

Inadequate Access on Hawaii Island

Source IHI John Wasson MD

Impact of Primary Care Shortage

• Delayed Care & Increased suffering• Higher ER utilization• Higher hospital utilization• Increased costs• Less focus on Prevention- Life style• Less screening- Cancer & Depression• Poorer outcomes

Health Disparities in Hawaii County 

Higher Death rates from:– All causes– Heart disease– Stroke– Overall cancer– Infant Mortality– Suicide– Traffic-related accidents

Lower Life Expectancy

Higher Teen Birth Rates

764.0

670.8

668.4

603.8

0

100

200

300

400

500

600

700

800

900

1000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

-Adj

uste

d D

eath

Rat

e pe

r 100

,000

pop

ulat

ion

All Causes - Age-Adjusted Death RateHawaii County Compared to the State

Chart: North Hawaii Outcomes Project - April 2011 Source: Office of Health Status Monitoring, 1999-2011

Hawaii County

State

153.4

Hawaii CountyHawaii County

93.4HP 2020 - 100.8

124.3

State 77.6

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

-adj

uste

d ra

te p

er 1

00,0

00 p

opul

atio

nCoronary Heart Disease - Death RatesHawaii County compared to State (1999-2009)

Chart: North Hawaii Outcomes Project - May 27, 2011 Source: Hawaii State Department of Health - Office of Health Status Monitoring 1999 - 2009

75.5

Hawaii County

42.7

61.9

State39.1

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Age-

adju

sted

rate

per

100,

000

popu

latio

n

Chart: North Hawaii Outcomes Project - May 31, 2011

Cerebrovascular(Stroke) Disease - Death RatesHawaii County compared to State (1999-2009)

Source: Department of Health - Office of Health Status Monitoring, 1999 - 2009

Healthy People 2020 Target - (33.8)

172.7

156.3151.9

140.7

0

20

40

60

80

100

120

140

160

180

200

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Dea

ths

per 1

00,0

00 a

ge-a

djus

ted

popu

latio

nOverall Cancer - Death Rate

Hawaii County Compared to the State - (1999-2009)

Chart: North Hawaii Outcomes Project - May 31, 2011 Source: Office of Health Status Monitoring, 1999-2009

State

Hawaii CountyHealthy People 2020 Target - 160.6

Institute of MedicineFramework for Population Health

Social and Physical Environment

Social, Economic & Physical Environment

(Socioeconomic Determinants)

Health-Related Behaviors

Health Systems

(Access to Care)

Population

Health Outcomes

9.8%

5.6%

8.3% 8.7%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

Hawaii County City & County of Honolulu Maui County Kauai County

Average Percent Unemployed 2010

Chart: North Hawaii Outcomes Project - January 2012 Source: American Community Survey 2010

$22,713

$28,629 $27,767$24,774

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

Hawaii County City & County of Honolulu Maui County Kauai County

Per Capita Income - 2010

Chart: North Hawaii Outcomes Project - October 2011 Source: U.S. Census, ACS 2010

35.0%

21.9%

28.4% 26.5%State - 24.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Hawaii County City & County of Honolulu Kauai County Maui County

Population at or Below 200% Federal Poverty - 2010

Chart: North Hawaii Outcomes Project - October 2010 Source: U.S. Census Bureau, ACS 2010

25.0%

18.0%

12.5%11.0%

State - 13.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Hawaii County Maui County Kauai County C & C of Honolulu

Youth Below 100% Federal Poverty Level 2010

Chart: North Hawaii Outcomes Project - October 2011 Source: U.S. Census, ACS 2010

21.2% 21.9%

25.2%

28.4%State - 22.5%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Hawaii County City & County of Honolulu Maui County Kauai County

Chart: North Hawaii Outcomes Project - October 12, 2011 Source: U.S. Census Bureau, ACS 2010

Population 25+ years With Some College, but no Degree (2010)

0

100

200

300

400

500

600

700

800

1994 1995 1996 1997 1998 1999 2000 2001 2002 *2003 *2004 *2005

Age

Adju

sted

Dea

th ra

te p

er 1

00,0

00 p

opul

atio

n

Less than 12 yrs of school 12 yrs of school 13 yrs of school or more

13th Year of School Associated with Lower Death Rates

U.S. Age-adjusted per persons 24 - 65 years of age

Chart: North Hawaii Outcomes Project - February 2010 Source: Health, United States 2008

*Reporting areas that have adopted the 2003 revision of the U.S. Standard Certificate of Death are excluded because educational attainment data based on the 2003 revision are not comparable with data based on the 1989 revision of the U.S. Standard Certificate of Death. Starting with 2003 data, data from California, Idaho, Montana, and New York are excluded. In addition to these four states, starting with 2004 data, Connecticut, Georgia, Michigan, New Hampshire, New Jersey, Oklahoma, Rhode Island, South Dakota, Washington, and Wyoming have adopted the 2003 revision and therefore are excluded. Because of different education profiles of the excluded states compared with the remaining reporting areas, 2003 and subsequent years are not directly comparable to earlier years.

Health Disparities - Hawaii CountyHealth Related Behaviors- 2010

Behavior State Hawaii County

Smoking 15% 20%Obesity 26.3 23.1Binge Drinking 17.9 17.7Adults no leisure physical activity

19.2 20.2

Health Disparities - Hawaii County

 Health Systems

Access to care:• Higher uninsured Lower ratio of physicians per 1,000 population• Higher percent of population without a personal doctor• Lower percent mothers receiving prenatal care

Utilization & Cost:• Higher acute care hospitalizations per 1,000 population

Quality: 

2.1

3.4

2.22.4

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Hawaii County City & County Of Honolulu

Maui County Kauai County

Lice

nsed

phy

sici

ans

per 1

,000

pop

ulat

ion

Licensed Physicians with a Hawaii Primary Address per 1,000 Population by County (2011)

Chart: North Hawaii Outcomes Project - September 2011 Source: Numerator from Department of Commerce and Consumer Affairs –July 27, 2011

*Denominator from U.S. Census 2010 .may or may not be active** Licensed physicians

Hawaii Island Increasing Provider Shortages

2010 2012 2014 2016 2018 20200

100

200

300

400

500

600

700

SupplyDemand

157331

Source : JABSOM Workforce Study, Kelly Withy

What Healthcare ProvidersAre Doing

• Collaboration to improve:– Hawaii Island Healthcare Alliance- – Hawaii Island Beacon Community

• Health information exchange• Clinical transformation, care coordination

– Hawaii Island Trauma Committee– Hawaii Island Perinatal Collaborative– Long Term Care Hui / Aging Resource Center,

• Island wide, voluntary, collaborative group of stakeholders

• Goal: Improve health & healthcare in Hawaii County by increasing healthcare workforce

• Friends of the Future is 501(c )(3) Fiscal Agent

SupportsGrowing Our Primary Care Workforce

Family Practice Residency Program in HiloGrowing effective use of mid-level providersImproving recruitment & retention of providers

Increase effective use of technology - Beacon Collaboration and leveraging resources

Regional planning Aligning high leverage policy change.

HAWAII ISLAND FAMILY HEALTH CENTERCurrent Health Training site

Health Workforce Shortages are in a Larger Economic Context

Negative Impact• Health Disparities are

Partly a Result of poorer rural economy

AND

• Health Workforce shortages are a Barrier to productivity & economic growth

Opportunity• Growing the health

workforce is an OPPORTUNITY to stimulate economy

• Job multiplier effect of Physicians is ~1 to 5

Healthcare is 3rd Largest Employer in Hawaii County (DBED Nov 2011)

Growing Healthcare sector is part of economic development for Hawaii Island

Employment sector # of Employees1. Government 12,0002. Retail trade 8,0003. Healthcare/social assistance 6,9004. Accommodations 5,5005. Food and beverage services 5,200

What Hawaii County Can Do

• Approach policy decisions through a health lens: “How will this policy impact the health of our

community-- now & in future ?” • Support Hawaii County economic development

of the science, energy, education & healthcare sectors

• Add community health improvement to Criteria for Community Development Conditions

• Advocate for State health data to be analyzed by County and Sub- county to better track needs & progress

How can HCC support economic growth of the Health sector?

• What health careers are expected to grow?

• What additional training is needed for existing health professions?

• What partnerships/ resources can help answer these questions?

Future Health Care? Address “silver tsunami” & shortages

• More team care• More allied personnel• More “care coordination”• More integration with behavioral health

– Lifestyle coaching• More use of population health data• More use of info systems

What health careers are expected to grow?

• Health Workforce Information Centerhttp://www.hwic.org/topics/professions.php

• Virtual Career Network - health care- a project of the American Association of Community Colleges

http://www.vcn.org/healthcare/careergrid/worktypecode/mdn/score/high

On line courses

Health Careers Expected to Grow

•Audiologists•Dietitians and Nutritionists•Health Aides, Assistants and Guides

• Community Health Workers• Health Educators• Home Health Aides• Medical Assistants• Nursing Aides• Patient Navigators• Personal and Home Care Aides

•Health Information and Informatics Occupations• Chief Information Officers• Chief Medical Information Officers• Health Informaticians• Health Information Administrators• Health Information Technicians

Health Careers Expected to Grow

•Health Technologists and Technicians• Cardiovascular Technologists and Technicians• Diagnostic Medical Sonographers• Medical Appliance Technicians• Nuclear Medicine Technologists• Radiologic Technologists and Technicians• Surgical Technologists

•Laboratory Professionals• Phlebotomists

•Medical Interpreters•Pharmacy Occupations

• Pharmacy Technicians and Aides•Speech-Language Pathologists•Vision Care Occupations

• Optometric Assistants and Technicians

10 Hot Careers in the Health Industry

1. Dental Assisting 2. Information Management 3. Health Care Administrator 4. Medical Assistants and Nurses 5. Massage Therapy 6. Medical Transcriptionists 7. Billing and Coding 8. Medical Imaging 9. Pharmacy Techs 10. Occupational Therapists

http://www.healthdegrees.com/10-hot-careers-in-the-health-industry

Top Ten (10) Fastest Growing

Allied Health Careers1. Medical Assistants:2. Cardiovascular Technologists3. Diagnostic Medical Sonographers:4. Physician Assistants:5. Respiratory Therapists and Technicians:6. Athletic Trainers:7. Surgical Technologists:8. Clinical Laboratory Technologists:9. Medical and Health Services Managers:10. Dietitians and Nutritionists:

Source: Bureau of labor statistics 8/2011

What additional training for existing professionals?

• Leadership & Change Management– Mentoring

• Healthcare Finances • Performance monitoring/Program evaluation • Effective use of data• Mediation/Negotiations• Communications• Billing & coding

What partnerships/ resources can help answer these questions?

• Hawaii Workforce Development CouncilTo support and facilitate the development of a skilled workforce that meets the needs of business and industry, enhances workplace productivity, and increases opportunities for employment and entrepreneurship.

•Contact:dlir.workforce.council@hawaii.gov808.586.8670

Benefits of Developing Hawaii Island Health Workforce- Health lens

• Improved Access– Timely care & decreased suffering– More recommended screenings

• More prevention & better lifestyles• Better outcomes & quality of life• Improved productivity of workforce• Improved economy - job creation• Decreased healthcare costs

• Lower hospital/ER utilization

Benefits of Developing Hawaii Island Health Workforce- Education lens

• Increased educational attainment• Increased economic potential of individuals • Can afford better living conditions, lifestyle• Increased health literacy • Better outcomes & quality of life• Improved productivity of workforce• Improved economy - job creation• Decreased healthcare costs

Improving Health & Healthcare for our community Is Our Kuleana

Contact info

vitousek@nhop.org www.nhop.org

www.hawaiihealthcarealliance.orgTools for policy makers

9.8%

5.6%

8.3% 8.7%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

Hawaii County City & County of Honolulu Maui County Kauai County

Average Percent Unemployed 2010

Chart: North Hawaii Outcomes Project - January 2012 Source: American Community Survey 2010

35.0%

21.9%

28.4% 26.5%State - 24.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Hawaii County City & County of Honolulu Kauai County Maui County

Population at or Below 200% Federal Poverty - 2010

Chart: North Hawaii Outcomes Project - October 2010 Source: U.S. Census Bureau, ACS 2010