Welcome

Building a Healthier Hawaii Island-- Together

DEC. 7, 2011, Tutu’s HouseHawaii Island Healthcare Alliance

www.hawaiihealthcarealliance.org

Hawaii Island - Health Problems• Higher death rates, lower life expectancy• Large & increasing workforce shortages,

– Primary Care

• Aging facilities & lack of capital • Higher costs,

– Higher hospital, Emergency Room use rates, – Higher Emergency Room rates

Health Disparities & Workforce Shortages are in a

Larger Economic Context

• Partly Result of poorer rural economy

AND • Contribute to more

economic challenges for business & government

AND • Barrier to economic

growth

However•Growing the health workforce is an OPPORTUNITY to stimulate economic growth

•Job multiplier effect of Physicians is ~1 to 5

Our Assumptions

• Need to reduce costs– Business as usual is Pau– Do more with less

• Collaboration is even more essential now

• We can’t (won’t) wait for someone else to solve our problems

Improving Health & Healthcare Is Our Monkey

Hawaii Island Healthcare AllianceSupports Solutions

Growing Our Primary Care Workforce Family Medcine Residency 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 IncreasingIncreasing Provider Shortages

331

Source : JABSOM Workforce Study, Kelly Withy

Why Action is Crucial Now

Verge of provider crisis

Neglected capital equipment is obsolete

Beacon provides new opportunities

UH JOHN A. BURNS SCHOOL OF MEDICINEAREA HEALTH EDUCATION CENTER

Hawaii Physician Workforce Assessment

Project, Act 219, SLH, 2007

Kelley Withy, MD, PhDwithyk@hawaii.edu

David Sakamoto, MD, MBA

dts@hawaii.edu

Projections

Hawaii Island Shortages-2011

Hawaii Island Medical Specialties Gaps

7

4

10

2

Hawaii Island Surgical Specialties Gaps

13

6 710

Act 18, SSLH 2009 Progress

10 priority areas identified at 2010 Workforce Summit

Support Training-Hilo FM Residency (interdisciplinary), SON/JABSOM joint training, increased rural training for nursing and med

Expand Pipeline-Increasing activities in rural areas, mentoring, coaching withy@hawaii.edu

Act 18, SSLH 2009 Progress

Tort Reform Lawyers and doctors met monthly for 1 year and are finalizing

recommendations for MCCP changes

Community Involvement in Building Workforce: 2011 Hawaii State Rural Health Association Meeting to bring

resources to communities

Local hosts needed for visiting students/welcoming committee

Possible telemedicine presentations at community health fairs

Act 18, SSLH 2009 Progress

Systems Change, Teamwork, Administrative Simplification, Payment reform, Electronic Health Records: Patient Centered Medical Home Conference 3/3/12-all welcome!

Continuing research Update findings with current licensure numbers

Where do docs come from and go to?

HMJ Physician Workforce Edition, Feb 2012

Hawaii Island Healthcare AlliancePolicy Priorities for 2012

UH Family Practice Rural Residency Hospital Capital Requirements Improvements to allow Health

Information Exchange (HIE)

What information do Legislators need to support policy priorities for 2012?

Family Medicine Residency in Hilo Hospital Capital Requirements Improvements to allow Health

Information Exchange (HIE)

Collaboration Is Even More Essential NowProgress on Solutions

• Family Medicine Rural Residency in Hilo• Beacon • Increasing use of “mid-level”/ non physician

clinicians • Hospital Collaboration• Policy Alignment

Family Medicine Residency - Hilo

Why:– Rural residencies grow the local provider work force– Growing Primary Care reduces death rates– Growing Primary Care reduces costs– Growing Primary Care grows the economy

Recent progress:Timeline:What's different now:

– Critical Success Factors are in place:

Family Medicine ExpansionHilo, Hawaii

Meeting the health care needs of the Big Island

COGME 20th Report to Congress

• There is compelling evidence that health care outcomes and costs in the United States are strongly linked to the availability of primary care physicians.

• For each incremental primary care physician, there are 1.44 fewer deaths per 10,000 persons.

• Patients with a regular primary care physician have lower overall health care costs than those without one.

COGME 20th Report to CongressRole for legislators:

• Provide increased incentives for physicians who practice primary care or other critical specialties in designated health workforce shortage areas.

• Substantially enhance funding for scholarships, loans, loan repayment, and tuition waiver programs to lower financial obligations for students who plan and pursue careers in primary care.

HAWAII ISLAND FAMILY HEALTH CENTER

Accomplishments

• Education– Numerous medical students, as well as nursing

and pharmacy students have rotated in the office.

– UH Family Medicine residents spend two months training at the Hilo Medical Center and in the community

• Six UH Family Medicine Residency Program graduates have settled to practice in Hilo.

Timeline

What’s Different Now?Then ( 90’s) Now 2010-2014

Planning -Planning not done with all stakeholders- Poor understanding of residency requirements and needs

-Expert analysis of costs -360 analysis by partners-HMC leading planning -Multiple governance and finance models explored -Community more aware of residency strengths and limitations

Partners JABSOMHMC

HMCHMc FoundationJABSOMTriWestHMSALegislatureSchool Of NursingSchool of Pharmacy

What’s Different Now?Then ( 90’s) Now 2010-2014

Funding Sources

Kellogg Grant HUD GrantHilo Medical CenterClinic Revenues

CMSTriWestHilo Hospital FoundationCounty of HawaiiSate of Hawaii HMSA FoundationClinic Revenue

Maximize Revenue

Not efficient Improved

Community Commitment

Medical Community focused

-All Community stakeholders invited to table-Greater presence of Academic community

What’s Different Now?Then ( 90’s) Now 2010-2014

Leadership Unclear lead roles -Community and HMC greatly involved-Leadership interested in community participation

Sustainability Poorly planned– lack of environmental analysis

-More robust planning , for short and long term-Multiple methods of funding explored**The future health and financial cost to not develop program is greater than the investment

Hawaii Island Beacon Objectives• Improve access to primary care, specialty care and

behavioral health care• Avert the onset and advancement of diabetes,

hypertension and hyperlipidemia• Reduce health disparities for Native Hawaiians and

other populations at risk• Achieve EHR adoption & meaningful use among >

60% of primary care providers

Beacon Model

HIBC Budget: $3.5M for HIE

Beacon Key Interventions

Chronic care system

AmalgaHIT Support

SmartCards

SpecialistPCP

D2DD2D• Clinical Transformation:― Island-wide, evidence-based

chronic disease management system

― Primary to specialty care triage pilot

• Enabling HIT:― Amalga pilot― Wellogic pilot― Smartcard pilot― Doc 2 Doc pilot― Island-wide HIT support service

• Community Engagement:― Mini-grants

Beacon Progress

• Meaningful use of Electronic medical records• Clinical Transformation• Mini-grants• www.hibeacon.org web site• Wellogic HIE• Amalga HIE

Health Information Exchange (HIE)Policy

• HIE “Harmonization bill”– Why– Benefits

Growing Effective Use of “Mid-level” Providers- Progress

• Why: – Extends capacity of physician providers

• Where:– Puna Community Health Center

• Impact: – High patient & employee satisfaction– Lower ER visits

• Addressing Barriers:

Hawaii IslandHospital Collaboration

Trauma care collaboration- “BITAC”Maternal/ Child collaboration- “CHI”Discharge planning-Beacon/ Long Term Care

Hui –Alliance Potentially Specialty Care coverage Potentially credentials verificationPotentially continuing education

Kona Community Hospital•Collaboration Initiatives -

– Level III Trauma Program– Big Island / Maui Collaborative / Cardiology

• Recruiting Challenges

– Primary Care– Cardiology– Obstetrics– Orthopedic Surgery– ENT– Urology– Hospitalists

Hospital Capital Requirements- KonaWhy: Replacement of aging equipment & facilities to accommodate program growth

What: -Kohala Hospital Renovations

-Cancer Center facilities

        -New hospital planningLegislative Funds

2010 2011 2012 2013

Kona Hospital

$2.1 M $1.0 M $ 6.0 M $ 3.15

Funded yes yes yes Needed

Hospital Capital Requirements- East Hawaii

Legislative Funds

2010 2011 2012 2013

HMC $28.164M $142.310M $ 34.794M $30.794M

Funded $91K Only None None Requesting

Hale Ho’ola Hamakua

$2.064M $2.564M $1.475M $1.475M

Funded None None None Requesting

Ka’u Hospital $13.423M $33.584M $ 7.254M $7.254M

Funded $5.339M None None Requesting

North Hawaii Community Hospital29 bed acute care hospitalRural and resort service area

– Kukio/Hualalai across the saddle to Laupahoehoe and north to Kohala

Serve 30,000 residents– ~33% Native Hawaiians– ~30% <200% FPL

Serve 5,000 part time residents + touristsSafety net hospital with no government backstop

– 42% of our expenditures are for Medicaid and Medicare patients

– In 2010, we lost $5.2 million on Medicaid and Medicare that required a cash subsidy

NORTH HAWAIICOMMUNITY HOSPITAL

H

Program 2010 Costs 2010 Payments Subsidy Needed

Medicaid $7.9 million $3.8 million $4.1 million

Medicare $11.6 million $10.5 million $1.1 million

Total $19.5 million $14.3 million $5.2 million

H

H

NORTH HAWAIICOMMUNITY HOSPITAL

What we are doing How you can helpServing as the safety net acute care hospital for North Hawaii and raising private funds to

offset the underfunding of Medicaid and Medicare

Recognize that underfunding Medicaid is a hidden tax on community hospitals – we cannot sustain continued reductions in

Medicaid funding

Directly employing physicians so that they can focus on providing care and be part of an efficient and effective integrated health

care system

Support the Island of Hawaii being designated a Health Professional Shortage Area (HPSA) for all categories of care thus improving the flow of Medicare funds to

island providers

Seeking Level III trauma certification to ensure our rural trauma system effectively triages, treats and transports critical injured

or ill patients

Be a catalyst for public/private funding so Queen’s achieves and permanently

maintains Level I trauma status

Addressing the shortage of specialty care through telemedicine

Enable widespread adoption of telemedicine including medical providers in

other states

What Other Solutions?

• DOH• HMA• Others

Collaboration on Priorities

How can we work together to achieve these priorities?

What barriers must be reduced?

Next Steps

What additional info?Who else is essential to be

included in the discussions?Policy conference call?

New systems of care,Pay for PerformanceAdministrative simplification,Transparency,

-Support Rural Residency Training -Loan repayment, -Alcohol tax,-Improve public education-Liability Reform

-Educational Pipeline,- Healthy Lifestyles -Social Integration  

-Worksite Wellness-Office space-Spouse Employment,-Business Services - Advocacy, 

Support Residency Training, Pipeline, Mentoring, Electronic Health Records, Group Formation, Telemedicine; Increase non-Physician Clinicians, Medical Home Model, Regionalization

Solutions by Group

Mahalo

• www.hawaiihealthcarealliance.org• Tools for policy makers