Welcome
Building a Healthier
Hawaii Island-- Together
DEC. 7, 2011, Tutu’s House
Hawaii 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 Alliance
Supports Solutions
Growing Our Primary Care Workforce
Family Medcine Residency in Hilo
Growing effective use of mid-level providers
Improving recruitment & retention of providers
Increase effective use of technology - Beacon
Collaboration and leveraging resources
Regional planning
Aligning high leverage policy change.
Hawaii Island
Increasing Provider Shortages
700
600
500
400
331
157
300
200
Supply
100
Demand
0
2010
2012
2014
2016
2018
Source : JABSOM Workforce Study, Kelly Withy
2020
Why Action is Crucial Now
Verge of provider crisis
Neglected capital equipment is
obsolete
Beacon provides new opportunities
Hawaii
Physician Workforce Assessment
Project, Act 219, SLH, 2007
Kelley Withy, MD, PhD
[email protected]
David Sakamoto, MD, MBA
[email protected]
UH JOHN A. BURNS SCHOOL OF MEDICINE
A R E A H E A LT H E D U C AT I O N C E N T E R
Projections
4,500
Demand
4,000
3,500
1630
600
FTE Physicians
3,000
Supply
2,500
2,000
1,500
2008
2010
2012
2014
Year
2016
2018
2020
Hawaii Island Shortages-2011
500
400
300
200
58
100
0
Total
Physicians
General
Primary Care
Supply
Demand
Hawaii Island Medical Specialties Gaps
16
14
12
10
4
10
Supply
8
Demand
7
6
4
2
2
0
Cardiology
GI
Neurology
Rheumatology
Hawaii Island Surgical Specialties Gaps
30
25
13
20
15
10
10
6
7
5
0
General
Surgery
OB
Urology
Ortho
Supply
Demand
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
[email protected]
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 Alliance
Policy 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 Now
Progress 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 Expansion
Hilo, 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 Congress
Role 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
Fiscal
Yr.
Critical steps needed
Financial Support
Est.
2012
Add of PD at Hilo (Jan 2012)
Apply to expand to Hilo Site
$ 450K (PD at Hilo,
Faculty at WGH)
2013
Site visit from RRC
Program expenses to match
As above
2014
4 Resident salaries (R 1)
$1 million (4 res. +
program costs
2015
4 New residents
$1.4 million (above
plus 4 new
residents)
2016
4 New residents
$1.8 million (above
plus 4 new
residents)
What’s Different Now?
Planning
Partners
Then ( 90’s)
Now 2010-2014
-Planning not done
-Expert analysis of costs
with all stakeholders
- Poor
understanding of
residency
requirements and
needs
-360 analysis by partners
-HMC leading planning
-Multiple governance and finance
models explored
-Community more aware of
residency strengths and limitations
JABSOM
HMC
HMC
HMc Foundation
JABSOM
TriWest
HMSA
Legislature
School Of Nursing
School of Pharmacy
What’s Different Now?
Then ( 90’s)
Now 2010-2014
Funding
Sources
Kellogg Grant
HUD Grant
Hilo Medical
Center
Clinic Revenues
Maximize
Revenue
Not efficient
CMS
TriWest
Hilo Hospital Foundation
County of Hawaii
Sate of Hawaii
HMSA Foundation
Clinic Revenue
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
• Clinical Transformation:
― Island-wide, evidence-based
chronic disease management
system
― Primary to specialty care triage
pilot
• Enabling HIT:
SmartCards
―Amalga pilot
―Wellogic pilot
―Smartcard pilot
―Doc 2 Doc pilot
―Island-wide HIT support service
• Community Engagement:
―Mini-grants
Wellogic
Beacon Key Interventions
D2D
PCP
Specialist
HIT Support
Amalga
Chronic
care
system
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 Island
Hospital Collaboration
Trauma care collaboration- “BITAC”
Maternal/ Child collaboration- “CHI”
Discharge planning-Beacon/ Long Term Care
Hui –Alliance
Potentially Specialty Care coverage
Potentially credentials verification
Potentially 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- Kona
Why:
Replacement of aging equipment & facilities
to accommodate program growth
What:
-Kohala Hospital Renovations
-Cancer Center facilities
-New hospital planning
Legislative 2010
Funds
2011
2012
2013
Kona
Hospital
Funded
$2.1 M
$1.0 M
$ 6.0 M
$ 3.15
yes
yes
yes
Needed
Hospital Capital Requirements- East Hawaii
Legislative 2010
Funds
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 HOSPITAL
North Hawaii Community Hospital
29 bed acute care hospital
Rural and resort service area
–
H
Kukio/Hualalai across the saddle to Laupahoehoe and north
to Kohala
Serve 30,000 residents
–
–
H
~33% Native Hawaiians
~30% <200% FPL
Serve 5,000 part time residents + tourists
Safety 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
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
NORTH HAWAII
COMMUNITY HOSPITAL
What we are doing
How you can help
Serving 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?
Solutions by Group -Support Rural
New systems of care,
Pay for Performance
Administrative simplification,
Transparency,
Third party
payers
-Educational Pipeline,
- Healthy Lifestyles
-Social Integration
Residency Training
-Loan repayment,
-Alcohol tax,
-Improve public
Govern education
ment -Liability Reform
Community
Business
Medical
Providers
Support Residency Training, Pipeline,
Mentoring, Electronic Health Records,
Group Formation, Telemedicine;
Increase non-Physician Clinicians,
Medical Home Model, Regionalization
-Worksite Wellness
-Office space
-Spouse Employment,
-Business Services
- Advocacy,
Mahalo
• www.hawaiihealthcarealliance.org
• Tools for policy makers