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
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.
Increasing Hawaii Island Increasing 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Why Action is Crucial Now Verge of provider crisis Neglected capital equipment is obsolete Beacon provides new opportunities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 MEDICINE AREA HEALTH EDUCATION CENTER Hawaii Physician Workforce Assessment Project, Act 219, SLH, 2007 Kelley Withy, MD, PhD firstname.lastname@example.org David Sakamoto, MD, MBA email@example.com
Hawaii Island Medical Specialties Gaps 7 4 10 2
Hawaii Island Surgical Specialties Gaps 13 6 7 10
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 firstname.lastname@example.org email@example.com
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 20 th 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 20 th 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.
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.
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 JABSOM 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 CMS TriWest Hilo Hospital Foundation County of Hawaii Sate of Hawaii HMSA Foundation Clinic Revenue Maximize Revenue Not efficientImproved 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 LeadershipUnclear lead roles-Community and HMC greatly involved -Leadership interested in community participation SustainabilityPoorly 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 Key Interventions Chronic care system Amalga Wellogic HIT Support SmartCards SpecialistPCP D2D 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 www.hibeacon.org 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 Funds 2010201120122013 Kona Hospital $2.1 M$1.0 M$ 6.0 M$ 3.15 Fundedyes Needed
Hospital Capital Requirements- East Hawaii Legislative Funds 2010201120122013 HMC$28.164M$142.310M$ 34.794M$30.794M Funded$91K OnlyNone Requesting Hale Ho’ola Hamakua $2.064M$2.564M$1.475M FundedNone Requesting Ka’u Hospital$13.423M$33.584M$ 7.254M Funded$5.339MNone Requesting
North Hawaii Community Hospital 29 bed acute care hospital Rural 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 + 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 NORTH HAWAII COMMUNITY HOSPITAL H Program2010 Costs2010 PaymentsSubsidy 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 HAWAII COMMUNITY HOSPITAL What we are doingHow 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
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 Performance Administrative 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