Welcome Building a Healthier Hawaii Island-- Together

1. WelcomeBuilding a Healthier Hawaii Island-- Together DEC. 7, 2011, Tutu’s House Hawaii Island Healthcare Alliance www.hawaiihealthcarealliance.org

3. 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

4. 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 • Barrierto economic growth However • Growing the health workforce is an OPPORTUNITY to stimulate economic growth • Job multiplier effect of Physicians is ~1 to 5

6. 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

7. Improving Health & Healthcare Is Our Monkey

8. Hawaii Island Healthcare AllianceSupports 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.

10. Hawaii Island Increasing Provider Shortages 331 Source : JABSOM Workforce Study, Kelly Withy

11. Why Action is Crucial Now • Verge of provider crisis • Neglected capital equipment is obsolete • Beacon provides new opportunities

12. Hawaii Physician Workforce Assessment Project, Act 219, SLH, 2007 UH John A. Burns School of Medicine Area Health Education Center Kelley Withy, MD, PhD withyk@hawaii.edu David Sakamoto, MD, MBA dts@hawaii.edu

13. Projections

15. Hawaii Island Shortages-2011

16. Hawaii Island Medical Specialties Gaps 10 4 7 2

17. Hawaii Island Surgical Specialties Gaps 13 10 7 6

18. 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

19. 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

20. 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

21. Hawaii Island Healthcare AlliancePolicy Priorities for 2012 • UH Family Practice Rural Residency • Hospital Capital Requirements • Improvements to allow Health Information Exchange (HIE)

22. 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)

23. 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

24. 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:

25. Family Medicine ExpansionHilo, Hawaii Meeting the health care needs of the Big Island

26. 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.

27. 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.

28. HAWAII ISLAND FAMILY HEALTH CENTER

29. 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.

30. Timeline

31. What’s Different Now?

32. What’s Different Now?

33. What’s Different Now?

34. 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

35. Beacon Model

36. HIBC Budget: $3.5M for HIE

37. Wellogic Beacon Key Interventions • 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 D2D PCP Specialist HIT Support Amalga Chronic care system SmartCards

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

39. Health Information Exchange (HIE)Policy • HIE “Harmonization bill” • Why • Benefits

40. 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:

41. 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 verification • Potentially continuing education

42. 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

43. Hospital Capital Requirements- Kona Why: Replacement of aging equipment & facilities to accommodate program growth What: -Kohala Hospital Renovations -Cancer Center facilities -New hospital planning

44. Hospital Capital Requirements- East Hawaii

45. NORTH HAWAII COMMUNITY HOSPITAL 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 H H H

46. NORTH HAWAII COMMUNITY HOSPITAL

47. What Other Solutions? • DOH • HMA • Others

48. Collaboration on Priorities How can we work together to achieve these priorities? What barriers must be reduced?

49. Next Steps • What additional info? • Who else is essential to be included in the discussions? • Policy conference call?

50. Solutions by Group -Support Rural Residency Training -Loan repayment, -Alcohol tax, -Improve public education -Liability Reform New systems of care, Pay for Performance Administrative simplification, Transparency, -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