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The Honolulu Advertiser
Posted on: Sunday, May 2, 2010

One health system's action plan

By Chuck Sted

Hawaii news photo - The Honolulu Advertiser

Hospitals continue to face financial challenges that affect care and the threat of the loss of doctors to the Mainland.

Gannett News Service

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There is much in the news about the changes coming with health care reform. Given the uncertainties, we are not waiting to implement meaningful change.

Hawai'i Pacific Health, our four hospitals (Kapi'olani, Pali Momi, Straub and Wilcox), 44 outpatient clinics and service sites, and its providers are taking a stand to protect and improve Hawai'i's health care by leading a collaborative effort to fundamentally change the way health care is delivered.

The people of Hawai'i deserve the best quality care, yet the system is fragile. From a state government in financial crisis to a dire physician shortage, we face many challenges. Last year, Hawai'i Pacific Health provided $108 million in support for the benefit of our communities, including $10 million in uncompensated care.

The most recent news of delayed payments for government programs like Medicare and QUEST means that hospitals and physicians will continue to face significant financial challenges that impact our ability to provide care. What's more, hospitals struggle to recruit and retain doctors, and the threat of losing doctors to the Mainland is constant.

Our effort, called Changing Health Care in Hawai'i, is a leadership initiative focused on creating a model of care that increases quality while slowing the rate of increase in health care costs.

In simple terms, the private insurance industry's current reimbursement structure locks providers into treating each discrete episode of illness or injury as a standalone event. This keeps costs high by rewarding providers for treating symptoms over and over again.

Instead, providers should have the right tools, support and incentives to help them create wellness. We believe everyone stands to gain from Changing Health Care in Hawai'i, patients, families, care providers, employers, insurers and government leaders.

Changing Health Care in Hawai'i emphasizes teamwork and collaboration between health care providers, with patients being active partners in their health. The clinical integration needed to truly change health care in Hawai'i exists at Hawai'i Pacific Health, thanks to systemwide implementation of Epic, our electronic medical record (EMR) system.

Today, we rank among the top 3.8 percent of hospitals, clinics and health systems nationwide in adopting EMR. Our substantial investment is already resulting in better care, reduced medical errors, and lives saved, all while protecting patient privacy. The result will be healthier patients, which will lead to lower utilization, lower premiums and lower copayments.

Using EMR as a foundation, Hawai'i Pacific Health has launched HealthAdvantage, a new model for the way health care is delivered. HealthAdvantage uses data available from Epic to provide physicians, medical staff and patients with the information they need to manage the patients' health.

In less than a year, we've demonstrated that this improved partnership between physician and patient leads to better care and lower costs for treating chronic illness. For instance, we have doubled the number of diabetes patients who are now receiving the right care. With chronic diseases representing more than 75 percent of health care costs, the potential for change is tremendous.

Changing Health Care in Hawai'i also calls for an investment in our people. Our ability to provide quality care is interdependent with attracting and retaining top-quality physicians to Hawai'i. Our state will need more than 1,000 additional physicians by 2030. This means we'll need 50 new physicians every year for the next two decades just to maintain the current levels of service.

The success of our Changing Health Care in Hawai'i initiative requires an effective partnership between hospitals, physicians and insurance companies like HMSA, which play an important part in supporting and paying for health care.

When one insurance company represents three of every four people with private health insurance, it makes it all the more important that we get it right. As providers such as Hawai'i Pacific Health change the delivery of care in response to health care reform, HMSA and the other commercial insurance companies need to support this provider-led change by recognizing and rewarding the value we bring.

The way reimbursements are paid must change so that payments for medical services tie directly to good results and the health of patients. It's only through this collaboration that we'll have improved health care quality, access and service while reducing overall cost.

This model of care also requires support from the government and private insurance companies. Providers need resources to invest in electronic health records, new equipment and the latest technologies. Hospitals and physicians cannot continue to struggle for resources to meet these needs.

We are fortunate to have terrific hospitals and physicians in our state. But it won't stay this way forever if we don't make fundamental changes. You can learn more at www.hawaiipacifichealth.org/change.

Chuck Sted is president and CEO of Hawai'i Pacific Health. He wrote this commentary for The Advertiser.