Groundbreaking work in Hawaii will improve health for millions of Americans

By Mark Mugiishi, M.D., F.A.C.S., HMSA executive vice president and chief health officer

Secretary of Health and Human Services Alex Azar and Centers for Medicare & Medicaid Services Administrator Seema Verma have announced a bold national program that will use Hawaii’s groundbreaking work to improve the health of millions of Americans.

Next year, Medicare will move in a new direction by paying primary care providers (PCPs) for delivering value to Medicare patients, not by the volume of office visits. This will improve the quality of patient care, create a better experience for patients, and control costs, according to our nation’s top health care leaders.

Helping the sickest patients

Sound familiar? It should. In 2017, the Hawaii Medical Service Association (HMSA) in partnership with Hawaii’s hospitals, physician organizations, and PCPs launched a statewide health initiative to achieve those goals.

Data from our first full year of the initiative shows better overall health for our members:

  • Quality of care, patient access to doctors, and the patient experience have increased.
  • Growth of the overall health care budget has been carefully controlled.

HMSA and Hawaii’s physician community worked together to design the initiative. It made us the first and only health plan in the country to pay every PCP in our network a monthly fee that includes extra money for doctors who need to give more attention to their sickest patients, which is called risk adjustment.

We truly believe in improving the health of the entire community and built the initiative to include members with Medicare, QUEST Integration, and health insurance through their employer.

Like us, Medicare will pay PCPs a fee each month for all of their Medicare patients. And like us, Medicare will pay doctors additional money for improving the health of patients with complicated conditions. Both HMSA and Medicare encourage physicians to use care teams, technology, and innovation to coordinate care for sicker patients and help healthy patients stay healthy.

Hawaii leads the way in better health

Change is never easy. But HMSA and our primary care network worked together to constantly refine and upgrade the initiative, mutually striving for better patient care.

Just as valuable as the clinical data are the heart-warming stories of doctors who are practicing medicine in the way that best helps their patients. The pediatrician now seeing her teenage patients at Starbucks because they want to meet her there. The family practitioner who has started doing house calls again for patients who need them. And the internist who has weekly “walk with a doc” exercise activities with his patients.

This is a tribute to the teamwork between our physician partners and HMSA.

Our state has always been a pioneer for excellent health care, starting with the Hawaii Prepaid Health Care Act. Our government policies, our physicians, and our health system have kept us near the top of the nation in the percent of residents with health insurance, the quality of care, and controlling the cost of care.

Now, our innovative health initiative has shown early results that it will help with all of those essentials. This time, the rest of the nation noticed.

About HMSA

Caring for the people of Hawaii is our promise and our privilege. Working together with employers, partners, and physicians and other health care providers, we promote well-being; develop reliable, affordable health plans; and support members with clear, thoughtful guidance.

HMSA is the most experienced health plan in the state, covering more than half of Hawaii’s population. As a recognized leader, we embrace our responsibility to strengthen the health and well-being of our community.

Headquartered on Oahu with centers and offices statewide to serve our members, HMSA is an independent licensee of the Blue Cross Blue Shield Association.