Categorized | Health

Critical action needed to address health services


The critical importance of improving the availability of healthcare services in Hawaii County – now and in the future – was brought home to state legislators at a recent discussion of health problems, solutions and policy priorities for 2012 sponsored by the Hawaii Island Healthcare Alliance.

“Poor access to care just because you live on the Big Island is simply not acceptable,” said one community member.

About 45 health stakeholders met Dec. 7 at Tutu’s House in Waimea with Sen. Josh Green and Rep. Cindy Evans and governor’s liaison John Buckstead to discuss how to align efforts to improve Hawaii Island health and healthcare.

The briefing focused on the Alliance’s three policy priorities: state funding for the UH Family Medicine Residency program in Hilo, funding hospital capital requirements, and improvements to allow Health Information Exchange (HIE), specifically the harmonization of state and federal regulations.

Hawaii Island has the state’s greatest shortage of primary care physicians, physicians’ assistants, and nurse practitioners, equating to 33 percent fewer than needed to adequately care for the population, according to a presentation by Kelley Withy, MD, PhD, author of the Hawaii Physician Workforce Assessment Project, UH John A. Burns School of Medicine (JABSOM) Area Health Education Center.

Withy said, “This shortage is projected to double by the year 2020, resulting in the island having more than 330 fewer physicians than needed to serve the population.”

“This provider shortage reduces access to healthcare on our island and is associated with higher death rates, lower life expectancy and higher hospital costs,” said Alliance Chairwoman Sharon Vitousek, MD.

One of the Alliance’s top priorities to address these disparities is to grow primary care providers through the UH Family Medicine Residency Program on Hawaii Island. Vitousek emphasized the economic as well as health benefits of this strategy.

“These Health workforce shortages are in the bigger context of large economic disparities on our island. The provider shortages are in part a result of a poorer rural economy with higher unemployment and higher uninsured and underinsured on Hawaii Island. But more importantly, since health providers (hospitals and clinics) are the largest employers in many of our communities, stimulating the health economy through growth of the health workforce would also stimulate economic development and grow jobs on our island,” she said.

Evans praised the Alliance for its leadership in uniting the healthcare community.

“Our healthcare system is the sum of its parts,” she said. “Having the Alliance represent agreement on priorities for the Big Island will help us better utilize our resources. We need solutions that will take us into the future, not just temporary fixes.”

Stakeholders agreed funding of the UH Family Medicine Residency Program represents the most viable option for reversing the primary care provider shortage.

Boyd Murayama, Assistant Administrator at Hilo Medical Center, which operates the Hawaii Island Family Health Center (the planned site of the Family Medicine Residency Program), noted more than 90 students from the UH Schools of Pharmacy and Nursing have rotated through the center this year.

The program recently hit a key milestone with the arrival this month of a program director. The next milestones are the application for accreditation in 2012 and then Family Medicine Residents will start in 2014.

“This will add four new Family Medicine doctors to our island every year thereafter” said Murayama, who has had extensive experience with medical group development at UCSF.

Following the meeting, Green responded to this immediate need for funding the Residency Program by expediting Hilo Medical Center’s agreement with the State Department of Health to provide $200,000 in funding over 12 months to support the residency program in the next year.

This funding enables the State to take advantage of matching funds from TriWest.

David McIntyre, President and CEO of TriWest Healthcare Alliance, a strong financial supporter of the Hilo Residency program, has indicated that TriWest’s donations were “designed to ensure access to care for its customers, the Coast Guard and the Army and Air Guard units in Hilo. And, TriWest is pleased that the initiative contributes to improving access to care on the Big Island.”

The approximately $2 million TriWest donation is contingent on an ongoing state match of funds for the Residency Program.
Building the primary care workforce is a pillar of the Alliance’s mission.

“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,” said Chip Hixon, MD, Department Chair of Family Medicine and Community Health, JABSOM. “Patients with a regular primary care physician have lower overall health care costs than those without one.”

“The current effort to launch the Family Medicine Residency program in Hilo is substantially stronger than the previous effort in the 90s,” said Neal Palafox MD of the UH John A. Burns School of Medicine. “The current effort has better planning, more partners, better funding, better revenue maximization, better leadership and most importantly stronger community support.”

Hawaii Medical Association Director and Alliance member, Dr. Chris Flanders also voiced strong support for the Hilo Residency program as a key strategy to improve access for the Big Island.

In addressing the Alliance’s HIE priorities, Susan B. Hunt, MHA, Beacon Grant Project Director and CEO, Hawaii Island Beacon Community, explained that Hawaii Island has the funding, the tools, the relationships and the motivation to build an extraordinary system of health information exchange thanks to the Beacon Cooperative Agreement.

“We need the support of the legislature to ensure that we have laws that provide an adequate level of protection of personal health information, while also allowing this information to flow in a timely and useable manner to improve quality of care and to improve the health of our population while reducing the overall cost of care delivery,” she said.

Jay Kreuzer, HHSC West Hawaii Regional CEO echoed Hunt’s comments, “We have an unprecedented opportunity with the Beacon community that will move our island forward while we address Hawaii’s provider shortage, upgrading facilities and equipment, and implementing new clinical and system technologies.”

Dan Domizio, a Physician’s Assistant, Alliance member and director of the Puna Community Health Center shared progress improving access in Puna through effective use of Physician’s Assistants which has helped save costs by reducing Emergency Room visits. Domizio urged the legislators to support reducing administrative barriers to effective use of mid-level providers.

The Alliance members include providers, insurers, businesses, policymakers, educators, and government, labor and community leaders.

The briefing’s presentation is available at (see Building a Healthier Hawaii Island Together – December 2011).

The vision of the Hawaii Island Healthcare Alliance is that Hawaii Island residents lead healthy and productive lives and have access to quality healthcare. The mission of the Alliance is to develop dialogue and promote consensus agreements and recommendations for improving access to and the quality of healthcare services on Hawaii Island.

Members include: providers, insurance, business, policymakers, educators, and government, labor and community leaders. The collaborative islandwide effort attempts to leverage community, state and national resources through an inclusive process that is open and transparent.

The Hawaii Island Healthcare Alliance fiscal sponsor is Friends of the Future, a 501(c) (3) organization.

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