How Healthy is Healthcare in Hawaii? - Extended Version
Leading doctors and other experts discuss major trends and problems in Hawaii healthcare
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Pressler: Okay. Now, before you step down I would like to ask you a couple of questions. You have taken on this new role in the Governor’s Office with health transformation. Tell us if you can in a few sentences as to which you see the mission of that office. What are you trying to accomplish?
Giesting: Our mission really is to seize the best thoughts and the best leaders and models in our community and get them to work on how we are going to address the problem. Fundamentally, we need to develop a system of competent health information technology. We need to get everybody using electronic health records, exchanging information. We need to analyze the data and when we do that we will be able to change our healthcare delivery model and also payment model. But first and foremost I think we need more information.
Pressler: So, do you believe that we actually can create economic transformation of healthcare in Hawaii in say the next decade?
Giesting: Not only do I believe we can. I believe that we absolutely must. Otherwise, healthcare costs are going to eat our lunch.
Thomas Tsang (Health Care Senior Advisor to the Governor): Well, my one word is innovation. My role is to advise the governor and advise the Office of the Governor and Office of Health Care Transformation about all the best practices across the country including technology innovations as well as systems innovations and changes that are going across the national landscape and what we can bring in and adapt for at least for the state of Hawaii and to really prepare Hawaii to be the top – not number four but to be the number one state in healthcare in the country. So, that is my role.
A little bit about what I want to talk about in terms of innovations: I think this is as huge, huge opportunity at this juncture in time as Rahm Emanuel said, you know, let not us waste a crisis. I think it is embedded in the American culture, that when we do have a crisis, we take advantage of it and we have – we create and the pressure creates innovations. It is not a surprise that the rest of the world is using Google and Apple products and Facebook. There is something to be said about American ingenuity and capitalism and how the market actually creates and nurtures innovations.
I think this is a roomful of innovators, and I think there are lots of opportunities for you guys to take part of. What are the opportunities? The opportunities are there is $30 billion incentive money in terms of technology going into providers and hospitals in terms of urging the provider community to actually advance health information technology. That is not part of the Affordable Care Act, it is part of the stimulus package. So $30 billion is there. It is going to be spread across the community. We can see it actually in the rise of healthcare stocks, technology stocks – 82 percent increase in health technology stocks.
The other thing is a little bit about the waste that Don Berwick talked about. If we look at the national budget of $2.6 trillion, if we take 20 percent of that, there is about $520 billion in waste that we need to reduce. Even if you look at one percent of that, it is a huge amount that we could actually save the country, if we could think of creative ways. We are actually seeing that in the industry; we see a lot of folks moving into two huge sectors.
The first sector is managing data, so this explosive field of data analytics and risk management. How can we harness and mine the power of data across the country to actually manage risk? It is risk management — being able to predict and target very, very few resources with a laser beam and target those high risks – those patients that have the co-morbidities, those patients who have the risk factors for becoming a second readmission patient.
We see that with United Healthcare buying up exchange information technology in Exilado. We see Aetna Healthcare buying up Medicity. We see Pfizer partnering with Humana and Medco to try to analyze millions of patients of data to look at new gene pool therapy. We see Walgreens partnering with iPads to engage patients. That is all about the data part and we see lots of partnerships.
The second pool is patient engagement. There is a huge new industry called gamification of healthcare and we see lots of games popping up with the X Box, mobile phones, etc., to really engage patients and consumers because that is what the next generation of healthcare will be driven by. It won’t be driven by providers, it will be driven by consumers. My bottom line is there are lots of opportunities for innovations and I think this room is full of people who could actually drive that process. So, thank you.
Pressler: Okay. So, before you step down I have a couple of questions for you. You have a national perspective. You’ve seen what is going on across the country and other states. What was it that drew you to be able to come to Hawaii and dedicate your life for the next year or so to our efforts here in Hawaii? What attracted you here?
Tsang: It’s the poke.
Pressler: Good answer but that is not the answer.
Tsang: Okay. I am a realist and in order to achieve tangible results you need to have the right components and when the governor called up and said, “How would you like to help me transform Hawaii’s healthcare system?” And after looking at the facts, from looking and meeting the people I really felt that this was a Petri dish of all the right substrates and you just need a little bit of a catalytic enzyme. I think all of the pieces are here and really we just need a little bit of spark to really go in the right direction and I think all the pieces and the right people are here. I think this is a great place to actually do something that could be accomplishable and we can actually do something here so.
Coral Andrews (Health Insurance Exchange): My word is the connector. As I talk about the Health Insurance Exchange, otherwise known as the connector, I really view it as a place where all other things will come together. Because the Health Insurance Exchange is relatively new, part of my five minutes is going to a bit of a 101 (course), so if you’ll bear with me I’m going to build that to getting into where the venture capitalist interest may lie.
The Health Insurance Exchange was created as the Hawaii Health Connector out of the 2011 legislative session and we’re unique in Hawaii if you look across other states because our state stood it up as a private nonprofit. It has created some interesting machinations in being able to move money to support the private nonprofit but we’re getting there. I think the idea behind it is to enable us to be fast on our feet, and we have great partners at the table and helping us to do so. We’ve talked about the Federal Health Reform Bill, a lot of different names for it: Obamacare, Affordable Care Act. ACA is usually the acronym you hear among healthcare folks but the idea behind Federal Health Reform was to create greater access to care and to expand coverage and the Health Insurance Exchange is an opportunity for us to be able to create access to healthcare utilizing technology like Dr. Tsang mentioned. And in Hawaii, we’ll have many partners at the table with us. The Insurance Commissioner will be regulating the healthcare plans.
The target market for the insurance exchange is small businesses and I imagine that is going to be many of you folks in the room. Individuals will also come to the Health Insurance Exchange. The small businesses will be companies with 50 or fewer employees, but the idea is to be a bit like Travelocity where you’ll have a front webpage screen where individuals or small businesses will be able to shop the exchange. The Insurance Commissioner will qualify the health plans. Based on them meeting the federal requirements and having essential or minimum health benefits they will be able to participate on the Health Insurance Exchange.
We do have a short timeframe to be able to get going by October 2013. The health plans need to be able to have themselves positioned with their health benefits to be posted on the website and by January 2014, we are going live. We’re very excited that Health and Human Services just awarded us a $14.4 million establishment grant.
When we talked in preparation today, I shared with the group that I have a son who is a senior in high school preparing for college and his interest is in engineering. So, I tried to imagine for venture capitalists, what would be the interest be in the Health Insurance Exchange and here’s what I would say to you is this – for those who are early into their careers, imagine that you’re going to need to have skill sets that are more interdisciplinary. We’ve heard about IT. We’ve heard about health. We’ve heard about economics. So, again working with our son and looking at engineering, we’re seeing colleges position themselves that way, where they offer interdisciplinary preparations.
I would encourage all of you as you’re anticipating the business models, don’t just look at a silo structure where it’s just healthcare, but IT is going to have a heavy role as you go forward and you’ve heard that from all of the panelists; efficiencies as well. We’re hoping to achieve those efficiencies with the Health Insurance Exchange. Five minutes isn’t a lot of time to tell you everything you want to know about the Health Insurance Exchange but we do look forward to pushing a lot more information out into the community about the connector and our focus of course is in assisting consumers to be able to access healthcare so we have a healthier Hawaii. Thank you very much.
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