How Healthy is Healthcare in Hawaii?
Leading doctors and other experts discuss major trends and problems in Hawaii healthcare
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Tsang: My role is to advise the governor about all the best practices across the country, including technology and systems innovations, and what we can bring in and adapt for Hawaii.
There are lots of opportunities for innovators; there is $30 billion in incentive money for providers and hospitals to advance health-information technology. We can see it in the 82-percent increase in the value of health-technology stocks, and we see a lot of folks moving into two huge sectors.
The first sector is managing data. How can we mine the power of data across the country to actually manage risk? Being able to predict and target very, very few resources with a laser beam and target those patients that have the co-morbidities, those patients who have the risk factors for becoming readmission patients.
The second sector is patient engagement. There is a huge new industry called gamification of healthcare, and we see lots of games popping up with the Xbox, mobile phones, etc., to really engage patients and consumers.
Andrews: I view the Health Insurance Exchange as a place where all other things will come together. The exchange was created at the 2011 Legislature. We’re unique in Hawaii, because our Legislature set up our exchange as a private nonprofit. The target markets for the insurance exchange are individuals and small businesses with 50 or fewer employees. The exchange will be a bit like Travelocity, where you’ll have a webpage where individuals or small businesses can shop. The Insurance Commissioner will qualify the health plans and providers that use the exchange so that they meet the federal requirements for minimum health benefits. It will be up and running in January 2014.
Anderson: Hawaii Health Systems Corp. is the safety net of the care system in the state. [The state-subsidized network provides] emergency and other essential services to the uninsured, the underinsured, those on Medicaid and others with special healthcare needs.
There are many other facilities that think of themselves as safety nets, but our business is really to keep our doors open and make sure people in Hawaii have the services they need. In many areas, particularly rural areas, we are the only healthcare providers. We work in partnership with physicians, clinics and others in all these communities, but we are the most important and largest provider of care on most of the Neighbor Islands. In fact, HHSC is the fourth-largest public-health system in the United States.
Pressler: Do you ever foresee a time when the HHSC, the state hospitals, will be self-sufficient and not require appropriations every year from the Legislature?
Anderson: No, I don’t, but we can reduce our expenditures, we can increase efficiencies and we are trying to work more closely with the private-sector facilities to coordinate care.
Pressler: Why aren’t we focusing on prevention?
Tsang: That has largely to do with the evidence and the economics of prevention. Much of the hardcore literature hasn’t shown equivocal evidence or unequivocal evidence that prevention saves money. I know that’s counterintuitive, but that’s what the evidence shows. With that said, a lot of what Beth and I are doing does have a prevention aspect, because you’re talking about care coordination and identifying outliers in the system that would benefit from interventions. That set of interventions would be hugely preventative. When you have 200,000 patients in the Medicaid system and you can identify, with the push of a button, which patients have not received a colonoscopy, that’s using technology to do population health management.
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