PCF— Health Care Day, part 2

We then traveled to Pali Momi to hear a panel discussion featuring Ben Godsey (PCF '09), President of ProService Hawaii (industry perspective); Hilton Raethel, Sr. Vice President, HMSA (insurance reform/health care perspective); and Chuck Sted, CEO/President, Hawaii Pacific Health (hospital service). The three different perspectives presented showed how deep some of the different interests run, but there was a general sense that each participant sought to find common ground in providing the best plans and care for Hawaii's residents.

Chuck Sted spoke of how health care is transitioning from a cottage industry to a systems-based industry. The goal is to connect all players (patients, doctors, families, clinics, billing) through electronic medical records systems (EPIC). This would take 32 different systems that are currently in use down to 1——> efficiency, cost effectiveness. he referenced the book Good to Great (Collins) to highlight crucial components of this transition:
1) prioritization and managing change well (take care of own physicians and their mental health— family, then community, then work)
2) position leadership
3) quality service, excellence
4) employee engagement

Ben Godsey mentioned how health care costs are currently 17% of GDP and those costs are rising at a rate of 8-10% per year. Hawaii's Pre-Paid Health Care plan (first enacted in 1975) provides a lot of benefits to Hawaii residents, but it also limits the possibilities for innovation. It is a fee for service program (which is a problem these days) but the resulting standard plans in Hawaii offer more than comprehensive plans on the mainland. In his view, the current Affordable Care Act places additional benefits on the Pre-Paid Health Care plans such as drug benefits and by eliminating lifetime limits it will cause costs to rise 13-15% in the first couple of years. Hawaii needs to be careful because its "platinum +" health care plans (pay 94-97% of all costs) may cause companies to move their jobs elsewhere to cut costs. ProService wants to roll out new plans that provide incentives such as going to primary care versus a specialist, preventive care to screen for expensive but more easily detected illness like prostate and colon cancer, and going to facilities that utilize electronic records and evidence-based care.

Hilton Raethel laid out a plan that seeks to:
— minimize duplication of service (communication between primary care physicians and specialists)
— minimize emergency room visits for non-life-threatening conditions (such as urinary tract infections)——> caused by physicians schedules being too packed due to their need to make so much money to cover their liability insurance or just to take advantage of the fee for service structure
— get recommended interventions (prevent conditions like diabetes from becoming life-threatening and thus very expensive; only 10% of diabetes patients in Hawaii get the required interventions)
— increase incentives for outcomes (versus fee for service)

Right now, according to Mr. Raethel, we have fragmentation of care that rewards volume over quality. We need to change the incentives to change the behaviors ——> connectivity, communication, more primary care. We then got a presentation from Dr. Donald Wilcox about how the EPIC system has revolutionized emergency care at his hospitals.

After a tour of the medical facilities to witness the tech advancements currently in use, we then traveled to Shriner's to see their new facilities.
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PCF— Education Day, part 3

The last leg of our trip had us busing out to Nanakuli High and Intermediate to hear from their principal, Darren Pilialoha. There we learned that the school has 990 kids who the papers do not do justice to in their descriptions of what these have done and what they can do.

Mr. Pilialoha presented Nanakuli's New Tech Initiative/Network (funded by Kamehameha Schools for training). Their core beliefs:
• All students can learn.
• With support systems, all students can succeed.
• We have a moral purpose in educating the whole child.

He then asked, "Are we educating a bunch of test-takers or people?" Critical skills:
— communication
— collaboration
— critical thinking
— people skills
— creativity
— innovation

Vision:
— college and career ready
— educational environment includes 21st century skills, 1-to-1 laptop program for 9th graders
— learning and innovation
— life and career
— media and technology
— personalized

in the program they are rolling out for 9th graders, students will comprise a culture of caring, respect and responsibility through which they will engage in project-based learning that is relevant and current. They will utilize technology and follow a business model:
— send a memo (history of need, rubric)
— know and need to know (research)
— roles and responsibilities (w/penalties for not following through)
— presentation to a panel

The day concluded with a presentation by Leigh Kincaid of Teach for America. Ms. Kincaid indicated how 4th grade is clear indicator of how far behind these kids are falling. Of 100 Kindergartners in Hawaii public schools, 65 will graduate, 34 of those will go to college, 24 of those will graduate in four years. The proof points are that kids in lower income communities have a greater challenge, but they can learn and they can achieve.

Teach for America seeks to close the achievement gap by aggressively recruiting from top colleges and universities. This pipeline for talent looks for achievement and leadership. Only 10% are initially interested in education but 65% stay in education after their two year initial commitment.

This day was supposed to end with a tour of the After School All-Stars program run by Dawn Dunbar (PCF '07) but we ran out of time. Fortunately we got to see the program after our Health Care Day the next month. Dawn left a lucrative career in the banking and business world to heroically lead this very worthy and significant program.

PCF— Education Day, part 2

The next part of our day was comprised by a panel of teachers and administrators from 'Iolani, Kamehameha, and Punahou discussing their respective schools' initiatives related to Private Schools with a Public Purpose. The panelists included:
• Carl Ackerman, Director of Punahou's PUEO program;
• Casey Agena, Director of Punahou Summer School program as well as a director of the PUEO program;
• Tony Lebron, Kamehameha Schools;
• Allison Ishii, Director of the Ka'i program;
• Hope Staab, Director of the Wo International Center;
• Diane Anderson, former Director of Instruction at Punahou, currently working with Academy 21 and Hawaii Association of Independent Schools.

Carl and Casey discussed the PUEO program and how it has 292 students from 50 schools, all on free or reduced lunch and scoring in the 25th-75th percentile on their standardized tests. The goal of this program is to encourage life-long learning and to get all PUEO scholars into college.

Tony spoke of Kamehameha's long-time and long-term commitment to community initiatives based on the Princess' legacy and her school's mission. They currently contribute $88 million for outreach and $104 million on-campus to go along with 36 partners in the community.

The Ka'i Program is modeled after LEAP in Seattle and PUEO in Hawai'i. Right now they have four student mentors working with 13 incoming seventh graders from Jarret Middle School in Palolo Valley, all in the middle range of skills and abilities, living at or below the poverty level. They expect to be working with 73 students when they are at full capacity.

Hope Staab spoke a little bit about the Student Global Leadership Program but since that only features kids from private schools she spoke mostly about the Wo Center's study abroad programs which are open to public school students.

Diane Anderson addressed the need to see the challenges facing schools through different lenses, both strategic and systemic. Schools are constantly changing and we need to keep moving towards inquiry-based, project-based learning to prepare our students for their futures as well as society's.

PCF— Health Care Day, part 1

JABSOM— John A. Burns School of Medecine

Dean of Clinical Affairs Roy Magnussen highlighted the coming health care crisis (as if we're not in one already) due to a man-power shortage and the increasing health care costs. There will be shortages due to:
— health care reform
— baby boomers retiring (and doctors retiring too)
— survival rates of patients
— obesity/diabetes
— gender changes (female doctors not able to out in as many hours due to family constraints)
— tight budgets
— generational differences (younger doctors want a life outside of medecine)
There are currently 3,253 practicing physicians in the state, leaving us with a 500 doctor shortage, and that will double over the next decade. Doctors in Hawaii are older on average than their mainland counterparts.

JABSOM started in 1965 as a 2 year school and then became a full-fledged medical training facility in 1973. There are over 250 full time faculty and over 1,000 volunteer faculty. The school brings in over $42 million a year in grants to Hawaii, providing jobs, a biomedical industry, and spin-off companies.
They rely on a Problem Based Learning model (versus just lecturing) in which students are given a clinical problem and then they are tasked with finding information (collecting, analyzing, syntesizing), and working in teams to come up with a diagnosis and course of action. The school also offers a Masters in Public Health that focuses on specific populations and preventive care.

At JABSOM, 90% of the students are local; 50% of practicing physicians in Hawaii are JABSOM graduates. 58% of the graduates go into some ind of primary care.
Imi Ho'ola is a program that provides opportunities to twelve students from disadvantaged backgrounds each year. Chessa DeCambra, spoke about how the program prefers applicants that can demonstrate ties to Hawaii and the Pacific Basin, but that is not required. They look at applicants' economic, social, and educational backgrounds and their willingness to serve. Their first move is to assess any pukas in their knowledge level and then they work to get them up to speed so they can get into the regular program.

Dr. Magnussen showed the impact of the current health care reform:
— greater coverage (demand up)
— incentives for primary care (currently these physicians are paid approx. 1/3 less than specialists— students graduate with $100-120,000 in school debt)
— no new residency increases

Where will the money come from:
— Accountable Care Organizations (eg. Kaiser, insurance companies, hospital care)
— electronic health records
— Quality agenda (no reimbursement for poor results; stop paying for readmittance in 30 days due to infections or complications)
————> save $600 billion

Challenges:
— health care companies kick back 50% of all claims ——> high administration costs dealing with duplicate paper work as a result; not necessarily due to liability since Hawaii is way ahead in terms of coverage and access, they're just behind in reimbursements

Finally, Vanessa Wong, assistant professor at JABSOM, spoke to us about the Native Hawaiian Center for Excellence that promotes physical and mental health of native Hawaiians. Part of the program also develops a cultural competence component of the graduates. Chess DeCambra

PCF— Education Day, part I

The day began with a breakfast session at the Plaza Club to hear new DOE superintendent Kathy Matayoshi examine the challenges facing Hawai'i's public schools and her vision for the future. Ms. Matayoshi comes to the job with a wealth of experience in the private sector: Hawai'i Business Roundtable, Community Links, Goodsill Anderson Quinn and Stifel, Hawaiian Electric, Department of Commerce and Consumer Affairs, P-20 Council. Her lack of direct experience in education raised some flags amongst some DOE members, but others see that as a plus in that she will bring private sector management and leadership skills to a massive job.

The DOE is comprised of 178,000 students and 13,000 teachers and librarians all encompassed in a single district (the 10th largest in the US). That size enables the Hawaii DOE certain advantages such as scaling and buying power, but it also presents as many if not more difficulties. The centralized services and the administrative systems in place are old, highly inefficient, and non-responsive. However, there is only one teachers' union to negotiate with.

According to Ms. Matayoshi, the bottom line is student achievement. The current Race to the Top program awarded Hawaii (one of only eleven recipients and then only one west of the Mississippi) $75 million for education reforms; none of that money can go to the budget. Due to its unique conditions the US DOE is looking to Hawai'i as a model for other states to follow. The P-20 initiative seeks to have 55% of all Hawai'i public school graduates complete two or four years of college in six years. The implications for the future are huge as the level of college attainment nationwide is falling dramatically after the 44-54 year old demographic. Hawai'i ranks 10th in terms of job that require post-high school education.

The first step is to turn around struggling schools. Waianae and Nanakuli, two schools in areas with strong communities, are first in line to get the funding and reform programs. Kea'au, Pahoa, and Ka'u complexes on the Big Island are also among the first to participate. It is agreed amongst all people that ages 0-5 are the most important ages for educational attainment. Seat time is not necessarily the most important indicator of student achievement— learning needs to be exciting; great teachers, great leaders. Under No Child Left Behind, Adequate Yearly Progress is callibrated to standards, but every state is different so that could lead to fraud until their are national standards.

Charter schools are a possibility but they got off to a rocky start in Hawaii due to varied quality and lack of accountability. Nevertheless, Ms. Matayoshi like the idea of having the charter schools act as the innovative wing of the DOE to try out new methods and practices that they can then share with the broader school population.

Dealing with the unions should also be on a new path with Al Nagasako, former principal at Kapolei, as the new head of the HSTA. Rather than the previously contentious collective bargaining model, they will seek to change the model to get the HSTA and HGEA in the same room to engage in interest-based bargaining. That will most likely include a new teacher evaluation method that puts equal emphasis on student growth and other measures such as leadership and department approval.