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— 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