There is still a fight on to preserve the soul of medicine. While health care reform opens the doors to increased access to care, costs must be trimmed to make it happen. Electronic health records create efficiencies, but they also enable closer monitoring of every medical visit. Through this window, payers have an expanded ability to direct how a physician practices via incentives and penalties.

However, the good practice of medicine involves a developed intuition and clinical judgment that comes only with a compassionate heart, a solid education and long experience in the field. To the extent that health care becomes reduced to a series of rigid algorithms, it will become too cookbook, the human element will wither and those who seek care will not be well served.

Nevertheless, there are certain fundamental elements that are widely accepted as the standard of care and must be offered when appropriate. It is here that HMSA has fostered outstanding progress in the field. According to Vice President Hilton Raethel: "HMSA is committed to supporting our network of primary care physicians across the state of Hawaii in the journey to improve the quality of care provided to our members. To this end, we have provided tools, resources and material financial incentives. Our goal is not to add to physicians’ workload, but rather to collaborate with them in their transition away from a volume-based fee-for-service model, to one that is based on improving the health of the population of Hawaii."

Last year Hawaii Medical Service Association launched a pay-for-quality (P4Q) program for primary care providers and the new Patient Centered Medical Home, which patients can use not just when they are physically ill, but for regular preventive care with attention to social and psychological issues.

This year, HMSA has launched P4Q for Akamai Advantage, a Medicare insurance product. Criteria for the new program include:

» Breast cancer screening.

» Colorectal screening.

» Cholesterol screening.

» Blood pressure control.

» Diabetes care: eye exam, kidney monitoring, blood sugar control, medication adherence.

HMSA’s P4Q initiative is good for all considered. Meaningful reimbursement is now being offered to providers who ensure that their patients receive universally accepted preventive screening. HMSA benefits by controlling costs, which, in turn, has the potential to minimize premium increases. Most important, this is good health care for the people of Hawaii.

We must continue to guard against the erosion of the healing arts amid health care reform and cost cutting. P4Q, however, helps ensure an excellent foundation for the more comprehensive practice of medicine.

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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.