Many of us who work in health care in Hawaii are strong supporters of the recently enacted national health care reform legislation and are working hard to understand and implement its many provisions.

However, for all of its many positive aspects, the Patient Protection and Affordable Care Act, in our opinion, does not address a number of underlying factors that continue to drive increases in our health care costs.

We are, quite simply, pricing ourselves out of health care. Our nation spends more for health care than either housing or national defense. As a community, state and nation, we are paying too much.

We believe that the biggest opportunity for solving the cost issue won’t come from Washington. Instead, it will stem from a shared vision and collaborative work effort between health care stakeholders in our own community, working to change the way health care is delivered and financed.

The Queen’s Health Systems and Hawaii Medical Service Association (HMSA) are working together to make that happen. Our organizations recently entered into a new contract that bases increases in HMSA payments to Queen’s on how well hospital patients are cared for and on successful outcomes. This is a profound shift from the current payment model, which pays health care providers based on volume. Under the current model, the more procedures and services are rendered, the bigger the payment, no matter what the outcome.

We embrace this change as a way to improve care, enhance wellness, and slow down the rate of cost increases.

Because we are attempting to change an entire system, improvements will take time. While the new contract signals our support of the pay-for-performance model, our organizations will spend the next year working to determine the outcome measures upon which reimbursements will be made. Our joint goals include improving:

» The prevalence of evidence-based care.

» Systems of care.

» Coordination of care.

» Discharge planning.

» Re-admission rates.

» Appropriate use of emergency care.

Both Queen’s and HMSA are committed to these goals, and each of us has much work to do.

For HMSA, its role is in facilitating hospital-driven improvement programs by providing the data, analytical support and financing mechanisms.

The mission of The Queen’s Health Systems is to fulfill the intent of founders Queen Emma and King Kamehameha IV to provide, in perpetuity, quality health care services to improve the well-being of native Hawaiians and all of the people of Hawaii. For 150 years, Queen’s has worked hard to provide superior patient care to the community, and has become widely known for its programs in cancer, cardiovascular disease, neuroscience, orthopedics, surgery, emergency medicine and trauma, and behavioral medicine.

However, Queen’s recognizes the rapidly changing landscape of the 21st century and understands that health care costs have been increasing at unsustainable levels. For Queen’s, the new agreement means identifying new and efficient opportunities to improve on its commitment to provide the highest standards of patient care and, in the end, help keep health care manageable and accessible for the people of Hawaii.

Ultimately, we believe that these new initiatives will result in better and less costly care for HMSA members and Queen’s patients. Working together, we are establishing the foundation for health care sustainability in our community.