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Editorial | Island Voices

Health reform initiatives paying off in Hawaii

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Recently, Hawaii Pacific Health announced that it had finalized a new three-year agreement with the Hawaii Medical Service Association (HMSA) that covers services provided by our four hospitals: Kapiolani Medical Center for Women & Children, Pali Momi Medical Center, Straub Clinic & Hospital and Wilcox Memorial Hospital. A collaboration was also announced between Hawaii hospitals, HMSA and Premier health care alliance on a new initiative to improve quality and reduce health care costs.

The new agreements create a "pay-for-performance" model that provides a certain percentage of payments based on whether our hospitals achieve or exceed agreed upon quality metrics. We have always been focused on clinical quality and service excellence, having worked with the Institute for Healthcare Improvement for many years. We are pleased that HMSA has recognized our commitment to quality and is now by paying us for the exceptional care we provide to our patients.

What does all of this mean for our patients? Since 2004, we have invested significant resources in pursuing the highest standards of quality for our patients. Our work has resulted in improvements in key areas such as hospital acquired infections. These conditions cost about $30,000 to $40,000 per patient to treat, so the cost savings is significant for all parties when our hospitals achieve and maintain a zero infection rate. More important, though, is that our patients can feel confident that they are receiving the best care possible in our facilities.

Our patients are also noticing a change in how we deliver their care, and our patient satisfaction scores reflect our efforts. In 2010, our emergency departments were recognized for being among the best in the country, with our hospital scores routinely in the top 10-15 percent. When patients express high levels of satisfaction with the care they receive, they are more likely to follow the recommendations for their care and achieve better outcomes as a result.

One of the advantages we have is the ability to connect all of our hospitals and physicians via an integrated electronic medical record system called Epic. Patients who see our physicians can also access their own medical records to monitor lab results, make appointments and query their doctors. This technology has made a tremendous difference in the way we provide care to our patients, and we are seeing real results.

In August 2010, we focused our attention on patients at Straub and Kauai Medical Clinic with known high blood pressure — higher than the recommended goal of 140/90. Today, 70 percent of our Straub patients and 72 percent of our Kauai patients have reached this goal, which is significantly better than the nation’s average. This means that approximately 300 more patients in Hawaii are now at lower risk of heart attack or stroke as a result of our work to improve care of high blood pressure.

For our patients with diabetes, a much higher percentage of our Straub and Kauai patients meet all of the quality measures for diabetes than the average for the nation. This means that an additional 440 patients in Hawaii now have a lower risk of diabetes complications.

Pay-for-performance models of reimbursements are not new. HMSA has had a quality program for doctors and hospitals in place for a number of years, and the Centers for Medicare and Medicaid Services requires health care providers to report their results in order to be reimbursed. What is changing both in Hawaii and throughout the nation as a result of national health care reform is the alignment of financial incentives between health care insurers and health care providers for quality outcomes.

This change will need to continue into the future in order to support a sustainable health care system for Hawaii and the rest of the nation. At Hawaii Pacific Health, we welcome this change. It is absolutely the right thing to do for our patients.

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