Michael Stollar, 59, had been with the Hawaii Medical Service Association for almost 32 years when he took over as its president and CEO about five months ago. That’s more than enough time to have witnessed enormous change in health care — both in how it’s delivered and managed.

At his start with HMSA, Hawaii’s landmark Prepaid Health Care Act already was in place, laying an employer-based, health-coverage foundation that, at the start, was unmatched by other states.

Stollar, married and the father of three, is the son of a physician. His two years in the Peace Corps took him to Tonga, but he was born in Saskatchewan, Canada, so knew that national single-payer health system. “Prepaid” wasn’t quite so startling to him.

In the U.S., the economics of this business sector has continually morphed, and HMSA, the largest health insurance provider in the state, has found itself juggling the advantages and costs of new medical technologies. Uncertainty over the Affordable Care Act has contributed to losses recently, and to the departure of about 5,000 members, he said, though others have joined.

The industry hasn’t been without its controversies. Stollar remembers about eight years ago the battles over reimbursements with hospitals. More recently there was a fight with dialysis centers that moved patients from Medicaid to a charity plan that, he said, did not always serve the patients so well, long-term.

But there’s been a cultural change in the local industry, too, and that has helped. There’s HMSA’s sponsorship of the “Blue Zones” wellness project, for one example. In general, Stollar assessed HMSA as better at working through changes with the stakeholders than it once was, though he acknowledged it’s a work in progress.

These include a change in the payment system, moving from fee-for-service, he said.

“We now pay them based on the quality of the care they deliver, their ability to improve their patients’ health over time and their participation in addressing cost,” he said.

QUESTION: With the repeal of the individual mandate, isn’t the future of the Affordable Care Act fuzzy?

ANSWER: It’s very fuzzy. And that uncertainty isn’t good for markets. It’s not good for insurers, it’s not good for patients, it’s not good for the providers who don’t know whether they’re getting paid or not paid. I mean, it’s just difficult.

Q: So, the 5,000 members who left, were they younger people?

A: Well, but we had others join. So really, the net loss was small.

Q:But a lot of churn?

A: Churn, lots of churn and lots of uncertainty. You just don’t know who you have, right? And therefore it’s very hard to project the future.

And so people here, people across the country in that particular line of business saw huge rate increases. And that’s where then people say, “Look how unaffordable it is.”

But that comes from the uncertainty, where they cut back everything … all the things they promised to stabilize the market, all the market stabilization aspects are now being threatened, so hence the huge rate increases. Because you don’t know what’s coming.

Q: And that’s still not resolved.

A: It’s far from resolved. But there are people trying to resolve it. There is some bipartisan work going on.

Q: Quietly?

A: Quietly — so who knows when it happens?

But Hawaii stays ahead of the curve. … Prepaid remains a positive. It’s not a perfect law; there are some challenges with it.

But, you know, I think we rank very highly when it comes to the Commonwealth Fund poll, the Gallup polls. You name whatever sort of assessment is going on nationally — Robert Wood Johnson, and all that — Hawaii ranks quite high.

And it’s not just about the weather, right? We’ve had a progressive health-care system, people able to get care, take care of things early because they’ve had coverage. We’ve had employers with the mindset of ensuring that their employees have good coverage. That all goes a very long way, and so different from many parts of the mainland.

Q: How can HMSA manage the rising costs, and insurance rates?

A: Premiums are driven by the underlying cost of care. We have numerous programs in place to help contain costs and therefore premiums. But in the long run, the best way to reduce demand for care is to improve health. The healthier our members are, the less demand there is for services and the less strain there is on the system.

Some of our new and innovative programs we are working on include a new way of paying for health care … and making the healthy choice the easy choice for people. Since people spend so much time at work, we’re working with employers to develop policies and programs that support a healthy environment.

Q: What lesson did you take away from your visits around the company?

A: More than anything it was a fantastic way for me to get re-energized and be inspired. … It was very evident that the driving force and spirit of our employees was for one purpose, and that’s to serve our members. Having grown up in the company, it’s been a great way to reconnect with so many people, catch up on families and events in everyone’s lives.

Visits to the neighbor islands to meet with employers, the media and our staff have been particularly meaningful. On a recent trip to Maui, I woke up at the crack of dawn on a Saturday and was able to participate in a couple of community events with our Maui team.

In addition to hearing dozens of people come up and tell us how much they love HMSA, I was able to see how passionate our employees are about helping others. Whether it’s to answer a question about insurance, assist someone in finding a new doctor, or help someone remember where they parked their car, our employees go above and beyond and their enthusiasm is refreshing.

Q: Can you update us on the Blue Zones Project?

A: There will be a total of eight Blue Zones Communities by the end of this year. The three communities on Hawaii island, Central Maui and Koʻolaupoko on the Windward side of Oahu are all doing well. Both HMSA and Blue Zone staff on Kauai and the Big Island are helping out where they can with the natural disasters.

Three more communities will kick off next month: Wahiawa on June 7; Kapolei/Ewa on June 16; “the 4Ms” — Manoa, Makiki, McCully, Moiliili — on June 24.

Q: How is HMSA helping in the fight against opioids?

A: We have medical, pharmacy and behavioral health experts along with case managers and social workers who work closely with physicians to help manage members who are using opioids. Some of our efforts include alerting pharmacists whenever an opioid is being refilled too soon, the dose is too high, a patient is taking more than what is recommended, or if a patient is on multiple opioids.

We help coordinate therapy, when more than one prescriber is treating the same patient. And we provide access to treatment for detox or opioid overdose.

Through a grant from the HMSA Community Grant Program, we’re supporting a pilot program for individuals on the West Side of Oahu to address the growing opioid epidemic in our local communities … located at the Waianae Coast Comprehensive Health Center’s main campus.

This program will provide evidence-based pain management interventions that include individualized treatment plans … providers from behavioral health, cultural practice, exercise therapy and acupuncture. …

Q: Did you have any major issues of concern at the Legislature?

A: We had a very productive session working with lawmakers to craft policies to support affordable health care for Hawaii residents, protect ACA benefits, and limit the negative impacts of short-term plans and association health plans, which protect consumers by keeping the playing field level. We also supported efforts to reduce opioid drug overdoses in Hawaii.

The policies we supported included extending dependent coverage for adult children up to 26 years of age, prohibiting health insurance entities from imposing a pre-existing condition exclusion, and prohibiting health insurance entities from using an individual’s gender to determine premiums or contributions.