.................. June 2010 Newsletter .................
Aloha! This is a long overdue note about the doings at East Hawaii IPA.
First, kudos to Rodney Ono for recognition in Honolulu Magazine's "Best Doctors in Hawaii" especially since he was one of only two neighbor island doctors so recognized. You can call him for hints on how he did it.
Second, although it comes three years late, we will be getting risk pool payments from Aloha Care for fiscal years 2006 and 2007.
For HMSA, unfortunately, we have been through three years of losses in HPH. Because of this, we are moving to upside gain only. Much of the loss has to do with some difficult and chronic cases. The losses seem to relate to a leukemic with multiple hospitalizations stretching over multiple years. While we have done better with HMSA Quest, there have been some losses over the last couple of years as well. Thanks to reserves and some of the quality and performance bonuses, we have not had to ask membership for payments as some groups have had to.
Evercare is still in the process of determining how things have gone. Again, the cost of running the IPA is being supported by management fees from insurers, and is not coming from providers.
HMSA-Amalga
HMSA is in the process of creating a Health Information Exchange (HIE). They will be using a large server/computer in cyberspace, called Amalga, a Microsoft product which will serve to bring together all of the medical records in digital form.
It will consist of labs, x rays, physicians' records (from those with EMRs) allowing communication between all providers and allowing for dialog between medical professionals and patients. This includes pharmacies, nurses, ER physicians, and other healthcare professionals.
The HIE would allow for sharing of data so that you can find out if a test was done, or a prescription filled (or duplicated). Physicians would not have to duplicate tests and you would not have to fax multiple copies to different venues. Each state is responsible for their HIE equivalent and they should all be able to communicate across platforms.
In order for physicians to access the server, you will need either EHR (Electronic Health Record) or a computer.
HMSA Changes
The current insurance model, as has become clear the last few years, with fee for service, is no longer sustainable. Premium costs, which lag the true cost of providing care, are on a path that is unsustainable. This leads to two new paradigms.
The first paradigm shift is that HMSA will be moving towards a new payment paradigm, and they want EHI to help pilot a project to create a new payment method. Realistically, this would initially be primary care. However, it appears that the future will bring capitation "plus" meaning capitation plus incentives. In order to make this adjustment, HMSA is willing to indemnify us against significant loss during the pilot. It would be to our advantage to deal with this proactively.
The second paradigm shift is that management of patient care will differ. This will mean a team approach, with group sessions, ancillary providers using protocols, patient education outside the office, and physician involvement for complications. Specifically we are talking about the Patient Centered Medical Home (PCMH) which has the patient at the center and the PCP leading the team which helps manage the care. The team would vary from patient to patient and the diagnosis. For instance, the team for Diabetes would be the PCP, the diabetic educator, the pharmacist, the dietician, and appropriate specialists. In the past, we have considered this an optimum method, but had issues with funding. HMSA, for the purposes of the pilot is now willing to lead the construction of the team.
When this happens, we will have pay for performance and cap, and the patient should see a seamless continuum of care, as opposed to the fragmented care that we have now. Any continuum that we have now is the product of an immense effort. With the new system in place, there should be a seamless continuum that will happen as a matter of course and at the center will be the patient and whoever is working with the patient at that moment. In the midst of this perfect storm have come some other opportunities.
KIAA
HMSA and KIAA will be working together to stabilize premiums in return for getting employers to work with the Health Pass program and to try to emphasize healthy lifestyles for their employees. This would mean freeing up time during the work day to allow health pass to come in, even for smaller groups. This would also mean screening for diabetes, lipids, HBP, and possibly to give flu shots and to follow up on abnormalities. This model, if it works, would likely be exported to the school system to identify students at risk, especially when they stop seeing Pediatricians on a regular basis. The abnormalities and the findings of the Health Pass would then be sent to the HIE and be available for downloading.
Beacon Community Grant
As I am sure you have heard UH-H has been awarded one of 16 hotly contested Federal grants for a three year period to pursue the integration of information technology in order to lower medical costs (bend the curve).
This is a big deal.
Mayo Clinic and Geisinger Health System were two of the other grant winners and in this case the grant is island wide with and involves the HIE and PCMH. The aims of the Grant dovetails with HMSA's efforts, and this will have a large impact on how medicine will be practiced in the future. EHI members' collaboration will have a major impact on this project, and we can help determine the future we will be living in.
Details on all of the projects will be forthcoming during the IPA Symposium so please attend.
IPA Health Care Symposium-August 20, 21, 22
The 2010 edition will again push the envelope, but will lay out a vision of the future that you can help create. The registration forms will be coming out before the end of the month, and in this one, EHI will really be at the "tip of the spear". This event has been approved for 12 CME Prescribed Credits by the AAFP. Registration can also be done online at www.ehipa.com. Please plan to attend.
Finally, I wish to welcome Peter Matsuura back from his Middle East deployment in support of our military. This was his third deployment, and I would like to thank him for his service.
Richard
