During the past few years in the newspaper and at a number of presentations, we’ve said “the house is burning” in our efforts to make visible the urgency and the growing size of the health care cost crisis. The crisis will only get worse as the state struggles to find money for other compelling needs such as homelessness or schools and teachers, and the federal government cuts Medicaid funding.
During the past few years in the newspaper and at a number of presentations, we’ve said “the house is burning” in our efforts to make visible the urgency and the growing size of the health care cost crisis. The crisis will only get worse as the state struggles to find money for other compelling needs such as homelessness or schools and teachers, and the federal government cuts Medicaid funding.
Many of these issues are beyond our ability to influence, but we are facing a burning issue right here in East Hawaii that we can do something about.
Unless we reduce the increasing trend of emergency room visits and inpatient admissions, our hospital, the Hilo Medical Center, will need to expand its facilities in order to meet the need. This will be a capital expense of tens of millions of dollars no one can afford. We can, however, prevent this by decreasing the avoidable use of the emergency room and the hospital.
In January, a team from Hilo went to Austin, Texas, to join with teams from Cincinnati, Detroit, Seattle and Philadelphia to explore the value of meeting non-medical needs of patients. Clearly, if by meeting these needs we can improve the quality of care and lower the overall costs, we should do so. We learned that there is a growing national consensus that new payment, data, and governance models that enable communities to address medical and social needs are needed to allow resources to be spent for greater value.
For example, if we can provide a patient with a refrigerator necessary to store their medications and eat healthier foods, and this will result in fewer emergency room visits and hospital admissions, why wouldn’t we do this? Better care at a lower cost is everyone’s goal, but there are multiple reasons why this doesn’t happen.
In the current system, funding can only be used in certain ways, and medical and social service providers have strictly defined scopes. Both cause gaps that the most complex patients fall through. There are good reasons for this. We cannot solve all social problems under the health care umbrella, and we need to safeguard against abuse.
No governance or coordination system exists to ensure the integration of medical and social services. Medical services are funded through health plans, and social services through the government or grants, with no one having accountability for the total health of a person or for the coordination across the continuum of services.
We think we can create a better system in East Hawaii, a more humane system that coordinates social and medical services and that has the flexibility to meet some of the unique needs the most complex and expensive patients have. To do this, we created a group called CAN, or Community Action Network, with a steering committee led by Darryl Oliveira and co-chaired by Randy Kurohara. This group is composed of representatives from HOPE Services, Legal Aid Society, East Hawaii Independent Physicians Association, Bay Clinic, public health nurses, Hilo Medical Center, the EMS Community Paramedicine Program and the county Office of Aging, to name some of the folks coming together.
As part of this group, we also are creating a Community Care Improvement Team that will look at cases that fall between the cracks and see how we can prevent this. Martha Yamada will be the chairwoman and Karen Teshima will be the co-chair for this team. I am deeply thankful for the leadership, commitment and experience Darryl, Randy, Martha and Karen bring to this initiative.
In the end, if we are to succeed, however, it will not be just because of a group like CAN.
Everyone, providers and patients alike, have to feel responsible for doing their part, which means willing to be kept accountable for what they’re supposed to do.
Everyone must do what they can.
Patients must keep appointments and comply with treatment plans, and we must enable them to do so. The system must be easy to access and not present a complicated maze of paperwork and agencies to those who are least able to make sense of it.
Funders must be willing to pilot radically different payment models and measures of value. Providers must be willing to work together in the community interest and not focus on protecting their turf.
It’s not easy. We will be among the first in the nation to do this.
Can, No Can?
In East Hawaii, CAN.
Barry Taniguchi is the CEO and chairman of KTA Super Stores. A leader Hawaii’s business and civic community, Taniguchi is dedicated to transforming health care delivery, payment and attitudes to create a sustainable healthcare system in East Hawaii.
This column was prepared by Community First, a 501(c)(3) nonprofit organization led by Taniguchi and supported by a volunteer board of community leaders. Community First was established in 2014 to help the community respond to the health care cost crisis and support initiatives that change health care from just treating disease to caring for health. To learn more about Community First, visit CommunityFirstHawaii.org.