5 Things Hawaii: Executive Order, Lessons from Texas, Richard Bettini

We’ve got a couple of interesting items for you this month, ranging from Amazon to President Trump’s executive order. The former will probably sneak up on you.  The latter is expected to make waves on Thursday.

Until then, here are 5 Things We’re Watching for leaders in Hawaii’s health care system.

DJ 5 Things Signature


1.  When Amazon enters health care

The news that Amazon will be looking for a second HQ spurred me to thinking about what it would look like if Amazon entered health care. It would likely come with an announcement as quick and straightforward as the HQ2 announcement, with just as many implications.

I lay out an 8-step strategy for Amazon that I think – while certainly a big deal – is probably not nearly as hard for the giant cooperation as entering the brick-and-mortar grocery space. Which, as you know, they’ve done. Amazon is already a health care giant based on its health care spend for it’s employee count alone. I recognize it’s not an apples-to-apples comparison. Nevertheless, that’s about 425,000 employees for which it already purchases care – soon to be 500,000.


2.  Exec order on insurance coming Thursday

President Trump is reportedly set to sign an executive order on Thursday that will loosen restrictions on association health plans and short term medical plans. The WSJ reports the intent is to provide lower cost solutions to the insurance market, and allow for cross-border sales of products through associations. However, the same article suggests market stability could suffer.  Vox argues the same, and cites Tennessee as an example of how this might turn out.

We asked insurance regulators and executives in a few states for comments, and compiled their responses here. Michael Stollar from HMSA is concerned about anything that could undermine Hawaii’s Pre-Paid Health Care Act.  California’s Insurance Commissioner is ready to go to courtAlaska is worried about the impacts of policy uncertainty on the markets.  Washington State Commissioner Mike Kreidler believes that state law would likely overrule an executive order.


3.  Lessons for Hawaii from Hurricane Harvey

Hurricane Harvey made landfall in Texas on August 26th. That seems like a lifetime ago after Hurricanes Irma and Maria. But, it also gives us some time to learn about how prepared the health care system was – not just on the delivery side, but the administrative side.

After 12 years of no hurricanes, the Texas administrative side of health care is still playing catch up. I was in Texas after the event and posted this story on some of the challenging administrative realities there. For example, who pays the co-pays when those are waived in public programs? How do you guard against fraud when you now have providers filing claims from locations at which they aren’t credentialed? What legal liabilities from audits befall providers and payers when they try to be flexible in a time of crisis?

One lesson from Harvey for Hawaii is this: don’t just plan your emergency response on the delivery side, but also plan it on the administrative and financial side, too. It’s a part of emergency preparedness that may be overlooked.


4. Video:  Richard Bettini

Richard Bettini is the President and CEO of Waianae Coast Comprehensive Health Center, Hawaii’s largest federally qualified health center. He joins us in this edition of “What They’re Watching” to discuss producing positive outcomes for a complex patient population.

“Think about this: Over the last four years, one million medical visits, clinical visits, and two-thirds of those patients had income below poverty level, the majority Medicaid, majority native Hawaiian. So it creates a really unique challenge as we look at where are the preventable costs, how do we get the best possible services and, at the same time, produce the best outcomes in terms of quality.”



5.  Read: “Worst mental health crisis in decades”

This recent story in the Atlantic has been generating buzz among social scientists, policy makers, and parents – or at least any parent that has had to deal with the issue of phones in their kid’s hands. It’s a read worthy of your time for a glimpse into the future of the American demography and economy.

The iPhone was released in 2007, making what’s known as the iGen (kids born between 1995 and 2012) the first generation to live entirely in a world of smartphones. The results: “It’s not an exaggeration to describe iGen as being on the brink of the worst mental-health crisis in decades. Much of this deterioration can be traced to their phones.”

“Eighth-graders who spend 10 or more hours a week on social media are 56 percent more likely to saw they’re unhappy than those who devote less time to social media. But those who spend six to nine hours a week on social media are still 47 percent more likely to say that are unhappy than those who use social media even less. In 2011, for the first time in 24 years, the teen suicide rate was higher than the teen homicide rate.”