Leaders met at the 2024 Hawaii State of Reform Health Policy Conference to discuss challenges with access to rural healthcare in the state. Much of the conversation related to increasing the healthcare workforce through encouraging students to enter the field while providing supportive programs.
Rosie Davis, executive director of the Maui County Area Health Education Center, said it was a real wake-up call when two doctors passed away during a short timeframe, combined with the fact that other doctors on the island were not accepting new patients.
“The issue for us became how do we keep physicians, or any healthcare professional, engaged in a place like Molokai or Lanai?” Davis asked.
She said it’s been a difficult process growing their own healthcare workforce, and the education center is attempting to increase access to the healthcare industry for Native Hawaiians by creating partnerships, like with the Molokai Education Center. She also finds it important to partner with the community in any way to secure funds for traveling, so that students in healthcare can gain more experience in the field.
“We’re trying to make those partnerships. We’re trying to improve access to the students,” Davis said. “While we’re creating all of this, we don’t have enough openings and jobs for all of these students, so that’s the other portion that we lack, and how do we provide that?”
He referenced a survey among youth that found their main reason for not entering the healthcare workforce was the perception that only rich people become doctors.
“And I thought, gosh, this is the mentality that we have.”
— Davis
Davis said the state can grow its own healthcare workforce, but wonders where they will go if they don’t have housing opportunities or family members on the mainland.
Caroline Carney, MD, president and chief medical officer of Magellan Health, said those living in rural settings face higher rates of medical conditions, like cancer, and they’re not receiving adequate health literacy.
“At Magellan, we really address the need for rural healthcare and behavioral healthcare shortages in a couple of different ways,” Carney said. “Think about a world in which we could better deliver services here so that kids don’t have to leave their home and leave the island.”
Wyoming, a very rural state, is a client of Magellan and has a program that works with children in state custody, or who are at-risk of being in state custody. Carney did not cite this program by name, but said it’s a waiver program from the state. Children can be referred to the program by families, including foster families, a treating physician, among others. It is a voluntary program that sees children ages four to 20 years.
“The kids who are identified then are put into a really interesting way of doing assessments for them. That is very, very person-centered and trauma-informed.”
Carney said individualized treatment plans are developed, as well as a team to provide family and care services to keep the children in their homes. This team is composed of licensed social workers, those with a bachelor’s degree or GED who have experience and training in conducting community-based work.
“We go into communities and we help build teams where we see the greatest population needs,” Carney said.
Outcomes for this program included 88 percent confidence of caring for youth in the home setting and 71 percent of children reporting increased functioning The program can be delivered at $20,000 per child, which creates savings for the Medicaid program, Carney said.