Like other states across the nation, Hawaii is experiencing a healthcare workforce shortage, yet it has unique challenges due to its geography. Healthcare leaders met at the 2024 Hawaii State of Reform Health Policy Conference to discuss ways to enhance the workforce through training, telehealth, and licensure compacts.
Moani Wright-Van Alst, senior manager of telehealth at the Hawaii Medical Service Association (HMSA), said HMSA was the first health plan in the nation to partner with a telehealth company to improve access to care in 2009. This partnership has allowed provider networks to virtually deliver care to members.
By 2016, the state pushed forward telehealth utilization efforts by enacting Act 226, which removed geographical restrictions for telehealth services, and required patient visits to be reimbursed at the same rate as an in-person visit.
While the rollout of Act 226 started slow, the COVID-19 pandemic accelerated the use of and need for telehealth services. The legislature passed Act 107 last year, which expanded telehealth access for behavioral healthcare.
“[Telehealth] can open the door to larger network providers by supplementing our awesome doctors here in our state,” Wright-Van Alst said. “Telehealth has the ability to give flexibility. Telehealth is wonderful—we all want work-life balance.”
Matthew Koenig, medical director of telemedicine and neurocritical care of neurology at The Queen’s Health System, said he saw an increase in the use of telehealth services at the health center last year. Since then, 15 to 20 percent of scheduled care visits for established patients have occurred virtually. Koenig noted that the Interstate Medical Licensure Compact was created to bolster access to physicians through telehealth.
“[The Compact] is also a recruitment tool for Hawaii,” Koenig said. “By joining the Interstate Medical Licensure Compact, it makes it easier for us to [attract] doctors from other states to move to Hawaii and provide in-person care.”
The legislature approved the Interstate Medical Licensure Compact last year, which will go into effect in 2025. Koenig hopes the state’s entry into the Nurse Licensure Compact won’t be too far behind, and would allow nurses who live in a compact state to become licensed and practice in multiple states, including through telehealth.
Brianne Atwood Kuwabara, program coordinator at the Hawaii Center for Nursing, said one out of every five healthcare workers are nurses, and that Hawaii is at the forefront of nurse training initiatives nationwide.
“[Nurse training initiatives have] definitely improved support and retention levels for the state of Hawaii overall.”
— Atwood Kuwabara
Although the state has seen improvements, recruitment and retention remain major issues within the state’s nursing sector, and losing employees is costly. In 2022, the nurse turnover rate was 33 percent, which was higher than it had been in preceding years, Atwood Kuwabara said.
“For nurse residency programs in the state, for those folks that are participating in them, we tend to do better than anywhere else in the U.S., and our retention rate over the seven-year average is 94 percent, so that’s staggeringly high,” Atwood Kuwabara said.
Despite improved health outcomes under nursing residency programs, barriers to program implementation remain, Atwood Kuwabara said, which generally relate to the cost of educators and curriculum in specialty care areas. Many of the programs are primarily focused on acute care settings, but 2024 marked the first year Hawaii implemented a nurse residency program in long-term care settings.