HMA working to develop SDOH transformation plan to help improve Hawaiians’ health outcomes


Shane Ersland


Health Management Associates (HMA) is working to develop a statewide social determinants of health (SDOH) transformation plan to help improve Hawaiians’ health outcomes.


Stay one step ahead. Join our email list for the latest news.



The plan will help identify, evaluate, and reduce health disparities based on factors including age, race, ethnicity, gender, primary language, and disability status. It is a project initiated by the state’s Department of Human Services’ Med-QUEST Division (MQD), which aims to build the Hawai‘i ‘Ohana Nui Project Expansion (HOPE) program, a multi-year initiative to develop and implement a roadmap to achieve a foundation for innovative programs that support and create healthy families and communities.

HMA Principal and project director Maddy Shea, PhD, said the project will be very comprehensive and will be implemented over 5 years. HMA will work with many different agencies, including government officials, community-based organizations, and health plan providers, to work on the project collaboratively.

“Right now, there’s a lot going on [around SDOH], but it’s not synergistic,” Shea said. “A hospital can’t solve poverty, and neither can a health plan, but if they’re working with government and community-based organizations, they can work together to solve some of these problems.”

The HOPE initiative will gather statewide information about various aspects that affect SDOH including economic stability, physical environments, housing, transportation, access to care, education, food insecurity, and local health care systems.

“We’re talking to Medicaid managed [care] plans, community health centers, state department heads, the university, and all the different entities that touch upon social risks,” Shea said. “We’re looking to see if they screen people for social risk factors, and if so, what do they do about that? Do they use some kind of platform to navigate those needs?”

One area of concern will center around rising costs related to inflation, which can be especially detrimental for Hawaiians given the space between islands, Shea said.

“If you’re on one of those outer islands, the cost of food and gasoline is way higher than in the continental US,” she said. “That’s what social determinants of health are; it’s financial, food, and housing security. If you can’t afford them, all of those things are a problem. But it’s worse in the outer islands. Transportation barriers are more of a problem, and in some places there aren’t even roads.”

HMA recently completed an analysis to explore federal financial flexibilities in Medicaid to pay for plan initiatives, Shea said. 

“We looked at what other states are doing to pay for this to see if there’s flexibility with Medicaid,” she said. “In addition to Medicaid flexibilities, we’re looking at other federal funds that would not cost the state money.”

HMA plans to meet with stakeholders to review the final transformation plan and discuss next steps in implementation in February.

“The overarching reason to address social determinants of health is to improve the outcomes for those who have the worst health right now,” Shea said.