Preventive care helps mitigate rising healthcare costs in Hawaii


Shane Ersland


Industry experts identified initiatives to help minimize inflation and rising healthcare costs at the 2023 Hawaii State of Reform Health Policy Conference.


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Gordon Ito, insurance commissioner at the Hawaii Department of Commerce and Consumer Affairs, identified several healthcare cost drivers. They included fragmented or uncoordinated care, unhealthy behavior and lifestyle choices of patients, and service reimbursement issues.

“Another issue is the aging population,” Ito said. “Hawaii has one of the [country’s] oldest populations, so that’s a challenge. And it’s only going to get worse.”

Lehau Pate, vice president of revenue cycle at The Queen’s Health System, said providers need to focus on primary and preventive care to help patients mitigate health problems before they worsen. The state’s smoking cessation programs have provided a good example, as lung cancer death rates have decreased significantly since 2019.

“Adult smoking prevalence went from one in five adults down to one in seven,” Pate said. “And even more significant were results from the youth going from 30% down to 8%. That is a huge decrease. The focus needs to be on improving morbidity rates and improving population health overall.”

A lack of sufficient long-term care options is another factor that makes ensuring the population’s health a priority. Pate said the recent closure of a home healthcare facility impacted 100 elderly patients.

“That leaves us with eight home healthcare facilities on Oahu,” Pate said. “And most of these places have very long wait lists. (Queen’s) is holding on to a lot of patients because we’re not able to place them in other community facilities.”

Queen’s is focused on improving ambulatory and outpatient access of care for patients to help with preventive care services. 

“We want to treat patients with preventive care to prevent them from ultimately ending up in the [emergency department], or [becoming] an inpatient, or [placed] on a ventilator or life support,” Pate said. “Unfortunately for a lot of our patients there’s non-compliance, for different reasons. They may not have transportation to go see their (primary care provider).”

Queen’s is also utilizing a patient community care navigation program, which allows navigators to visit patients in their homes, Pate said.

“They provide education, making sure they’re compliant with their medications, and making sure they’re taking care of their wounds so these problems don’t escalate and require a higher level of care in a higher cost setting,” she said. “We can do preventive care to help our patients stay in that continuum of care. Then we can save a lot of costs, and they’ll have better outcomes than ending up in the (emergency department) or as an inpatient.”

Matt Reeves, senior vice president of clinical integration at the Hawaii Medical Service Association (HMSA), said HMSA is utilizing value-based reimbursement to manage health costs to promote preventive health.

“Value-based contracts such as the Payment Transformation program provide primary care providers with the flexibility so they can increase their focus on health and well-being,” Reeves said. “Value-based programs align incentives around desired outcomes, which are measured in health outcomes.”