As a result of a rural population, diverse patient needs, and shortages in licensed health care providers, health care access is a significant issue for the people of Hawaii County, which is also known locally as the “Big Island” of Hawaii. According to census data, there are about 37 people per square mile on the Island—a much lower population density than the average for the state as a whole. This population is served by 395 physicians, which is approximately 40 percent fewer physicians than it should have to adequately serve its population; these shortages affect nearly all specialties. Patients experience long waits for an appointment to see a health care professional, particularly for primary care and specialty care. Many residents must travel more than an hour for routine medical care. For specialty care, it is often necessary to travel off the Island.
Care for patients with diabetes, high blood pressure, and high cholesterol, when combined with shortages of particular health care professionals, leads to inefficient care delivery and lower quality of care than is possible—even though Hawaii is renowned as a relatively high-quality, low-cost state when compared nationally. Native Hawaiians between the ages of 19 to 35 are more than five times as likely as non-Hawaiians to be diagnosed with diabetes. Between age 36 and 64, Native Hawaiians have a rate of diabetes that is more than twice that of other populations, contributing to the wide health disparities on the Island.
The Hawaii County Beacon Consortium (HCBC) has put forth a vision for the health care delivery system of the Big Island that will address these multiple challenges together using technology. These efforts build care delivery improvements on a regional health information exchange that will supply providers with timely quality and outcomes data at the point of care. The Big Island’s new information technology-enabled care model will help support more scalable solutions that would previously have been unaffordable in more rural communities. For example, nurse care managers will be able to leverage the health information exchange system to provide care management services for high-risk patients with diabetes across several physician locations, thereby improving patient outcomes without adversely impacting physician practices. Moreover, Hawaii will invest in new tele-medicine programs that will allow residents of the Big Island to access needed services in other parts of Hawaii without having to get on a boat or airplane. This will help ensure that patients are receiving the right care at the right time.
Goal of the Program
The goal of the HCBC is to improve the health of the Hawaii Island residents through implementation of a series of health care system improvements and interventions across independent hospitals, physicians, and physician groups and in partnership with public and private health insurers. Engaging patients in their own health care is also a primary focus.
The HCBC is targeting the following specific community objectives:
- Improve access to primary care, specialty care, and behavioral health care through the implementation of a patient-centered medical home model and the use of telemedicine
- Monitor patients more carefully and in a more targeted manner to help avert the onset and advancement of diabetes, high blood pressure, and high cholesterol
- Reduce health disparities for Native Hawaiians and other populations at risk by developing personalized interventions that ensure that Native Hawaiians receive the care they need
- Assist physicians in achieving meaningful use of electronic health records, which will drive further improvements in health and health care delivery
The HCBC will leverage health information technology (health IT) to help improve the quality of care, increase efficiencies, and expand capacity by:
- Pursuing a regional health IT-enabled strategy to facilitate coordination of care across sites, and empower physicians and other care providers with more comprehensive patient information
- Employing an electronic and expandable patient-centered medical home model using a range of technologies to help extend the providers’ reach through physician extenders such as physician assistants, APRNs, and pharmacists
- Creating scalable health IT-enabled care management models which provide small, rural physician practices access to care coordinators to better manage high-risk, chronically ill patients
- Embedding health workers and volunteers in communities to provide culturally sensitive, group classes to promote patient engagement and provide health and wellness education
- Developing IT-enabled referral triage tools to expand access to specialty care by ensuring referrals to specialists meet threshold criteria
- Connecting the dispersed provider community and providing patients with access to their own health information through a personal health record
- Using performance measurement and feedback processes to give physicians actionable insights about their relative performance and adherence to evidence-based protocols
The HCBC program involves a consortium of organizations and agencies including Hawaii County, the University of Hawaii at Hilo College of Pharmacy, health plans, associations, hospitals, clinics, physicians, and community groups. The HSBC is also working with the Hawaii Health Information Exchange, a Regional Extension Center funded by the Office of the National Coordinator for Health Information Technology, to encourage and assist providers to adopt EHRs. The Regional Extension Center will provide technical assistance in achieving meaningful use and qualifying for Medicare or Medicaid incentives, offer continuing education credits for classes in health IT implementation, and coordinate efforts among vendors, EHR resellers, and consultants.
Improvements for Patients and the Community
The HCBC program aims to provide every resident of the county with a medical home and a personal health record.
By the end of 2013, the HCBC expects to improve the quality of care for its community through:
- More comprehensive, coordinated health care, particularly for the chronically ill
- Shorter waits for appointments
- Greater access to medical specialists
- The opportunity for more involvement in their own health care
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