Medical heavyweights team up for new approach to quality health care

HAWAII ISLAND—The Queen’s Medical Center and HMSA are now working together on a new payment system that rewards hospitals for the quality of the care they provide. The system will provide incentives for both companies to coordinate care with the goal of improving health outcomes while controlling costs.

The Queen’s Medical Center and HMSA believe that this new reimbursement model will result in higher patient satisfaction as well as lower costs.

“Health care costs have been increasing at unsustainable levels,” said Art Ushijima, president and CEO of The Queen’s Health Systems, in a statement. “Queen’s and HMSA have come together to find concrete ways to address this urgent situation. The new agreement focuses on quality and efficiency and will help us bend the cost curve over time with the goal of keeping health care manageable and accessible for the people of Hawaii.”

Youth News for The Hawaii Independent spoke with Hilton Raethel, senior vice president of HMSA Quest, to try to understand how the new system works.

Here are our questions along with her answers:

What do you mean by sustainable?
By sustainable, we mean a healthcare system that we can afford. There is no point in having the best hospitals, doctors, techonology, and drugs in the world if we in Hawaii can’t afford the care. Under this new model of healthcare delivery, we are focusing on providing the right care in the right place at the right time, and addressing the issues of overuse, underuse, and misuse of healthcare resources.

In a practical sense, it means increasing access to primary care, for example, so that a mother with a sick chlid at 7:00 p.m. can see a primary care physician in an office at a cost of $100, instead of having to take the chlid to an emergency room at a cost of $1,000. It means ensuring that every keiki and every kupuna has access to vaccinations so that our keiki don’t get measles and chickenpox and our kapuna don’t get sick from the flu. It also, means motiving people to eat better, execrise regularly, and stop or don’t start smoking so that we reduce the incidence of people with chrononic disease in the community.

How will you measure improvements in quality and safety?
Some of the measurement criteria will be process metrics. For example, when a patient is discharged from a hospital with a prescripition or prescripitions, the hospital communicates with the patient’s primary care physcian to ensure the primary care physcian knows what the new medications are so he or she can ensure that there are no adverse drug reactions or conflicts with the medications that the primary care physcian has been prescribing for that patient. HMSA will be measuring whether that call was made from the hospital to primary care physcian.

Another example is looking at the claims that the hosptals submit to HMSA to ensure that if a patient has a certain diagonosis, that the appropriate tests and treatment were provided to that patient based on industry wide best practice.

When will you start the new program?
The new contract between Queen’s and HMSA started on April 1, 2010. During the first year of new contract, a representative group from Queens will meet with a representative group from HMSA on a regular basic (approximately once per month) to collaborate on the development of a set of metrics which Queens will be measured for subsequent years. The first meeting occured last week at Queen?s Medical Center. 

For more information, visit www.hmsa.com or call (808) 547-4975.