A sweeping health care change is coming to Hawaii County from the largest health insurance provider in the state.
But most patients, organizers say, are unlikely to notice — at least right away. They will, though, if a hoped-for stabilization — or even a decrease — in health insurance premiums takes place.
Hawaii Medical Service Association has eliminated the piles of paperwork required for the fee-for-service model of health care and, instead, plans to pay health practitioners a standard fee, based on past payments.
That change, called “payment transformation” by HMSA (an independent member of the Blue Cross Blue Shield Association), will allow each medical practice to determine how best to provide care for its unique group of patients.
Some seemingly radical changes might happen, such as communicating with patients via email (and doctors getting reimbursed for their time) instead of needing an office visit. Or, perhaps, the return of house calls.
One pediatrician, for example, overcomes the high rate of office no-shows among teens by texting them directly and showing up where the young people are — instead of hoping, without any guarantee, that they’ll show up for an office visit.
In that way, the physician actually saves time and makes sure the teens get more routine, proactive care. She also gets paid the same amount as if she stayed at the office and she’ll get financial rewards for providing higher quality of care rather than greater amounts of care.
HMSA President and CEO Mike Gold said in a telephone interview that the vision for the payment transformation system formed about seven years ago when “we decided things really had to change in health care to make the health care system sustainable.”
At the time, doctors were frustrated because they wanted to spend more time with patients — but couldn’t because they felt overwhelmed by the amount of paperwork required, and by the shear volumes of patients.
“It got down to they couldn’t practice medicine the way they envisioned it when they went into medicine in the first place,” Gold said.
In the company newsletter to consumers, Dr. Mark Mugiishi, HMSA senior vice president and chief medical officer, calls the change to the new payment system “one of HMSA’s most-transformational initiatives ever.”
Hilo practitioner Dr. Kevin Kurohara said that change is difficult, “especially for myself, being in practice 30 years but trying to effectively utilize the benefits of technology, yet not lose the ‘hands-on’ personal touch.”
Kurohara has been among the early adopters who entered an HMSA pilot program studying the new payment plan.
He said, given the choice, those medical providers who have tried the new payment system would choose not to return to the old one.
Gold said the goal is “trying to get away from the almost universally recognized fee-for-service payment system. … It’s just the wrong incentive. It leads to the system that we’re in now.”
With fee for service, the more X-rays a health provider orders, the more dollars that roll in. Under the new payment system, the doctor will get paid the same amount, regardless of how many X-rays are requested. The new philosophy, already tested in the pilot program, works to decrease the unnecessary tests while also giving doctors time to adequately review, analyze and explain necessary ones.
“We started an early pilot program,” Gold said. “We started it in Hilo. We had a group of physicians who were really interested in doing that. It worked out phenomenally well. I don’t think we have a happier group of people.”
The change in payment systems helped physicians provide care tailored to the needs of patients, while producing better quality of care outcomes.
“It stabilized the cost of health care there,” Gold said.
“There were problems that we worked with physicians to fix. …We, and they, learned a lot from it.”
Dr. Michael Nagoshi, chief medical officer at Central Medical Clinic, told HMSA’s “Island Scene” newsletter that doctors don’t get paid when they keep patients from getting ill, only when they treat a sick person. He wants to change that through teams of health providers working collaboratively to prevent patients from getting sick.
Starting in 2017, HMSA, a nonprofit insurance provider, plans to roll out the new method to all Hawaii Island physicians whose patients carry HMSA policies.
Will that impact other health insurance providers that serve Hawaii Island? Gold said he will be glad to entertain inquires from other insurers interested in making the change.
HMSA says the pilot program, which began in April 2016, has allowed it to “continue to refine the model that we have out there, continue to listen to physicians, continue to listen to their patients.”
The method of keeping the philosophy dynamic is expected to continue long term.
“You have to be able to change in an environment that’s changing rapidly,” Gold said.
HMSA hopes to roll out the new system to specialty physicians and hospitals starting in 2018, with pilot programs for specialists and hospitals in 2017. There might be unforeseen delays.
But, “certainly by 2020, everybody would be in it, in some way,” Gold said.
He said the first priority has been to stabilize the growth in the cost of health insurance premiums. Premium costs have been increasing drastically for consumers across the country.
The new HMSA payment system “will bend the cost curve and keep that under control,” Gold said. Copayments and deductibles will stay the same, unlike on the mainland, where many policies have shifted the cost to consumers’ premiums, deductibles and copayments.
“To me, in the long run, that’s just self-defeating,” Gold said.
Instead, HMSA is looking toward a stronger future — for itself, for patients and for the health care system.
Email Jeff Hansel at jhansel@hawaiitribune-herald.com.
