Something that resonates with everyone in Hawaii is the idea of “laulima.” It means many hands working together.
Because of our geographical isolation and limited resources, making effective use of those limited resources is sometimes our only option. On Oct. 3, Community First’s Community Care Improvement Team, or CCIT, hosted a Care Coordination Summit.
CCIT is part of the community action network headed by Darryl Oliveira and Randy Kurohara. During the summit, case managers, outreach workers, community health workers, patient care coordinators, patient navigators and leadership from health care and social service providers met to understand what resources are available in our community and how to better access those services for patients.
Seventy-seven people from 30 different organizations participated. This issue is so important that Dr. Virginia Pressler, director of the state Department of Health, and Joy Soares, a project director representing the state’s Med-QUEST Division, also attended.
The CCIT summit represented a different approach to solving the problem of caring for high-need patients. Normally, attendees would have voted on the challenges and come up with a list of action steps, which might or might not be followed up on. The CCIT had no illusions about solving these issues in one meeting. Instead, the main purpose was to meet each other face to face and learn to communicate with each other. So much more can get done when you know the person on the other end of the phone. Each provider was given two minutes to explain their background and services to all the attendees.
Then small groups were formed and given case studies modeling real world patients. Each group was asked to envision what services they could provide for the patient and how they could help the patient move smoothly from one service provider to the next. One goal of the CCIT is to use this case study process for real clients and patients to identify front-line situations where policy meets reality. This summit was a first step for providers to work together in a different way.
We confirmed what many of us have known for a long time: We need to coordinate medical and social services to meet the needs of the most complex and expensive patients. Although many social service agencies, health plans and medical providers provide care coordination to some degree, no one seems to be coordinating care across the whole continuum of medical and social needs that these patients have. Oliveira attests to this gap from his experience as Civil Defense administrator responding to natural disasters. We need to coordinate care coordination in our community.
To effectively use the case study method to improve care across the community, a legal framework to share protected health information and to protect the straightforward discussions needed to improve the system is being developed. We will be forming an Organized Health Care Arrangement which will enable medical and social service providers to share protected health information, and we will explore forming a Quality Assurance Committee to protect their discussions.
Initially the QAC will need to be formed under a health plan or a hospital in East Hawaii. At the next legislative session, however, we hope to pass legislation allowing the OHCA to have a quality assurance committee independently. We are hopeful this can pass because it simply involves reconciling two differing definitions of a QAC in the state laws, but we will need community support to accomplish this.
Beyond being the right thing to do to improve the quality of life and the health care outcomes for patients, we need to coordinate care coordination to reduce avoidable emergency department visits and inpatient admissions at our hospital, Hilo Medical Center. If we don’t, given the increasing trends, we will have to expand HMC’s facilities at an enormous capital expense — millions of dollars that our community and state cannot afford. Let’s “laulima” to avoid this crisis.
Martha Yamada is Hawaii Island supervisor for Public Health Nursing. Karen Teshima is the statewide partnership lead for the BlueZones Project Hawaii.
This column was prepared by Community First, a nonprofit organization led by KTA’s Barry Taniguchi, and supported by a volunteer board of local community leaders. Community First was established in 2014 to help the community respond to the health care cost crisis and support initiatives that change health care from just treating disease to caring for health. To learn more about Community First, visit CommunityFirst.com.