Big Isle physicians work to improve health care

Did you know that most of the patients in East Hawaii are cared for by independent primary care physicians? Many of these approximately 50 physicians work as sole-proprietor, small business owners.

Like many small businesses, family members pitch in, with a spouse handling billing, a niece serving as receptionist or a cousin helping with IT. These providers are an integral part of the community, taking care of aunties, church members and high school classmates.

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Some were born and raised in Hilo or nearby towns. Others worked at Bay Clinic, a Federally Qualified Health Center, to pay off medical school loans, then fell in love with the local lifestyle and/or a partner and stayed. The majority have close relationships with patients and their families spanning decades from cradle to grave. Together, they form the East Hawaii Independent Physicians Association.

The physicians of this organization care for approximately 50,000 Hawaii Island residents. Much of primary care on the mainland and even Oahu is delivered by large hospital-based systems where care is touted to be of higher quality. These systems typically carry high fixed overhead costs that are contributing to the unsustainable cost of health care. Addressing this cost crisis requires reforming the payment system and fundamentally changing the way primary care is delivered.

In addition to the national cost crisis we are facing, we face a local crisis, as many in our community lack access to basic primary care. This is compounded by a growing provider shortage due to population expansion, impending retirements of many local physicians, and a reluctance of newly trained physicians to start up their own practice or take over the practice of an aging physician.

Fortunately, innovative solutions to our local health care crisis are in the works, thanks to the pioneering work of East Hawaii IPA and funding support from Hawaii Medical Services Association. For several years, the IPA has been diligently working to expand well-coordinated care delivered at the right time for patients. Initially, the IPA served as a pilot site for a new HMSA payment system (now offered statewide) where physicians are compensated monthly, on a per-patient basis to provide all necessary primary care services.

Dr. Kevin Kurohara points out that this payment model, when combined with easy-to-use technologies, “gives my patients and me the flexibility needed to provide highly personalized care, whether that be through a traditional office visit, a phone call, secure email and text, a telehealth video visit, or even a home visit, if that would be best.”

East Hawaii IPA is working hard to form a medical group designed to attract, recruit and retain new providers while also expanding access for new patients. Under your physician’s direction, care will be delivered in a team-based fashion to include advanced practice registered nurses, physician assistants, pharmacists and other clinical professionals with the goal of providing comprehensive care in a friendly, hometown fashion.

”We are very excited about the enhancements we are undertaking to make it easier for our patients to connect with us,” says Dr. Lynda Dolan.

These include the use of iPads and website portals to complete screening forms; electronic access to medical records; 24/7 patient hotline; and phone apps to monitor your health. A management services organization is also forming to handle billing, IT and other administrative work, so physicians can focus their attention on caring for their patients. Without these solutions, our current physicians will burn out, and new physicians will shy away from private practice and look for work elsewhere.

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East Hawaii IPA believes the best care is delivered by physicians who are dedicated to the health and well-being of our community, while maintaining close relationships with patients. For this reason, the organization is determined to support its independent physicians as they seek to provide state-of-the-art care and creating long-term sustainability for private practice on Hawaii Island.

Dr. Lynda Dolan is president of East Hawaii IPA; Dr. Kevin Kurohara is vice president of East Hawaii IPA. This column was prepared by Community First, a nonprofit organization led by KTA’s Barry Taniguchi and supported by a volunteer board of community leaders.

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