campaign<\/a> against the move, warning of unintended consequences for Hawaii\u2019s families and
\nbusinesses that could deepen already unacceptable gaps in care.<\/p>\n\u201cExperience from other states shows that when insurers and care providers merge, costs rise, access narrows, and the community ultimately loses,\u201d wrote Queen\u2019s. \u201cAnd when one entity gains control over both the financing and delivery of care, critical services can be pulled away from the hospitals that depend on them to stay open. These are exactly the kind of unintended consequence other states have seen.\u201d<\/p>\n
Queen\u2019s said furthermore that Hawaii\u2019s independent hospitals and rural communities could be placed under new financial pressure, small businesses could face premium increases they cannot absorb, and families could see fewer local care options.<\/p>\n
During a legislative briefing last month, some state lawmakers also voiced concern over whether One Health Hawaii would become a preferred network
\nor steer patients to HPH hospitals. Some were concerned the new entity could \u201ccherry-\u00adpick\u201d patients with better insurance coverage, leaving other hospitals to bear the burden of caring for more vulnerable patients at greater costs.<\/p>\n
Queen\u2019s officials argued the move would negatively affect vulnerable populations such as Native Hawaiians, kupuna, and those relying on Medicare and Medicaid, and that they would bear the brunt of
\nrising costs and restricted access.<\/p>\n
Queen\u2019s President and CEO Jason Chang testified before a state Legislature joint briefing that commercially insured patients help fund critical services such as trauma care, and that a 1% shift in this market share is equivalent to a $9 million loss for Queen\u2019s. Thus, a
\n5% shift would result in a $45 million loss.<\/p>\n
But HPH and HMSA insist this will not be the case, as other hospitals and insurance payers are invited to be part of their network.<\/p>\n
HPH hospitals also serve as a safety net for vulnerable patients, Vara said, with emergency rooms that serve a high volume of patients. The Kapi\u2018olani Medical Center for Women &Children does not divert patients either, as the only specialized children\u2019s hospital in the state.<\/p>\n
The network\u2019s model of care, however, will be a \u201cvalue-based\u201d one that ties provider payments to patient health outcomes. Rather than a \u201cfee-for-service\u201d model, the \u201cvalue-based\u201d plan is a per-member-per-month, fixed amount for a set time.<\/p>\n
HPH in 2022 adopted
\nthe \u201cvalue-based\u201d model, which it calls a \u201chealthier community\u201d strategy, and successfully lowered the rate of premium increases, according to Vara.<\/p>\n
Value-based plans, however, have not been popular with Hawaii\u2019s primary care providers or private practice physicians. Some private practice physicians have expressed concerns about the HPH-HMSA partnership, pointing to studies that show vertical integration is frequently associated with higher costs, reduced competition and risks to access, especially in small, highly concentrated markets such as
\nHawaii. Studies have also shown integration shifts care from physician offices to hospital outpatient departments, they say, where prices are significantly higher.<\/p>\n
HMSA insures more than 750,000 people statewide, while HPH operates major hospitals including Kapi\u2018olani Medical Center for Women &Children, Pali Momi Medical Center, Straub Medical Center and Wilcox Medical Center on Kauai.<\/p>\n
The proposed partnership requires regulatory approval by state and federal agencies including the U.S. Department of Justice, and a possible certificate of need from the Hawaii State Health Planning and Development Agency.<\/p>\n
Vara said the partnership is expected to take between six to 18 months or more to finalize.<\/p>\n","protected":false},"excerpt":{"rendered":"Two dominant players in Hawaii\u2019s health care landscape continue to press forward on their plans to form a…\n","protected":false},"author":2,"featured_media":292797,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[72,38971,103,397,396,61,60],"class_list":{"0":"post-292796","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-business","9":"tag-editors","10":"tag-health","11":"tag-health-care","12":"tag-healthcare","13":"tag-ie","14":"tag-ireland"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/292796","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/comments?post=292796"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/292796\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media\/292797"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media?parent=292796"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/categories?post=292796"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/tags?post=292796"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}