announced plans<\/a> to vertically integrate with Hawai\u2018i Pacific Health into a new nonprofit entity, One Health Hawai\u2018i, that is undergoing regulatory review by state and federal agencies.<\/p>\nOne Health Hawai\u2018i, however, has publicly embraced the value-based model known as \u201cpayment transformation\u201d that HMSA promoted heavily a decade ago. Under that model, providers receive an up-front, fixed amount, ranging from about $20 to $80 per patient per month, instead of being paid per service, regardless of how often a patient is seen.<\/p>\n
At least one independent Hilo medical provider will be closing down soon, due in part to insurance policy changes and other challenges.<\/p>\n
Hilo Family Medicine has informed its patients that it will be closing its office Sept. 30 after 27 years in business.<\/p>\n
In a letter to patients, Drs. David Nakamura and Melanie Arakaki said \u201cdrastic changes\u201d by a large insurance company would reduce their operating revenue and \u201cmake it impossible to continue to provide the service that you need and deserve.\u201d<\/p>\n
Both doctors said they would be working at the Hilo Benioff Medical Center Primary Care Clinic and that patients would need to register there for follow-up care with them.<\/p>\n
Hawaii Health Partners informed Correa, an advanced practice registered nurse, that some 450 patients would be dropped from her panel. She said that\u2019s nearly 40% of the clinic\u2019s patients covered by HMSA, equating to a loss of about $162,000 annually.<\/p>\n
These challenges come as Hawaii experiences a longtime doctor shortage crisis, particularly among PCPs such as family doctors and internists who take care of routine checkups.<\/p>\n
Patients report waiting anywhere from six to nine months to get an appointment with a PCP and longer for a specialist.<\/p>\n
Questions remain <\/p>\n
Dr. Katie Min, an independent physician in Honolulu, expects to lose at least 50 patients due to the changes but is unsure what the final numbers will be, based on the criteria.<\/p>\n
\u201cWhat\u2019s a PCP and what\u2019s not?\u201d she queried.<\/p>\n
The number could be higher, depending on what HMSA considers a PCP. Will HMSA, for instance, count another doctor who is seen more times for diabetes as a PCP? She is unsure how that is determined, as it can be complicated.<\/p>\n
While she has seen most of her patients in the past 18 months, there are some who do not come in because they are in good health \u2014 and too busy.<\/p>\n
Min, a third-generation doctor practicing out of the same office that her father and grandfather did, is nevertheless bracing for a much lower payment come September.<\/p>\n
\u201cWe\u2019re already frustrated with the fact that they\u2019re cutting our income, essentially,\u201d she said, \u201cand we\u2019re just told to make it work when it\u2019s not like we\u2019re operating at large margins here.\u201d<\/p>\n
Transition to the fee-for-service model means putting in more hours for more appointments and that patients will have to schedule appointments for matters currently managed over the phone. In addition to the patients dropped from her panel, she said quality payments for meeting goal posts, which are offered up-front under the value-based model, will instead be retroactive.<\/p>\n
Correa is also questioning the numbers, as at least 177 of the 450 patient she\u2019s been told will be dropped had been to the clinic for a visit in the past 18 months.<\/p>\n
She also noted that hundreds of claims are sitting in a queue, some since February, waiting to be processed by HMSA, which could skew the data.<\/p>\n
\u201cThere are some tremendous flaws in their algorithms,\u201d she said. \u201cSo we\u2019ve been corresponding with HMSA to please give us the data they\u2019re going off of.\u201d<\/p>\n
Fears for rural care <\/p>\n
In 2016, HMSA launched \u201cpayment transformation\u201d in partnership with more than 100 PCPs that was touted as revolutionary.<\/p>\n
The value-based Primary Care Payment Model that replaced the fee-for-service model was supposed to favor quantity over quality. Many providers did not like the switch.<\/p>\n
Correa, however, built her clinic around the value-based model, which was heavily promoted by HMSA at the time. For the first five years, the clinic accepted only HMSA to streamline operations. She has since begun to accept other forms of insurance.<\/p>\n
\u201cWhile forcing us to go from transformation to fee-for-service, they have alluded that once they merge with Hawai\u2018i Pacific Health, they plan to switch back to payment transformation,\u201d she said.<\/p>\n
As Correa sees it, this shake-up will potentially strip tens of thousands of patients from independent healthcare providers, and these patients will be back on the market and refunneled to Hawai\u2018i Pacific Health\u2019s preferred providers.<\/p>\n
As more clinics close in rural areas such as hers, she fears more patients will have to fly to Honolulu for routine exams.<\/p>\n
To her mind, HMSA is moving away from patients being able to choose their providers, whether it\u2019s to get a second opinion or for other reasons, while making it more difficult for providers to add on new patients.<\/p>\n
But HMSA says the move to fee-for-service for primary care is about getting \u201ca clearer picture of the care members are receiving.\u201d<\/p>\n
\u201cPatient attribution is intended to identify the primary care provider most involved in a member\u2019s care,\u201d said Smith in a statement. \u201cPrimary care providers who do not see a patient during an 18-month look-back period will not have that patient included in monthly per-member payments because HMSA believes a primary care physician should interact with their patient with at least that frequency to maintain care quality.\u201d<\/p>\n
This change, she added, supports \u201cthe original engagement intent\u201d of the Primary Care Payment Model.<\/p>\n
\u201cMember coverage is unaffected by this change, and they may continue seeing any provider covered by their plan,\u201d she said. \u201cThis transition provides a stronger foundation for the next generation of value-based care, which HMSA will continue to develop with Hawaii physicians to support quality, access, affordability, and a strong primary care network.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"Primary healthcare providers are bracing for significant cutbacks due to two new payment policy changes by Hawaii\u2019s largest…\n","protected":false},"author":2,"featured_media":601468,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[114,40077,163,521,85,46],"class_list":["post-601467","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-business","tag-editors","tag-health","tag-healthcare","tag-il","tag-israel"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/601467","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/comments?post=601467"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/601467\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media\/601468"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media?parent=601467"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/categories?post=601467"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/tags?post=601467"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}