vertically integrated system called One Health Hawai\u02bbi<\/a>. Although led by HMSA and Hawai\u02bbi Pacific Health, the new system is designed to be open to all providers, which would make it different from Kaiser Permanente\u2019s closed organization. That One Health proposal still faces regulatory approval by federal and state officials.\u00a0<\/p>\nGreen has remained neutral about One Health, which is being vetted by his State Health Planning and Development Agency. But the governor said he saw the need to intervene about HMSA\u2019s payment model.\u00a0<\/p>\n
\u201cI felt it was the right time to step in on this,\u201d Green said.<\/p>\n
Payment Change Raises Question <\/p>\n
Even with its extended deadline for doctors to comply, HMSA\u2019s change in its payment model presents a question concerning One Health\u2019s public messaging about its future payment model: One Health proponents have specifically said the organization plans to use HMSA\u2019s current payment model, the same one HMSA has announced it will abandon.<\/p>\n
HMSA established its current payment model nearly a decade ago. Under it, the insurer pays providers a fixed amount per month for each patient under the doctor\u2019s care, typically around $20 to $40. The amount is the same no matter how many times the patient visits, like a monthly allowance.\u00a0Doctors also can receive bonuses for reaching certain performance milestones, like making sure patients get regular mammograms and colonoscopies, sometimes called \u201cvalue-based care.\u201d<\/p>\n
Some doctors have expressed frustration with the monthly-allowance payment model, which has required them to generally maintain a roster of 1,500 to 2,000 patients to make ends meet.\u00a0<\/p>\n
Still, they adapted to the model and now they are being asked to adapt again.\u00a0On May 1, HMSA announced it was switching back to a traditional fee-for-service model, with bonuses for meeting performance milestones.\u00a0<\/p>\n
The insurer said it needed to make the change for various reasons. Access to primary care doctors has declined since the Covid-19 pandemic, leading patients to seek treatment in more expensive emergency rooms and urgent care clinics, HMSA has said, and the allowance-based payment model has produced data gaps that make it hard for the insurer to track outcomes and deal with regulatory compliance issues.<\/p>\n
Regardless of the reasons, that was the adjustment the insurer gave primary care doctors until July to make, leading many to say they couldn\u2019t deal with such an enormous change that quickly. Now they have six extra months.<\/p>\n
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Gov. Josh Green, a medical doctor, said it\u2019s important for HMSA and Hawai\u02bbi Pacific Health to get \u201con the same page\u201d concerning payment models as they work toward a deal to create a vertically intergrated system involving the two entities. (Kevin Fujii\/Civil Beat\/2024)<\/p>\n
But Hawai\u02bbi Pacific Health chief executive Ray Vara has said the monthly-allowance payment model, known as capitation in healthcare parlance, has been working so well for Hawai\u02bbi Pacific Health that One Health would expand the model broadly to include all providers affiliated with the organization.\u00a0<\/p>\n
That means doctors would presumably be required to switch back to capitation if the One Health deal goes through.<\/p>\n
On The Same Page?<\/p>\n
On Monday, Mugiishi told Civil Beat that HMSA remains committed to One Health using a value-based care model involving monthly-allowance payments for all of its doctors, not just primary care doctors. However, he said, HMSA does need to go back to the fee-for-service model for a while to better track what treatments primary care doctors are doing and the outcomes of those treatments.<\/p>\n
Additionally, Mugiishi said, HMSA was not able to confer with Hawai\u02bbi Pacific Health before announcing the change to fee for service, because the U.S. Department of Justice could have viewed that as an improper, \u201cgun-jumping\u201d collaboration before the One Health deal is approved.<\/p>\n
Green said he understood that there\u2019s a perceived discrepancy between One Health\u2019s message and HMSA\u2019s action. He\u2019s withholding judgment on the One Health proposal, but said it\u2019s important to make sure the parties \u201care on the same page.\u201d<\/p>\n
Mugiishi said that is generally already the case.<\/p>\n
\u201cWe are on the same page when it comes to value-based care,\u201d he said. \u201cOn this particular pivot, I don\u2019t know.\u201d<\/p>\n
For their part, providers are waiting to see what\u2019s next. Kaleo Correa, a nurse practitioner who runs Waimea Primary Care on Hawai\u02bbi island, commended HMSA\u2019s change of heart on the deadline it\u2019s imposing on providers.\u00a0<\/p>\n
\u201cWe won the battle, but we haven\u2019t won the war yet,\u201d said Correa, who said she and a group of doctors have been in talks with Honolulu attorney Eric Seitz about taking legal action to block the change. \u201cSo we\u2019re going to keep fighting.\u201d<\/p>\n
Seitz commended Green for stepping in and HMSA for extending the deadline. But he said more work needs to be done to help doctors.<\/p>\n
\u201cI appreciate that HMSA has taken this action to avoid the need for us to take action through litigation,\u201d Seitz said. \u201cHowever, there are still challenges facing doctors that we need to address.\u201d<\/p>\n
![\"Civil](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/06\/logo10.png\")
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![\"Dr.](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/06\/IMG_7138-1024x768.jpeg\")
Dr. Katie Min says a change in HMSA\u2019s model for reimbursing patients will put enormous financial stress on primary care doctors who already are in short supply. She applauded the insurer\u2019s decision to give doctors more time to comply with the change. (Stewart Yerton\/Civil Beat\/2026)<\/p>\n