CMS State Innovation Model Design Award - Hawaii

Program Location: 
Honolulu, HI
Payer Type: 

Hawaii's Healthcare Innovation Plan identifies six essential catalysts to successfully implement the "Triple Aim":

  • primary care practice redesign 
  • health information technology
  • care coordination
  • workforce development
  • payment reform
  • policy strategies and levers

Primary Care Practice Redesign aims to ensure that at least 80 percent of Hawaii's residents are enrolled in a Patient-Centered Medical Home (PCMH) by 2017 and to integrate behavioral healthcare into the primary care setting. Stakeholders agreed to adopt PCMH as the foundational model for delivery system reform and adopted the National Committee for Quality Assurance (NCQA) 2011 Level 1 standards as the medical home minimum standard for all plans and payers. Health Information Technology will improve connectivity and capability across the healthcare ecosystem and collecting and using data to support delivery and payment transformation. The care coordination catalyist will implement programs for high-risk/high-need populations, including establishing Medicaid Medical Homes and Community Care Networks for high-risk Medicaid and commercial beneficiaries and initiating super-utilizer pilot programs. 

A focus on workforce development will expanding capacity for team-based care, addressing workforce shortages and improving cultural competency of providers. The innovation plan's payment reform model will transition all payers to value-based purchasing. The final catalyst for change focuses on policy strategies and levers, which will aligin state recources to drive policy change. 

Payment Model: 

Payment reforms outlined in the February 2014 SHIP

Hawai‘i has already started by recognizing a common definition of PCMH, aligning select payment strategies that support its growth, and collecting data for a set of core quality metrics. However, ultimately, Hawai‘i seeks to transition all payers to value-based purchasing. 

  • PCMH providers are required to manage patient registries, target patients that need preventive exams and services, develop quality improvement programs/plan for their practices, and more. A PMPM structure will provide monthly revenue to allow providers to invest in practice transformation. 
  • All plans and payers have already agreed to adopt a core set of P4Q metrics. 
Last updated September 2015
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