Hawaii

Hawaii's Healthcare Innovation Plan, includes several catalysts for change to achieve the "Triple Aim." The plan focuses on primary care redesign and aims to have 80 percent of the population enrolled in medical homes by 2017. Additionally, the plan aims to implement Health Homes for Medicaid recipients with an existing diagnosis of Severe and Persistent Mental Illness or Serious Mental Illness will qualify for the Health Home. Additionally, Medicaid recipients with at least two of the following conditions will also be eligible: Diabetes, Heart Disease, Obesity, Chronic Obstructive Pulmonary Disease, and Substance Abuse. 

The Healthcare Innovation Plan will also establish Community Care Networks (CCN) to provide extra support to patients and practices with needs not readily addressed by PCMHs. CCNs will be modeled after the Health Home, with similar population criteria, provider standards, aligned quality metrics, technology tools, and services, but they will target Employer-Union Trust Fund and commercial insurance patients.

The implementation of this Healthcare Innovation Plan, however, will not be possible without legislative action, significant stakeholder engagement, and the use of existing policy levers. The state’s efforts will build on the existing assets and opportunities for healthcare transformation to ensure statewide, multi-payer implementation of reforms that are effective and sustainable.

Primary Care Innovations and PCMH Activity

Dual Eligible 2703 SPA CPC CPC+ PCMH QHP PCMH Legislation Private Payer

Multi-Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
Hawaii Comprehensive Primary Care Plus Multi-Payer Statewide CMS Comprehensive Primary Care Plus (CPC+)

Private Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
QUEST Primary Care Patient-Centered Medical Home & Pay for Quality Program Commercial Statewide

State Legislation

Legislation Status Year
HB 1444 Primary Care Payment Reform Collaborative

The purpose of this Act is to establish a task force known as the primary care payment reform collaborative to:

     (1)  Examine current levels of primary care spending in the State;

     (2)  Explore primary care spending mandates in other states;

     (3)  Examine alternative methods and models of enhancing primary care spending;

     (4)  Explore data collection issues related to understanding the State's primary care spending, including the capture of non-claims based primary care spending; and

     (5)  Generate recommendations to the legislature.

The collaborative shall develop annual recommendations to the legislature to strengthen the primary care system in the State.

Pending 2019

State Facts:

Population:
1,369,900
Uninsured Population:
5%
Total Medicaid Spending FY 2013: 
$1.6 Billion 
Overweight/Obese Adults:
55.4%
Poor Mental Health among Adults: 
27.5%
Medicaid Expansion: 
Yes 

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