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 |
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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+) |
   
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Public Payer Programs
| Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
|---|---|---|---|---|
| CMS State Innovation Model Design Award - Hawaii | Grant | Statewide | CMS State Innovation Model (SIM) | |
| Hawaii Patient Reward and Incentive Program to Support Empowerment (HI-PRAISE) | Grant | Statewide | ||
| Improving the Health and Care of Low-Income Diabetics at Reduced Costs | Grant | CMS Health Care Innovation Award (Round 1) | ||
| Kapi'olani Medical Center for Women and Children Asthma Task Force | Other | Statewide |
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| Pharm2Pharm, A Formal Hospital Pharmacist to Community Pharmacist Collaboration | Grant | Rural Hawaii | CMS Health Care Innovation Award (Round 1) |
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 |
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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 |
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Hawaii Medicaid Managed Care Contracting Hawaii requires Medicaid Managed Care Organizations to report on and increase the percentage of medical expenditures devoted to primary care. |
Enacted | 2021 |
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
News and Events
September 1, 2020 | American Academy of Pediatrics
July 16, 2018 | Honolulu Civil Beat
June 16, 2014 | Medscape
