Tuesday | January 16, 2018
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HMSA chief promises to advocate for patients

Hawaii’s largest health insurance provider wants to deliver more support to its members over the next several years, the company’s new CEO said Tuesday.

“We are going to be the advocate for you in the health insurance system,” HMSA CEO Michael Gold said during a West Hawaii visit.

Gold, who took on the top job last month after working for the company for 38 years, said he sees two reasons to take on the role of advocate. One is philosophical, one is business, he said.

“That’s what we’re all about,” Gold said. “Maybe we haven’t delivered the message correctly. We’re about making sure the people of Hawaii — our friends, neighbors and family — have the best underlying health they could have, and they have access to adequate health care.”

On the business side, Gold said he understands health insurance companies may get to a point, through federal regulations and mandates, where the products companies offer and the costs are similar. At that point, HMSA will need something to set itself apart from its competitors, and Gold said higher levels of customer service and advocacy can fill that need.

Looking at health care services across the country, Gold said if the country doesn’t reach some decision about how to handle rising health care costs, “there could be a much broader federal solution, and the populace will want that.”

Hawaii is already in a good position, compared with other states, with lower than average rates of charity cases. He said he does believe states have a responsibility to make sure people have access to health care, but that doesn’t necessarily mean a system of government-run medicine that countries such as Canada and the United Kingdom offer. Even with broader health care coverage offering insurance for people who might have previously ended up as charity cases, premiums aren’t likely to drop, Gold said.

“You’re not going to see a trend with health care costs going down,” Gold said.

If the federal government would increase reimbursement rates for Medicare and Medicaid, something physicians have requested for years, that wouldn’t drive down premiums, Gold said. As technology improves, the cost of delivering health care and associated improved outcomes, will continue to rise, he added.

“It’s not the same health care as 20 years ago,” he said. Advantages of improved technology include “longer life spans and maybe less pain and suffering.”

At the same time, the aging population is growing, and that is the population that will drive up health care costs, he said.

HMSA has been a driving force in Hawaii to create a health information network that allows providers on different islands and in different offices to have access to a patient’s medical history, Gold said. Recent health care reforms passed through Congress emphasized the need for those health information networks, Gold added.

The company has in the past asked members of Hawaii’s Congressional delegation to get an increase in Medicare and Medicaid reimbursements, without success, Gold said. The company made the same request to state legislators. Hospitals in the state are probably reimbursed at 20 to 30 percent below their actual cost for Medicaid patients, he added.

Gold also responded to recent reports that Arizona-based Banner Health has expressed interest in taking over several state-run hospitals on the Big Island and Maui. He said HMSA officials have reached out to Banner officials for a meeting to discuss what such a move would mean for HMSA.

“From everything I’ve heard, Banner would bring a level of professionalism, systems, processes that would make those hospitals better,” Gold said. People with whom he has spoken who are familiar with Banner “think the level of quality care would go up. People at the hospital may disagree.”