Community First seeks to cut cost of health care

HILO — Business owners, CEOs, insurance companies, hospitals and clinics are stoking the flames of a coalition that wants to cut the cost of East Hawaii health care.

But the effort could spread beyond Hawaii.

“This is actually a unique thing nationally,” said Harold Miller, a recognized expert in health reform.

Most communities haven’t created a broad coalition like the one in Hilo, which is called Community First. Miller has watched the evolution of Hilo’s grass-roots efforts and suggests they have the potential to impact health-care costs nationally.

“I think you could potentially be a laboratory,” Miller told community leaders who assembled at the ‘Imiloa Astronomy Center Wednesday night. He’s hopeful business owners and managers, in particular, will band together to pressure insurance providers to change how health services are paid for.

“You could potentially get a movement started that other people could then later join,” Miller said.

The current system, he said, rewards doctors for performing more exams, lab tests and surgeries. But it actually penalizes health systems that keep their patients healthy. If the patient stays well — and out of the hospital — the hospital doesn’t get paid, Miller said.

Instead, he said, planners on the County of Hawaii level, particularly in Hilo, want doctors to get paid a set dollar amount to treat their patients who have diabetes, another amount for patients with high blood pressure and a third to care for all their patients with allergies.

That will allow physicians the flexibility to answer emails, for example, without making the patient go in to the office. In the past, in order for the doctor to get paid, the patient had to go to the office.

Theoretically, doctors will save an average of nearly 15 minutes for every email, freeing them to spend quality time with sicker patients who actually need it.

Miller suggested Hilo-area businesses should start a coalition of their own to apply pressure to insurers to pay for a higher quality of health care, rather than paying more only to those providers who do more tests, blood samples and X-rays.

Change is never easy, Miller noted, and it won’t be for insurance companies or health providers.

“You want to be able to give people time to change, enough time — but not too much,” he cautioned.

Businesses, Miller said, often try to get the biggest discount on health-insurance policies for their workers. As a result, less expensive health-insurance policies tend to discourage patients from seeking care because patients worry about deductibles (the amount that must be paid each year before health insurance starts to pay) and copayments (the money a person pays out-of-pocket for each prescription or doctor appointment).

But, Miller said, that is “pennywise and pound short.” Instead, he said, it makes more sense to encourage workers to seek care — thereby preventing crises that lead to much-costlier hospitalizations.

Miller challenged East Hawaii businesses to coalesce into a group that will have the buying power to force change in the health-care payment system.

Audience member Moanikeala Akaka, from the Aloha Aina Education Center, said more doctors are needed desperately on the island. But it’s hard to retain them. Paying the doctor more in the short term, she said, “might actually save you money.”

What’s been done so far to change the health system nationally has had both good and parts, Miller said. More people have health insurance nationally, he said, however the “affordability” part of the Affordable Care Act needs to be addressed.

Yet he emphasized to East Hawaii business and health leaders that “you don’t want to just sit around and wait for the people in Washington to figure out how to do things better.”

Instead, he said, the Hilo region should make changes, show that they work and then “you should be going to Washington (D.C.) and saying, ‘Look at what we have been doing.’”

When employers have said “we’re going to make a change” around the country, it has indeed made a difference in the cost of health care, Miller said. For example, it has been effective when employers banded together, threatening to start their own insurance coverage if an insurer won’t change its policies to pay for patients to stay healthy.

If enough East Hawaii employers get together so that several hundred employees can wield power through their companies, it would bring enough clout that insurers would need to listen. Already, health insurers are at the table in East Hawaii.

But Miller said the broad coalition must be nurtured. Too many small employers mean it’s tough for any single business to create change. Instead, the effort must be collaborative, Miller said. The cost of health care, he said, is like the growth of a slow cancer. It seems as if you can leave it, for today, because it’s slow-growing and you can take care of it tomorrow.

But the longer you wait the more difficult it gets to treat.

The same is true with spiraling health-care costs, Miller said.

Barry Taniguchi, president of KTA Super Stores, told those in attendance that “our greatest asset is a great sense of community.”

But the collaboration in East Hawaii will be at risk, Miller said, because if a single collaborator gets miffed, the whole effort can fall apart. That, he said, is why its essential for efforts to continue moving forward with positive energy.

Email Jeff Hansel at jhansel@hawaiitribune-herald.com