Subtitle Study shows primary care delivery changes improve patient health and care The world’s premier peer-reviewed general medical journal, the Journal of the American Medical Association (JAMA), published on July 2 an in-depth study of the partnership between the Hawai‘i Medical Service Association (HMSA) and primary care physicians to improve patient care, recognizing the noteworthy improvements in care resulting from this groundbreaking initiative. “We’re proud that JAMA chose to publish the study by the University of Pennsylvania team about HMSA’s pilot program to transform primary care in collaboration with providers across Hawaii. Sometimes, a single, strategic, focused change in how things get done can change everything,” said HMSA President and CEO Michael B. Stollar. The pilot began as a partnership between HMSA and 107 primary care providers on Oahu and Maui in 2016. The program tested a single idea: Replace the traditional fee-for-service model – where PCPs are paid for individual services, which favors quantity over quality – with a single monthly payment for every HMSA patient in that provider’s practice. Payments are adjusted to reflect the needs of the sickest patients while also compensating providers when they engage patients with preventive measures like screenings. This change makes it easier for providers to care for their patients as they think best and gives them the opportunity to: • Offer more comprehensive health services in fewer office visits. • Free up their office schedules to accommodate those most needing their attention. • Improve the quality of care for all their patients. “We’re now four years into the program. The JAMA publication, recent adaptation of this model by the Centers for Medicare & Medicaid Services (CMS), brand-new CMS data showing that Hawaii doctors provide the best care to Medicare patients in the nation, and data from the study and our participating providers confirm that we’re on the right track,” Stollar said. Healthier outcomes The results of the pilot program show an 11% increase in the quality of patient care and preventive services with no additional health care costs. Physician organizations are reporting increases in the percentage of patients receiving colorectal cancer screenings, mammograms, immunizations, and diabetic eye exams. Although it’s early to make assumptions on the long-term effects of the program on health care costs, it’s very promising to note that several physician organizations were able to control the growth of health care expenditures to a rate that’s very close to consumer inflation — much less than what usually happens with medical costs. “This one change impacts a provider’s entire practice. While that change may be challenging, ultimately, it’s rewarding to the providers and their patients,” said Mark M. Mugiishi, M.D., F.A.C.S., HMSA executive vice president and chief health officer. “We applaud the tenacity and dedication of providers who are successfully making the transition and we’re working with others who are still processing and implementing it. Hawaii providers have done incredible work to bring it this far and we’re forever grateful.” “In just the last couple of months, CMS data reports that our primary care physicians are number one in the nation at delivering quality care and JAMA, the respected and most widely circulated medical journal in the world, published the study that demonstrates the potential of this transformative program. At HMSA, we see this moment as a confirmation and motivation to keep going — keep improving and getting it right,” Mugiishi said. Stuart Baker, M.D., executive officer and president emeritus at Navvis, a national population health company that supports payment transformation, said, “Payment transformation and the associated population health programs in Hawaii are the nation’s first statewide implementation of value-based payments for primary care providers.” “What’s special about the work in Hawaii is that it transcends financial incentives alone to include the services and resources needed to empower primary care providers,” Baker said. “HMSA’s model for health care transformation, a harbinger of things to come, is a great example for any health plan or health system looking to lead meaningful change in their markets.” Video link HMSA and many of the primary care physicians in the pilot recently celebrated the study’s publication in JAMA. A video of the celebration is here: https://bit.ly/2xNEHcv About JAMA JAMA is an international peer-reviewed general medical journal published weekly. Established in 1883, JAMA is a premier journal focusing on health care trends, care quality, and advancements in medical science and patient care. It publishes 4% of the thousands of research papers it receives each year. About HMSA Caring for the people of Hawaii is HMSA’s promise and privilege. Working with employers, partners, and physicians and other health care providers, HMSA promotes well-being; develops reliable, affordable health plans; and supports members with clear, thoughtful guidance. HMSA is the most experienced health plan in the state, covering more than half of Hawaii’s population. As a recognized leader, HMSA embraces its responsibility to strengthen the health and well-being of our community. Headquartered on Oahu with centers and offices statewide to serve members, HMSA is an independent licensee of the Blue Cross Blue Shield Association.