HAWAI‘I PRIMARY CARE ASSOCIATION ANNUAL REPORT 2010

Now.All Together.

Our members don’t focus on the fact that

their patients are homeless, or uninsured,

or live in poverty.

They don’t turn their patients away

because they speak another language, are

unemployed, or have special needs.

Our members simply focus on the

patient, on her family.

And on nurturing their health.

Together.

We remain committed to the cause of health care access for all,

and believe that a strong primary care infrastructure, particularly

for underserved and vulnerable populations, is essential for our

island communities.

We are focused on developing and sustaining that infrastructure,

and on preparing Community Health Centers for the future.

We believe in building vibrant, healthy communities

that work together, and are committed to the

partnerships, innovation, and teamwork that will

transform our health care system and improve the

lives of all Hawai‘i’s people.

We are the Hawai‘i Primary Care Association

EXECUTIVE MESSAGE

Beth GiestingCEO, Hawai‘i Primary Care Association

Emmanuel KintuBoard Chair, Hawai‘i Primary Care Association

Enactment of health care reform created significant opportunities for Community Health Centers (CHCs), as they are the delivery system that will shoulder a major-ity of the burden for providing care to millions of previously uninsured patients. In Hawai‘i alone, almost 100,000 people will be now be eligible for some level of health care coverage.

The Affordable Care Act’s recognition of CHCs as excellent models of quality, cost-effective care is also evident in its allocation of resources for expansion of CHC infrastructure, as well as funding for outcomes-based transformation of the Medicaid system. As long-standing Patient-Centered Medical Homes, health centers represent the future of the health care delivery system by investing in comprehensive, integrated primary care that lowers long-term costs. Additionally, CHCs have the unique advantage of being governed by consumer-led boards that ensure fidelity to community needs.

Modernization of the CHC infrastructure in our state will require resources, naturally, but more importantly it calls for wide-ranging and open cooperation among all the organizations involved in health care. Providers and health plans, employers and government, schools and community organizations; everyone has a stake in making this endeavor a successful one. And only by working together can we grow the health care system sensibly, responsively, and efficiently.

The Hawai‘i Primary Care Association (HPCA) has a long history of bringing diverse interests together in the service of the common good. For over twenty years we’ve served as a nexus between the broader health care system and those who serve our most vulnerable popula-tions, forging innovative and credible partnerships based on mutual respect and trust.

As we move into this new era of health care, HPCA is hard at work preparing health centers for the collaboration and teamwork needed to transform the health care system in our state, and we are fully prepared to engage with our partners and other organizations in that spirit of cooperation.

TABLE OF CONTENTS

Our Members ........................................................................................................................................................................ 11

Our WorkAdvocacy ......................................................................................................................................................................... 13Strategic Collaboration ...................................................................................................................................... 15Clinical Quality and Information Technology ...............................................................................16Programs ..........................................................................................................................................................................17

Our Value .................................................................................................................................................................................18

Our Finances .........................................................................................................................................................................20

Our Organization ..............................................................................................................................................................22

OUR MEMBERS

11

Community Health Centers are the most cost effec-tive providers for vulnerable populations in Hawai‘i. They provide comprehensive health care services to patients with complex and intensive needs, reducing inpatient and emergency room expenses.

Health centers also help make communities livable by supporting jobs, attracting resources, and providing high quality health care that residents in vulnerable and otherwise economically-depressed communities need.

In 2009, Hawai‘i’s health centers experienced significant growth in all major service areas without a comparable increase in funding. By harnessing the innovation of their own organizations and working with their community partners, hospitals, and other health care organizations, health centers in Hawai‘i were able to care for more patients while saving the health care system one hundred thirty-five million dollars last year.

HAWAI‘I’S CHCs ALSO

SAVEDMEDICAID$64 MILLION

TOGETHER, HAWAI‘I’SCOMMUNITY HEALTH CENTERS

PROVIDED CARE FOR 26% MORE MED-QUEST,33% MORE DENTAL, &

46% MORE MENTAL HEALTHPATIENTS IN 2009THAN THE PREVIOUS YEAR.

HEALTH CENTERS

Bay Clinic, Inc.

Hāmākua Health Center

Hāna Community Health Center

Ho‘ōla Lāhui Hawai‘i

Kalihi-Pālama Health Center

Kōkua Kalihi Valley Comprehensive Family Services

Ko‘olauloa Community Health & Wellness Center

Lāna‘i Community Health Center

Mālama I Ke Ola Health Center

Moloka‘i Community Health Center

Wai‘anae Coast Comprehensive Health Center

Waīkīki Health Center

Waimānalo Health Center

West Hawai‘i Community Health Center

ANNUAL REPORT 2010

OUR WORK

13

HPCA works closely with policymakers at national and state levels to promote solutions that address the health needs of underserved communities. Our congressional delegation is historically understanding of and sympathetic to these concerns. They unanimously contributed to the passage of the Affordable Care Act and actively supported Hawai‘i’s CHCs with appropriations for capital and operating needs, as well as funding key health professions education programs.

TO G E T H E RWITH KEY LEGISLATORS,

ADVOCATES, AND OUR

PARTNERS,HPCA SECURED NEARLY

$16 MILLIONFOR HEALTH CENTERS

Working with many State elected and administra-tive officials can be more challenging. Given the grim financial situation facing the 2010 Legislature, it took more than educating policymakers on the needs of our communities to garner broad support for continued CHC funding. It also required the discipline of our CHC members to support a central policy agenda so that lawmakers were presented with a single, unified voice.

This unity culminated in a successful Community Health Center Day at the Capitol, which gave urgency to the concerns of our members. In addi-tion, HPCA mobilized an extensive communications effort throughout the session that supported our priority legislation.

HPCA worked diligently this year to cultivate positive working relationships with legislators, key House and Senate staff, and a coalition of health care organizations and health plans. This cooperative strategy produced nearly $16 million in funds for health centers; a successful result in any year, but an even greater accomplishment during these difficult economic times.

LOOKING FORWARD

The Affordable Care Act recognizes CHCs as leaders in providing comprehensive primary care services, as ideal models for the Patient-Centered Medical Home, and the providers best suited to care for the previously uninsured population. Given this historic opportunity, HPCA’s advocacy efforts will focus on working together with the new administration, legislature, and our members to help remake our health care system and position health centers as vital partners in the process.

ANNUAL REPORT 2010

ADVOCACY

OUR WORK

15

As the principal emissary for Hawai‘i’s health centers, HPCA spends a considerable amount of its resources to develop and nurture partnerships with other organizations that can help create an effective, sustainable health care system. This year, HPCA took an active role in the ad hoc coalition of Medicaid providers to help navigate the financial crisis that imperiled the state’s Med-QUEST program.

More often, HPCA is called upon to marshal health centers collectively to address common issues and prepare for shared opportunities. In 2010, two of these collaborative projects dealt with issues of paramount interest to all health centers in Hawai‘i: how to prepare for growth in the wake of health care reform, and the challenge of transforming their systems of care into thriving Patient-Centered Medical Homes.

STRATEGICCOLLABORATION

STRATEGIC GROWTH PLANNINGThe Affordable Care Act (ACA) created signifi-cant opportunities for health centers to grow, by guaranteeing that patients without insur-ance would be able to obtain coverage through Medicaid expansion and insurance exchanges. More importantly, the ACA recognized the value of health centers by using them as the model for how these millions of newly-insured patients would gain access to care.

In order to assist health centers in effectively planning for this growth, and to address wide-spread gaps between the needs of vulnerable populations and our ability to care for them, HPCA spearheaded regional planning meetings that encouraged CHCs to identify the principal systemic challenges they face and to discuss potential solutions they can strive toward.

What was most evident from these planning discussions is the need for more widespread and consistent collaboration among all Hawai‘i health centers and a wide array of partners.

PCMH TRANSFORMATIONThe only way to improve patient outcomes while effectively reducing long-term costs is to transform the system of health care from one focused on acute, incident-based care to one that encourages wellness and holistic care that is driven by the patient.

CHCs have long been proponents of com-prehensive and integrated care that uses evidence-based quality outcomes to improve care at the point of delivery. They have also been pioneers in the use of electronic medical records and have provided complementary care services for decades. This makes them the perfect model for the Patient-Centered Medi-cal Home, a nationally-recognized delivery system specifically targeted by the ACA to help improve care and reduce costs.

To that end, HPCA has taken the lead in facilitating a pilot to model the PCMH in four CHCs which will eventually serve as technical resources for all centers statewide.

ANNUAL REPORT 2010

The essential relationship between an organization’s data and their clinical quality improvement has been evident for many years. Health centers in Hawai‘i have been using sophisticated tracking and reporting systems for a decade now to improve the health of patients with chronic diseases that come with both co-morbid conditions as well as significant costs.

The value of this data is greater than ever, with the propagation of pay-for-performance systems that reward clinicians for improving outcomes and intensified focus on the Patient-Centered Medical Home, which relies heavily on evidence-based decision making and care coordination.

To better address these integrated needs, HPCA has reorganized its quality, HIT, and technical assistance resources to be more programmatically and strategically aligned.

DIGITAL DASHBOARD

HPCA continues to innovate and refine its quality dashboard, which tracks chronic disease data from health centers. The dashboard allows health center staff to monitor their own aggregate performance and to compare their progress to that of their peers. In many ways, this also serves as a proving ground for health centers which will participate in a more extensive health information exchange. By learning how to collect, report, and transmit data on a smaller scale today, community health centers will be better prepared for their role in a future data warehouse.

Building on its experiences with the digital dash-board, this year HPCA began development of a more robust set of quality measures that would provide health centers with a longitudinal view of the health outcomes of their patients.

Refining data collection and analysis in this way will help centers to support their quality, payment, and medical home initiatives.

CLINICAL QUALITY & HEALTH INFORMATION TECHNOLOGY

HAWAI‘I PRIMARY CARE ASSOCIATION

16

17

Children are the most vulnerable members of our society, making our work on their behalf vital to their health and well-being. In light of the ongoing economic crisis that has left many working parents without coverage, last year Hawai‘i Covering Kids conducted a massive communications campaign to help educate low- and middle-income households on coverage availability for their children.

The campaign included a variety of touchpoints, including postcards mailed to all residences and post office boxes statewide, shopping mall posters, and in-theater advertisements.

Working as always in collaboration with other organizations — thirty–three in all — Hawai‘i Covering Kids was instrumental in getting an additional 3,082 children enrolled in Med-QUEST, including almost a thousand children under the age of five.

PROGRAMS

HAWAI‘I COVERING KIDS

HPCA continues to provide logistical and financial support to eight professional peer groups, one of the most widely-recognized and highly-rated of our programs. Each quarter CHC professionals meet and exchange technical assistance, identifying and solving problems collectively.

We also continue to strengthen CHC workforce development through our management training program. Selected participants take part in a monthly series of lectures and hands-on application of critical business skills and competencies directly related to work in health centers.

WORKFORCE SUPPORT, TRAINING, & DEVELOPMENT

ANNUAL REPORT 2010

OUR VALUE

FOR EACH

DOLLAR PAID

IN DUES, OUR

CHC MEMBERS

RECEIVE MORE

THAN $1000

IN DIRECT

FINANCIAL

BENEFITS.

19

PATIENT-CENTERED MEDICAL HOME• Supported the PCMH pilot workgroup as lead

project coordinator, held a project kickoff event, and negotiated a technical assistance consulting contract to train health centers.

• Developed publications that address the merits of CHCs as PCMHs.

DATA AGGREGATION AND HIT• Supported CHC/AlohaCare-led Data Aggregation

workgroup and the overall HIT effort by holding periodic support group meetings to address training and technical assistance priorities.

• Held a learning session for members of the Health Center Controlled Network (HCCN) on HIT planning and implementation.

• Ensured that every CHC has viable video teleconferencing equipment and connections.

OPERATIONSUpdated contracts management and compliance process to ensure that HPCA met all required program and reporting deliverables.

COMMUNICATIONS AND ADVOCACY• Completed and published its communications plan.• Developed additional means of communicating with

CHC boards to support their interests in advocacy, best practices, and networking.

• Worked successfully with legislators and the administration to secure over $16 million in funding for CHCs.

• Provided needs assessment and health care reform briefings to community leaders, health center management, board members, and staff.

• Engaged other Medicaid providers and health plans in a solution-oriented coalition to address proposed payment and benefit changes to Med-QUEST.

• Joined Workforce Development Council effort to address health care workforce issues.

• Regularly monitored CHC satisfaction with QExA plans on a quarterly basis and convene meetings with plans and MQD as indicated.

• Was named to a national Negotiated Rulemaking Committee on federal medically underserved and health professional shortage area designations.

With a staff of fifteen, the Hawai‘i Primary Care Association undertakes a significant level of activity to support community health centers in our state. In an effort to fulfill its mission and to meet the needs and requirements of its funders, HPCA routinely provides a vast array of services, including:

Advocacy & communications to support policies and funding for underserved populations and CHCs. HPCA leadership has been essential in securing resources for CHCs including changing PPS rules/process and other state funding initiatives. Additional activities that further these objectives include:

• Engaging the general public, Legislature, Congressional delegation, and Federal / State Administrations

• Representing CHC interests on Hawai‘i Health Information Exchange board and the state Medicaid Coalition

• Administration of the Hawai‘i Covering Kids program

HPCA secures and manages contracts that provide significant resources to CHCs:

• Outreach and eligibility (DHS)• Congressionally-Mandated Funds (Senator Inouye)• HCCN (HRSA)

HPCA provides extensive technical assistance and training to support quality, efficiency, and growth among CHCs:

• Support for eight professional peer groups• Workshop series for CHC leadership staff• UDS training• Training for outstationed and other eligibility

workers• Scholarships for HFMA annual training conferences• Technical Assistance and support for

• Quality improvement• Emergency Preparedness• Trainings on EHR, PCMH, and advocacy• EHR procurement and implementation• HIT and Data Systems:

• Coordination of HCCN• Support for VTC bridge and DOH

uninsured database development• Aggregation of QI measures and

maintenance of dashboard report

In addition to its ongoing activities that strengthen the network of health centers in Hawai‘i, this year HPCA successfully addressed the strategic priorities identified by our board:

ANNUAL REPORT 2010

OUR FINANCES

Bureau of Primary Health Care

Agency for Healthcare Research and Quality

Centers for Medicare and Medicaid Services

Office for the Advancement of Telehealth

Office of Health Information Technology

State of Hawai‘i Department of Human Services

State of Hawai‘i Department of Health

The Research Corporation of the University of Hawai‘i

AlohaCare

California Primary Care Association

Chamber of Commerce of Hawai‘i

Hawai‘i Community Foundation

Hawai‘i Womens Legal Foundation

Healthcare Association of Hawai‘i

HMSA Foundation

Papa Ola Lōkahi

The Harry and Jeanette Weinberg Foundation, Inc.

FUNDERS

(FUNDERS, REVENUE, AND EXPENSES FOR THE PERIOD 04/01/09 TO 03/31/10)

HAWAI‘I PRIMARY CARE ASSOCIATION

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State DOH/DHS Contracts$1,377,730

Federal Grants (includes IT, HCK)$1,026,279

Bureau of Primary Health Care$731,517

Private Grants$323,928

Other - $200,503

Member Dues - $29,050

Operating Expenses$1,712,855

Payments to CHCs, Consultants$1,593,982

Trainings, Conferences, Meetings$244,128

Meeting / Travel Subsidies for Members$73,989Depreciation$65,887

REVENUE EXPENSES

FEDERALLY QUALIFIED HEALTH CENTERS

Bay Clinic, Inc.Hāmākua Health CenterHāna Community Health CenterHo‘ōla Lāhui Hawai‘iKalihi-Pālama Health CenterKōkua Kalihi Valley Comprehensive Family ServicesKo‘olauloa Community Health & Wellness CenterLāna‘i Community Health CenterMālama I Ke Ola Health CenterMoloka‘i Community Health Center Wai‘anae Coast Comprehensive Health CenterWaīkīki Health CenterWaimānalo Health CenterWest Hawai‘i Community Health Center

NATIVE HAWAIIAN HEALTH CARE SYSTEMS

Papa Ola LōkahiHui Mālama Ola Nā ‘ŌiwiHui No Ke Ola PonoKe Ola MamoNā Pu‘uwai Inc.

ASSOCIATE MEMBERS

AlohaCareBayanihan Clinic Without Walls, Inc. Hawai‘i Health Systems CorporationHawai‘i Medical Service Association (HMSA)Hawai‘i Pacific Health Kaiser Permanente Mobile Care Health ProjectPacific Islands Health Officers AssociationPuna Community Medical CenterQueen Emma Clinics

May AkamineWaimānalo Health Center

Dana Alonzo-HowethMālama I Ke Ola Health Center

Sheila BeckhamWaīkīki Health Center

Richard BettiniWai‘anae Coast Comprehensive Health Center

David DeraufKokua Kalihi Valley Comprehensive Family Services

Laura DeVilbissKokua Kalihi ValleyComprehensive Family Services

Michael GleasonThe Arc of Hilo / Bay Clinic Board of Directors

Susan HuntHāmākua Health Center

Emmanuel KintuKalihi-Pālama Health Center

Joelene LonoKe Ola Mamo

David PetersHo‘ōla Lāhui Hawai‘i

Ben PettusKo‘olauloa Community Health & Wellness Center

Desiree PuhiMoloka‘i Community Health Center

Diana M.V. ShawLāna‘i Community Health Center

Hardy SpoehrPapa Ola Lokahi

Paul StraussBay Clinic, Inc.

Richard TaaffeWest Hawai‘i Community Health Center

John TomosoHui No Ke Ola Pono

Cheryl VasconcellosHāna Health

Emmanuel Kintu, ChairDavid Derauf, Vice-ChairSheila Beckham, TreasurerRichard Taaffe, Secretary

Paul StraussDesiree PuhiAt Large

Beth GiestingChief Executive Officer

Kathy Suzuki-KitagawaChief Operating Officer

Charlene BlairClinical Services Coordinator

Tricia SiarotChief Financial Officer

Beverly ChinTechnical Assistance Coordinator

Carol GotoAdministrative Assistant

Robert HIrokawaInformation Officer

Elin KooAccountant

Barbara LukschHawai‘i Covering Kids Project Director

Nani MedeirosPublic Affairs and Advocacy Director

Matthew NagatoCommunications Director

Matt OkahataIT Analyst

Alison Rowland-CiszekAdministrative Coordinator

Napualani SpockWorkforce Development Director

Monique van der AaHCCN Project Director

BOARD OF DIRECTORS

OFFICERS

STAFF

OUR ORGANIZATION

HAWAI‘I PRIMARY CARE ASSOCIATION

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HAWAI‘I PRIMARY CARE ASSOCIATION

To learn more about our organization, or for information on becoming a member, visit our website at http://www.hawaiipca.net

COLOPHONThe original source file for this report was developed in Adobe Creative Suite 4 Design Standard, processed using High Quality Press filters, and output to PDF. The diagrams, graphics, and miscellaneous iconography were created or modified using Adobe Illustrator. Photographs were processed or enhanced using Adobe Photoshop and Kubota Power Tools.

Typefaces used in this report include St Ryde, Frutiger Linotype Light, TW Cen. The report was printed (offset) on 70-pound Domtar solutions smooth paper and saddle stitched.

Copy, Design and Layout: Matthew NagatoEditor: Elizabeth Giesting

Photo credits: KYC Studios (Covers, pages 6, 14); Matt Okahata (page 12); Matthew Nagato (page 10)

Printed by Obun Hawai‘i Group, Honolulu, Hawai‘i

ANNUAL REPORT 2010

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