Ka Wai Ola - Office of Hawaiian Affairs, Volume 16, Number 12, 1 December 1999 — OHA's Native Hawaiian Health Care Initiative [ARTICLE]

OHA's Native Hawaiian Health Care Initiative

By Sam Millington OHA Special Projects LAST FEBRUARY, planning began for comprehensive, integrative health care intervention to address critical shortfalls affecting under-served Hawaiians. From the beginning, efforts to design an effective health care response were supported by a critical mass of grim statistics and sobering reports. For example, Hawaiians tend to suffer disproportionately worse outcomes in terms of disease!onset and mortality in the key areas of diabetes, cardiovascular disease and certain cancers. In addition, a significant number of Hawaiians have inadequate insurance coverage in comparison to their medical and hnaneial needs.

Finally, a small but vulnerable pocket of Hawaiians do not consistently access heahh care services or coverage for whieh they are ehgible. On Sept. 28, an intervention initiative was presented to the Board of Trustees of the Office of Hawauan Affairs. This initiative capped efforts to identify a cost-effective way to ahgn communityvahdated heahh care goals with OHA's fiscal threshold. The result, the Kūpuna Health Care Initiative, also proposed a model for leveraging community and govemment resources to better address pressing heahh care needs afifecting kūpuna. Throughout September, planners had worked closely with the Native Hawaiian Heahh Task Force and a technical advisor from the Federal Health Care Finance Administration (Medicare/Med-

icaid). After task force members had reviewed a draft of the proposed action item, their changes were incorporated in the final version submitted for the board's consideration on Sept. 28. The proposed Medicare Part B Assistance Program offered the possibility for systematic change, especially in terms of OHA's relationship with the govemment. Ultimately, OHA, in collaboration with other key Hawaiian agencies, could secure a "carve-out" arrangement with the federal and state governments. Such an arrangement could allow OHA to become the effective allocating agent for health and health-related funding in areas covered by Medicare, Medicaid and a range of federal grant-making initiatives. Planners also tied into the proposal a number of community-driven, cost-effective program hnkages that included assessments of health risk and benefits and medieal screenings. In addition, they relied on the expertise of world-renown health care economists to provide cost projections for the next ten years. Finally, they built into this initiative a number of eonservative fiscal controls that eliminated financial risk for OHA.

Divided into three segments - a threemonth implementation planning phase, a six-month model demonstration phase and an ongoing full implementation phase - the proposed initiative also sought to develop collaborative relationships with agencies serving kūpuna throughout the state. Based on informal discussions, planners felt confident of their ability to estabhsh formal ties through negotiations to take plaee during the first two phases. At the Sept. 28 board meeting, however, this initiative did not receive a majority vote that would have allowed it to go forward - despite supportive testimony from task force members and leaders representing agencies serving Hawaiians across the state (including, but not limited to, Papa Ola Lōkahi, eaeh Native Hawaiian Health Care System agency, Queen's Heahh Systems, St. Francis Health Care System, Queen Lili'uokalani Children's Center, Alu Like ine.) as well as kūpuna who would be served through OHA's efforts. The next step? It is likely the task force will try to meet again in the near future. Based on the members' input, the initiative's planners will evaluate their options and and proceed accordingly. ■

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