The Aloha State is having some growing pains with its Payment Transformation system, a capitated model run by “Hawaii Medical Service Association, the state’s largest health care insurer.” It works like this: HMSA pays a family doc about $24 per patient, per month. All the doc has to do is keep costs in line, and figure out how to care for their panel with that monthly chunk. It’s an exciting new innovation designed “to control rising costs and improve care.” Which makes it basically Direct Primary Care, but backed by a larger payer.
Which of course is only innovative for anyone too young, too forgetful, or too dishonest enough to remember the 1990’s, when the HMO rage was certain to enrich family physicians, streamline services, and make patients happy with great, uninterrupted care. Authentic administralian is spoken by Dr. Gerard Livaudias, vice president of not-for-profit (can you hear my eyes rolling?) Hawaiʻi Health Partners: “By not making them do certain things in order to get paid — instead just say, ‘Hey, here’s some money go figure out what is the best thing’ — that’s really liberating.” As well it might be, but for pesky quality care goals which must be tracked, documented, collated, and submitted, all adding to an administrative burden that conveniently transfers the profit from the physician to the (ahem), “non-profit.” This site has for years has explained to readers that “quality” goals are unproven, and there is no reason to believe that has changed. While the state workforce assessment informs us that there is no data to show that the new payment system is driving doctors off the island, they do admit that the islands are short about 800 physicians, and that a third of those are in primary care.
Will DPC work in Hawaii? In a high cost area where more patients are having a tough time with costs and access, that may be the only sustainable solution. The Payment Transformation system is NOT DPC, and there is no reason to think it is the answer.