Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model - AHEAD Proposal Abstract Summary Statement Judy Mohr Peterson PhD, Administrator of Department of Human Services (DHS) Med-QUEST Division (MQD), the state Medicaid agency (SMA), and Jack Lewin MD, Administrator of SHPDA, the State Health Planning and Development Agency, and on behalf of Governor Josh Green MD, are co-chairing the application development for the CMS/CMMI AHEAD model for the State of Hawaiʻi. The proposal reflects the bold aspirations of the AHEAD model and will clearly move the state significantly toward reaching the top health priority of achieving universal access to high-quality, equitable, and affordable health care for all. Hawaiʻi enjoys a history of significant health care innovation beginning before statehood, when waves of immigrant agricultural workers and their families were guaranteed health care. Hawaii’s Prepaid Health Care Act (PHCA) was implemented in the 1980’s, after years of judicial challenges, guaranteeing all workers and their families access to health care. The PHAC remains an efficient, popular, and unique asset that covers 60% of the population, provided largely by two commercial payers and without tax subsidy. Hawaii’s successful Med-QUEST (Medicaid) program is poised to be at parity with Medicare reimbursement and is already a nearly 100% fully capitated managed care model delivered through 5 commercial plans. Finally, Hawaiʻi is nearing full implementation of its statewide all-payer claims database (APCD) under the authority of SHPDA through contracting with DHS and the University of Hawaiʻi with the addition of robust Health Analytics Program to analyze the APCD data under development with MQD. The APCD already has the data for 1 million of the 1.4 million total population under management. In addition to the APCD, Hawai’i also has other excellent clinical data sources, which when coordinated, can effectively track the AHEAD goals in primary care, hospital reimbursement, health equity, and a total-cost-of-care (TCOC) global budget. Among states, Hawaiʻi has the greatest longevity, is typically among the top 3 in the CDC population health rankings, and has among the lowest per capita Medicare spending. That said, Hawaiʻi has glaring gaps in primary care access, equity among Native Hawaiians and others, and serious disparities in rural health, all of which contribute to lower-than-expected per capita Medicare costs and preventable mortality. And despite broad support and some successes, Hawaii lags in transitioning away from fee-for-service and DRG reimbursement and toward value-based payment care models. As a very high cost-of-living state, Hawaiʻi has had difficulty maintaining an adequate health care work force. And as health care spending continues to increase with rapid advancement of costly technology, increases in chronic disease, and an aging population, Hawaiʻi faces future health care cost unsustainability, as does the entire nation. In summary, the AHEAD grant is an apt and timely means of addressing state goals of improving primary care access and effectiveness, transitioning to value-based reimbursement, improving health equity, and keeping TCOC increases low enough to ensure future affordability.
