HIBC Initiatives

Patient Engagement

The Hawaii Island Beacon Community (HIBC) patient engagement and support services initiative was providing culturally sensitive disease prevention and health enhancement services to address the tremendous health disparities faced by native Hawaiians and other populations at risk, including the uninsured. By collaborating with an established community agency, Hui Malama Ola Na ‘Oiwi (HMONO), HIBC was able to make great strides in this area of health care.  

Hui Malama Ola Na ‘Oiwi (HMONO), is a 501(c)(3) non-profit agency established under the Native Hawaiian Health Care Improvement Act, and is recognized as the health entity caring for Hawaii Island’s native Hawaiians. HMONO services include diabetes, hypertension, nutrition education and ongoing monitoring targeting the primary health disparities of Native Hawaiians.  Additional enabling services include social service outreach, health monitoring for home-bound clients, case management, and transportation.  The program integrates traditional Hawaiian values and practices into all aspects of delivery.

HMONO excels at the delivery of evidenced based curriculum. Native Hawaiians often struggle to balance their belief in western medicine and traditional healing, reflecting their belief that treating oneself with pharmaceutical medicine as opposed to natural means of healing causes one’s body, mind and spirit to be unbalanced and not in “lokahi” or harmony. HMONO promotes holistic health and active lifestyles to restore lokahi and overall balance.

HMONO enrolled 190 participants in the Patient Engagement program in 2012, offering health education classes free of charge to community members. HMONO staff facilitated and presented weekly clinical and non-clinical classes in the "local style", using local vernacular in a respectful yet informal manner, putting clients at ease and increasing their receptivity and engagement. The following are HIBC's key accomplishments:

    Established HMONO as a vital component of the Beacon Neighborhood Care Network.

    Provided referrals to one-on-one patient support programs.

    Implemented a hypertension management and education program.

    Implemented means for clinical data transfer.

    Encouraged patients to self-refer.

    Implemented a diabetes management and education program.


Hui Malama Ola Na Oiwi
is expanding its interactive classes island-wide and also growing its free screening program to include more frequent follow-ups.




National Kidney Foundation of Hawaii
is providing new group education and support visits in providers’ offices to teach patients chronic illness self-management tips.



Lessons learned:

    1) Building community relationships is an essential component in developing care coordination pathways. Creating partnerships across settings (e.g. housing, transportation) is integral to success.

    2) Networking with community resources helps identify availability of resources, as well as gaps in service.

    3) Open lines of communication between Primary Care Providers (PCPs), care coordinators, pharmacists, and other essential care providers are necessary for program success.

    4) Family/support team engagement is a key component of successful care transitions when implementing a 'Patient First' approach.

    5) Senior leadership support is important to ensure stability and sustainability of patient engagement programs.

    6) Incorporating culturally based programs into a traditional health system is a process; it requires time, patience, trust optimism and results.