HIBC Initiatives

Practice Redesign

The Hawai‘i Island Beacon Community Practice Redesign initiative was developed in close affiliation with Hawai‘i Medical Services Association (HMSA). HMSA facilitated the East Hawaii Independent Physicians Association (IPA) Model Office Pilot involving ten early adopter primary care physicians (PCP) who participated in the Patient Centered Medical Home (PCMH) practice redesign curriculum developed and offered through TransforMED, a subsidiary of the American Academy of Family Physicians. In addition it agreed to participate in a new pay for quality program which offers additional incentives for PCPs who commit to adopting the principles of the PCMH and who incorporate population health management into their practice.  The resulting measureable improvement in selected quality metrics for the Model Office participants led to a partnership with HIBC in an effort to expand the program to a second cohort of 19 physicians including the Five Mountains IPA (North Hawai‘i) and the West Hawai‘i IPA.

HIBC provides free health IT technical support to all physicians participating in the practice redesign effort. IT specialists assist physicians with a process for selection followed by the actual installation of certified Electronic Health Record (EHR) software. They set up office computer networks, troubleshoot problems with office equipment connectivity, and facilitate the process toward Stage 1 Meaningful Use in partnership with the Hawai‘i Pacific Regional Extension Center.

Furthermore, in partnership with the National Kidney Foundation of Hawai‘i, HIBC supervised the work of Practice Redesign Facilitation Coaches who worked with each physician practice on completing their TransforMED assignments and fulfilling the requirements for achieving PCMH status.

The HIBC TransforMED cohort began with 25 Physicians in 18 Practices in April 2012. After eight months, HIBC has demonstrated significant progress toward its clinical intervention goals for Practice Redesign, with 19 of the targeted 25 providers and approximately 20,000 of the targeted 23,000 patients impacted by the program.  The following are HIBC’s key accomplishments: 

    Provided free curriculum.
    Provided practice redesign facilitation coaches.
    Provided practices with free health IT support.
    Made dramatic process improvement to office operations in a 10 month period.
    Used Cozeva software to provide real time claims data in a registry format.
    Implemented Patient Experience Assessment Tool (PEAT Survery)
    Practice Coaches provided leadership and guidance throughout the transformation process.

TransforMED
National Kidney Foundation of Hawai‘i
Hawai‘i Medical Service Association (HMSA)
Hawai‘i Island Care Coordination Services (HICCS)
East Hawai‘i Independent Physician Association
West Hawai‘i Independent Physician Association
Five Mountains (North Hawai‘i) Independent Physicians Association
Hawai‘i Pacific Regional Extension Center

Lessons learned:

    1) Practice Facilitation Coaches are essential. Achieving PCMH status depends on coaches who have experience working in a clinic or private practice as an office manager, RN, LPN, or MA.
    2) Payment reform must align with the change process. It is a great motivator.
    3) A standardize approach and curriculum like TransforMED’s is the essential for progress.
    4) High performing office staff are instrumental in moving the practice toward PCMH status and qualifying for incentive payments.
    5) Practices should use payments wisely. When possible, practices should reinvest incentive payments in office infrastructure and building capacity for new payment models.
    6) Payment reform must align with the change process. Up front pay for performance incentives must be aligned with the change process to facilitate rapid movement toward PCMH.