Hawaii health plans
take national honors

By Helen Altonn
Star-Bulletin

Two Hawaii health plans are among 40 in the nation to receive a prestigious "excellent" accreditation status from the National Committee for Quality Assurance.

They are: Health Plan Hawaii, a federally qualified health maintenance organization of the Hawaii Medical Service Association, and Kaiser Permanente Hawaii.

The 40 HMOs designated for the new accreditation were chosen from more than 650 across the country. They had to achieve scores at or near the top 25 percent of all the health plans.

"It is not easy; it is not just promises," said Gerry Okamoto, in the human resources department of GTE Hawaiian Tel, which has 3,500 employees, plus spouses and dependents enrolled in the two "excellent" HMOs.

"They actually have to be able to show they've done certain performances in immunizations, mammograms, smoking cessation, eye exams for diagnosed diabetes, claim processing, access to care and overall patient satisfaction," Okamoto said. "Those are not easy."

Okamoto, who will be president next year of the Hawaii Business Health Council, said the high accreditation rating is "very good news. It validates what we've been working towards, to make sure we have a quality health care plan rather than going for cost. When you start doing wellness and preventative (programs), your costs go down."

Applauding the designation of the two Hawaii plans among the nation's elite 40, Gov. Ben Cayetano said it "reaffirms our confidence in the quality of medical care received by the majority of Hawaii's people."

"This unique honor validates the notion that Hawaii is "the health state," said Robert Nickel, president and chief executive officer of Health Plan Hawaii.

Bruce Behnke, Kaiser Permanente Hawaii's president and regional manager, said, "There is a strong commitment to keeping people healthy through prevention and a recognition that we must work together in the interest of the entire community."

To retain their accreditation status in the year 2000, NCQA is requiring that health plans handle denials and appeals fairly, coordinate medical and behavioral health care, use a "prudent lay person" standard for emergency room care coverage, provide sufficient access to care and give patients the option of taking unresolved appeals to an independent third party.

Hawaii's Patients' Bill of Rights already provides most of those protections.

HMSA and Kaiser Permanente Hawaii supported the state legislation and were among the first health plans in the nation to adopt President Clinton's Health Care Consumer Bill of Rights and Responsibilities in January 1998.

Kaiser Permanente, Hawaii's largest and most experienced HMO, serves 210,000 members statewide. Kaiser has 300 physicians and 3,500 employees. It operates 17 outpatient clinics on Oahu, Maui and Hawaii and contracts with the Kauai Medical Group to provide care for residents there.

Health Plan Hawaii, founded in 1981 as an HMSA affiliate, has 78,000 members and a statewide network of more than 1,500 participating physicians, health professionals, hospitals and health centers.

Pauline Bailey, past president of the Hawaii Business Health Council, which has 26 employer groups representing about 50,000 insured people, said "excellent" rating for the two Hawaii plans is extremely important for consumers.

"So far, what we've had in health plans is people looking at costs and people looking at accessibility, but really no way of knowing that the quality of care is excellent," she said. A plan may address costs and accessibility, she said, "but without quality, it's not worth anything, especially when it comes to something as important as health."

Okamoto said GTE Hawaiian Tel requires NCQA accreditation for its plans. When he joined the company in 1996, he said he met with HMSA "to make sure they understood they needed to get that. They spent a lot of time and effort and subsequently did receive, not only accreditation, but the highest accreditation."

He also met with Kaiser and went over its program, he said. "It has always had an excellent program."

Kaiser twice has received three-year, full accreditation from the national organization. Health Plan Hawaii received three-year accreditation last year.