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Hawaii’s World
EVER since it expanded to Hawaii in 1958, I have been a certified fan of the Kaiser Permanente medical-care program. Nationally, it pioneered pre-paid medicine. This means that, for members who pay pre-set monthly fees, Kaiser provides overall care, including medications and hospitalization, for minimal extra charges. This leads naturally to a stress on preventive medicine. Kaiser uses
team careIt contrasts with traditional fee-for-service medicine, which charges based on services required. The sicker you are, the higher the bills. Health insurance modifies fee-for-service outlays, but not the concept.
The Hawaii Kaiser system got a five-star rating from Newsweek magazine last November and is one of two Hawaii health maintenance plans (HMSA's is the other) holding a special accreditation for excellence from the National Committee for Quality Assurance. The Hawaii Kaiser plan has 213,000 members and a staff of 300 doctors serving 16 clinics and the hospital at Moanalua.
The late great industrialist, Henry J. Kaiser, personally fought to get the system started in Hawaii against intense opposition from the local medical community.
THAT preface leads up to a new trend being introduced into Kaiser systems -- team medicine. It's one I'm pretty sure Kaiser himself would approve.
Hawaii is partially into it, expects to be fully into it by the end of next year. By that time it will have just about all its patient records in its computers. They will be accessible only to qualified personnel with a need to know. Simpler language versions will be available to the patients themselves.
Now patient records are in individual files, some very thick, toted to doctors' offices on the day of an appointment.
In team medicine each patient's assigned personal physician (there are about 150) remains the signal-caller, the quarterback. But four doctors may work together on the team and be supported by an array of six or seven assistants, a couple of them with advanced health-care degrees. They, too, get to know the patients.
It turns out that 20 percent of patients need 60 percent of the care due to chronic diseases like high blood pressure, heart problems, asthma and diabetes. The non-doctor team members help train patients in the intricacies of their personal health regimes. They also help patients break smoking habits and combat obesity.
TEAMS get to know patients and each other. They meet every two weeks to talk things over. Their co-chairmen include one physician and one non-doctor.
Dr. Geoff Galbraith, the Hawaii Permanente Medical Group vice president overseeing quality of medical care, says the old method of medicine was for skilled people to "practice alone together."
The new emphasis is on collaboration. The rate of conversion to team medicine still is in low percentages in Hawaii but is expected to speed up markedly. It has to be adjusted, of course, for clinics with fewer than four doctors.
Dr. Benjamin A. Tamura, the chief of internal medicine, coordinates the teams. He insists that all doctors have beepers to make them available at all times.
Tamura says Kaiser is the first major medical group in Hawaii to adopt the team approach but says it is found in some smaller non-Kaiser clinics. Where a change of lifestyle is needed, as with obesity, he says, the team approach works immensely better.
Cost control, he adds, is important but not the driving force behind the team medicine approach. Cost dividends are harvested, however, by involving persons with lesser skills than doctors when it is appropriate. It's good for overall morale, too.
A.A. Smyser is the contributing editor
and former editor of the the Star-Bulletin
His column runs Tuesday and Thursday.
