FAIR Health Delivers Keynote at Hawaii State of Reform Conference

January 16, 2020

On January 14, FAIR Health President Robin Gelburd delivered the morning keynote address at the fourth annual Hawaii State of Reform Health Policy Conference in Honolulu, Hawaii. The address was the latest in a series of State of Reform keynotes delivered by Ms. Gelburd in a number of states, most recently Oregon in November 2019, and previously Arizona, Texas, Washington and Alaska.

Speaking to an audience of healthcare practitioners, thought leaders and policy makers, Ms. Gelburd shared data revealing distinctive aspects of Hawaii’s healthcare environment.

Venues of Care
Ms. Gelburd presented data on alternative venues of care—such as urgent care centers, ambulatory surgery centers (ASCs) and telehealth—as well as a more traditional venue, emergency rooms (ERs). In Hawaii from 2009 to 2018, usage of urgent care centers (measured by claim lines for urgent care centers as a percentage of all medical claim lines) increased 1,009 percent, a greater rise than the national growth in that period of 546 percent. Growth in usage of ASCs in Hawaii in that period (60 percent) was much smaller and closer to the national figure (54 percent). Growth in usage of ERs in Hawaii (57 percent) was lower than on the national scale (119 percent)

Ms. Gelburd presented data on diagnoses in the different venues. The second most common diagnosis in Hawaii across all venues in 2018 was sprains, strains, breaks and fractures (7.6 percent of claim lines)—a category that was not among the top five diagnoses nationally. This may be related to Hawaii’s large population of vacationers, who may seek medical care for injuries sustained during leisure activities.

Age distribution was also distinctive in Hawaii in 2018. In Hawaii, the 0-22 age group accounted for the largest share of claim lines for urgent care centers (29.7 percent), but nationally the 23-40 age group held the largest share (32.8 percent). In Hawaii, the largest share of ER usage was associated with the over 60 age group (32.1 percent), compared to the 0-22 age group nationally (27.8 percent).

Behavioral Health
Ms. Gelburd discussed use of behavioral health services in Hawaii. Adjustment disorders were the top behavioral health diagnosis in Hawaii in 2018 (26.3 percent of behavioral health claim lines). The top diagnosis nationally was mental and behavioral disorders due to psychoactive substance use (21 percent).

Costs
Ms. Gelburd showed how costs for specific procedures differed in Hawaii versus the nation based on varying reimbursement models. For example, for CPT^®1 99283 (emergency department visit, moderately severe problem), the 80th percentile of charges was $806 in Hawaii compared to $665 nationally, but the 80th percentile of imputed allowed amounts was $351 in Hawaii compared to $244 nationally.

Within Hawaii, costs for the same procedure differed among types of venues. For example, in Hawaii, the average charge for CPT 66984 (removal of cataract with insertion of lens) in 2018 was $3,408 at an outpatient facility and $2,942 at an ASC. The difference was even greater in average imputed allowed amounts: $1,724 at an outpatient facility and $683 at an ASC.

For more information on FAIR Health custom analytics and services to states, contact us by email at info@fairhealth.org or call us at 855-301-3247, Monday through Friday, 9 am to 6 pm ET.

^{1. CPT © 2019 American Medical Association (AMA). All rights reserved.}