PREVENTIVE MEDICINE A TOP PRIORITY AT UHA

Q. What's wrong with the healthcare business?

A. The answer to that is very complex. Basically, everyone agrees that healthcare is way too expensive and providing healthcare services to everybody is a huge problem. Healthcare costs have been rising about twice the rate of general inflation for some time, although it seems to be leveling off a little bit. It's still way too high. Excessive costs result from excessive demand from consumers that are required in large part to treat complications that result from our increasingly prevalent unhealthy lifestyles but also because of significant quality problems. A report of the National Institutes of Health's Institute of Medicine found that some medical services are overused, like taking antibiotics for the common cold, and some medical services are misused. That occurs when an appropriate service results in a preventable complication, such as administering the wrong dosage of drugs or prescribing drugs that conflict with each other. Each of these quality problems adds to the cost of healthcare services. The Juran Institute has estimated that 30 percent of the cost of healthcare results from these quality problems.

Q. One of the focuses of UHA is preventive medicine. How does that work?

A. Prevention would reduce healthcare costs significantly, and even more importantly, it would extend our lives. Yet, there are a variety of these preventive services that are significantly underused in the U.S. They include smoking cessation classes, flu shots, breast cancer screening and colorectal cancer screening. For instance, less than 50 percent of adults get colorectal cancer screening. Another example is the use of aspirin to prevent heart attacks. Adult men over 40 years old and women over age 50 should use aspirin daily, but less than half of the people in those age groups do use aspirin! The result is we end up treating heart attacks that could have been prevented and widespread cancers that could have been cured. The human and financial costs of the underuse of preventive services is huge. Access to healthcare is another problem that I think is related to the high cost of care also. There are too many people in the United States that are not insured and therefore don't have access to good healthcare. The high cost of providing healthcare services drives the high cost of health insurance, not the other way around. Providing health insurance for all will be prohibitively expensive if we don't get control of the cost of healthcare services.

Q. You have been encouraging employer groups to become involved in encouraging healthier lifestyles for them and their employees. How do you get employers who pay most of the healthcare premiums to buy into this?

A. First we point out that their healthcare costs are what drive their premium increases. We then point out that much of those costs went to treat preventable illnesses. If their employees don't get sick, their healthcare costs don't go up and their premiums stay low. We also provide as benefits weight-reduction programs, smoking cessation programs, and we have reduced or eliminated co-payments for some drugs that are critical to the treatment of diabetes, for instance. We also go to some work sites to check blood pressures or to test people who may have diabetes or whose cholesterol levels are too high and when we identify individuals who are at risk for heart disease, we encourage them to participate in disease management programs, which we provide as a benefit.

Q. What other preventive measures do you advocate?

A. We also provide flu shots. Flu shots are a pretty high cost item. But the flu causes a lot of absenteeism and some people get very sick and have complications like pneumonia, which can be life-threatening. Ideally, 90 percent of individuals should have a flu shot, but the current rate is a good deal lower than that. We provide free flu shots to our members. Sometimes we've gone to work sites to provide flu shots and we have a partnership with Longs that allows our members to go to Longs on certain days to get shots for free. They can also go to their own physician for no charge. When somebody goes to the hospital for flu-related complications like pneumonia, we're looking at costs of anywhere between $50,000 and $100,000. On the other side, we can provide the flu shot for about $25. So the incentive for us is very great.

Q. What kind of coverage is provided for breast-cancer screening?

A. Yearly mammograms will detect breast cancers, which are 96 percent curable. A mammogram costs about $140, and for our members, there's no co-insurance. The treatment of late-stage breast cancers cost tens of thousands of dollars and is way less effective. Is this cost-effective or what? Women over 40 should get a mammogram once a year but not enough of them do. One of the things we are doing to increase this number is to identify women who have not had a mammogram in two years and contact them by mail to encourage them to do so. We've also provided incentives for physicians to encourage them to try harder to get their patients to have a regular mammography. If a physician can show that their patient received a mammogram, we pay them an extra $25. One doctor on Maui was able to demonstrate that more than 20 of her UHA patients had mammograms, and we paid her an extra $500. We were very pleased with that.

Q. Tell us a little about the history of UHA.

A. UHA was founded about 10 years ago by a group of faculty members at the University of Hawai'i's John A. Burns School of Medicine. We thought that having an insurance company directed by physicians could influence the quality of healthcare in the state of Hawai'i. In 1996, we took over HDS Medical, which wanted to get out of the medical insurance business. At that time, the membership was about 8,000. Now it's about 43,000. The growth has been steady, but we've been careful that we don't outgrow our capabilities. We're dedicated to continuous quality improvement, and customer service is an important part of that process. That's something we won't sacrifice for growth.

Q. You've had some trying times?

A. We were in rehabilitation for three years, between 2001 and 2004. That's a very difficult position to be in. For a mutual benefit society, it's similar to bankruptcy and it was very tough. The odds of coming out of rehabilitation are pretty low, and we're just so proud of the fact that we were able to dig ourselves out of that hole and do very well. Looking back, we were really small and we wanted to grow. One thing that happens when you grow rapidly is that your incurred, but not reported, expenses grow very rapidly. We didn't have enough capital to expand that rapidly, so our reserves fell below the statutory limits. I can tell you the greatest moment in my life is the day the judge removed us from rehabilitation. We have been profitable since, and our reserves as of Aug. 31 total $14 million. This is $6.42 million more than required by statute.

Reach Rick Daysog at rdaysog@honoluluadvertiser.com.