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The Honolulu Advertiser
Posted on: Thursday, February 18, 2010

State delay of Quest payments untenable


By Steve Van Lier Ribbink

Hawaii news photo - The Honolulu Advertiser

Administering flu shots is just one benefit provided to some Quest patients through the Hawaii Medical Service Association.

ADVERTISER LIBRARY PHOTO | 2009

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For more than 70 years, the Hawaii Medical Service Association has been dedicated to providing Hawai'i's families with affordable access to quality health care. It's a commitment we live each and every day, and something that has increasing relevance as our community struggles with the challenge of balancing growing medical needs with diminishing financial resources.

Arguably, nowhere are these competing interests more visible than in the state of Hawai'i's Quest program, which provides health care coverage for low-income families. Quest enrollment and use of health care services by recipients are at all time highs at the same time the state is strapped for cash and unable to make timely payments to health plans.

HMSA continues to pay doctors and hospitals for the services they provide Quest members. Yet the state is behind in its contractual payments to HMSA and now says that it will run out of money in April, or possibly earlier.

Based on recent public statements by Quest officials, it now appears likely that the state will not pay health plans for the final three (or possibly four) months of its fiscal year ending this June.

The amount of money involved is significant. HMSA distributes $22 million a month to pay hundreds of health care providers statewide for the care they deliver to families covered by Quest. Expand that number by the four other health plans participating in the Quest program and you understand the severity of the financial situation.

More important, however, is the tremendous negative impact this could have on the medical care for Hawai'i's at-risk families and the medical providers that treat them.

As a long time kama'āina company whose employees live, work and raise families statewide, we recognize this is a serious community challenge. We all need to work together to find solutions to protect the most vulnerable in our community and lead us to real, long-term answers.

Finding those answers requires the ability to understand the problem from a number of perspectives certainly from the viewpoint of the Quest members, but also the physicians and clinics who serve high numbers of Quest patients, vendors who do business with these doctors and hospitals, and non-Quest members of health plans whose membership dues are being used to subsidize the state's shortfall.

Over the long-term, the state's delayed, or no-payment plan hurts all of these constituent groups, threatens an already fragile health care delivery system, and puts various stakeholder groups in opposition at a time when the challenges we face compel us to work together.

We are firm believers that crises like these provide opportunities. We now have a chance to work together to create a sustainable Quest program that balances need with available resources. And in that spirit, we've extended a hand to the state to work together to solve these problems.

Certainly, within HMSA we're doing all we can to make sure that each and every Quest dollar spent pays for quality health care that is appropriate and results in positive health outcomes.

These are times that require sacrifice and compromise. More than anything else, what's required now is leadership from both the public and private sectors to build a sustainable and accountable Quest program. The time is now to give our full community attention to this effort before Hawai'i's health care safety net further deteriorates and breaks down.