Building a Healthier
Hawaii Island-- Together
Hawaii Community College
Community Economic Development
Strategies,
April 27 2012
Sharon Vitousek MD,
North Hawaii Outcomes Project ,
www.nhop.org
Hawaii Island Healthcare Alliance
www.hawaiihealthcarealliance.org
How can HCC support economic
growth of the Health sector?
• What health careers are expected to
grow?
• [What additional training is needed for
existing health professions?]
• [What partnerships/ resources can help
answer these questions?]
Why should we collaborate to
grow the health sector on Hawaii
Island ?
Inadequate Access
on Hawaii Island
Source IHI John Wasson MD
Impact of
Primary Care Shortage
•
•
•
•
•
•
•
Delayed Care & Increased suffering
Higher ER utilization
Higher hospital utilization
Increased costs
Less focus on Prevention- Life style
Less screening- Cancer & Depression
Poorer outcomes
Health Disparities in Hawaii County
Higher Death rates from:
– All causes
– Heart disease
– Stroke
– Overall cancer
– Infant Mortality
– Suicide
– Traffic-related accidents
Lower Life Expectancy
Higher Teen Birth Rates
All Causes - Age-Adjusted Death Rate
Hawaii County Compared to the State
Age-Adjusted Death Rate per 100,000 population
1000
900
800
Hawaii County
764.0
700
600
500
670.8
668.4
603.8
State
400
300
200
100
0
1999
2000
2001
2002
2003
Chart: North Hawaii Outcomes Project - April 2011
2004
2005
2006
2007
2008
2009
Source: Office of Health Status Monitoring, 1999-2011
Coronary Heart Disease - Death Rates
Hawaii County compared to State (1999-2009)
180.0
160.0
Age-adjusted rate per 100,000 population
140.0
153.4
Hawaii County
Hawaii County
120.0
124.3
100.0
93.4
HP 2020 - 100.8
80.0
State
77.6
60.0
40.0
20.0
0.0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Chart: North Hawaii Outcomes Project - May 27, 2011 Source: Hawaii State Department of Health - Office of Health Status Monitoring
1999 - 2009
Cerebrovascular(Stroke) Disease - Death Rates
Hawaii County compared to State (1999-2009)
100.0
Age-adjusted rate per 100,000 population
90.0
80.0
75.5
70.0
60.0
Hawaii County
61.9
50.0
42.7
40.0
State
Healthy People 2020 Target - (33.8)
39.1
30.0
20.0
10.0
0.0
1999
2000
2001
2002
2003
Chart: North Hawaii Outcomes Project - May 31, 2011
2004
2005
2006
2007
2008
2009
Source: Department of Health - Office of Health Status
Monitoring, 1999 - 2009
Overall Cancer - Death Rate
Hawaii County Compared to the State - (1999-2009)
200
Hawaii County
Deaths per 100,000 age-adjusted population
180
172.7
Healthy People 2020 Target - 160.6
160
140
120
156.3
151.9
140.7
State
100
80
60
40
20
0
1999
2000
2001
2002
2003
Chart: North Hawaii Outcomes Project - May 31, 2011
2004
2005
2006
2007
2008
2009
Source: Office of Health Status Monitoring, 1999-2009
Institute of Medicine
Framework for Population Health
Social and Physical Environment
Social, Economic &
Physical Environment
(Socioeconomic Determinants)
Health-Related
Behaviors
Health Systems
(Access to Care)
Population
Health Outcomes
Average Percent Unemployed
2010
12.0%
10.0%
9.8%
8.0%
8.3%
8.7%
6.0%
5.6%
4.0%
2.0%
0.0%
Hawaii County
City & County of Honolulu
Chart: North Hawaii Outcomes Project - January 2012
Maui County
Kauai County
Source: American Community Survey 2010
Per Capita Income - 2010
$35,000
$30,000
$28,629
$25,000
$27,767
$24,774
$20,000
$22,713
$15,000
$10,000
$5,000
$0
Hawaii County
City & County of Honolulu
Chart: North Hawaii Outcomes Project - October 2011
Maui County
Kauai County
Source: U.S. Census, ACS 2010
Population at or Below 200% Federal Poverty
- 2010
50.0%
45.0%
40.0%
35.0%
35.0%
28.4%
30.0%
State - 24.6%
26.5%
21.9%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
Hawaii County
City & County of Honolulu
Chart: North Hawaii Outcomes Project - October 2010
Kauai County
Maui County
Source: U.S. Census Bureau, ACS 2010
Youth Below 100% Federal Poverty Level 2010
30.0%
25.0%
25.0%
20.0%
18.0%
15.0%
12.5%
State - 13.9%
11.0%
10.0%
5.0%
0.0%
Hawaii County
Maui County
Chart: North Hawaii Outcomes Project - October 2011
Kauai County
C & C of Honolulu
Source: U.S. Census, ACS 2010
50.0%
Population 25+ years With Some College,
but no Degree (2010)
45.0%
40.0%
35.0%
30.0%
28.4%
25.0%
20.0%
State - 22.5%
25.2%
21.2%
21.9%
Hawaii County
City & County of Honolulu
15.0%
10.0%
5.0%
0.0%
Chart: North Hawaii Outcomes Project - October 12, 2011
Maui County
Kauai County
Source: U.S. Census Bureau, ACS 2010
13th Year of School
Associated with Lower Death Rates
800
U.S. Age-adjusted per persons 24 - 65 years of age
*Reporting areas that have adopted the 2003 revision of the U.S. Standard Certificate of Death are excluded because educational attainment data based on
Age Adjusted Death rate per 100,000 population
700
the 2003 revision are not comparable with data based on the 1989 revision of the U.S. Standard Certificate of Death. Starting with 2003 data, data from
California, Idaho, Montana, and New York are excluded. In addition to these four states, starting with 2004 data, Connecticut, Georgia, Michigan, New
Hampshire, New Jersey, Oklahoma, Rhode Island, South Dakota, Washington, and Wyoming have adopted the 2003 revision and therefore are excluded.
Because of different education profiles of the excluded states compared with the remaining reporting areas, 2003 and subsequent years are not directly
comparable to earlier years.
600
500
400
300
200
100
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
*2003
Chart: North Hawaii Outcomes Project - February 2010
Less than 12 yrs of school
12 yrs of school
13 yrs of school or more
*2004
*2005
Source: Health, United States
2008
Health Disparities - Hawaii County
Health Related Behaviors- 2010
Behavior
State
Hawaii
County
Smoking
15%
20%
Obesity
26.3
23.1
Binge Drinking
17.9
17.7
Adults no leisure 19.2
physical activity
20.2
Health Disparities - Hawaii County
Health Systems
Access to care:
•

•
•
Higher uninsured
Lower ratio of physicians per 1,000 population
Higher percent of population without a personal doctor
Lower percent mothers receiving prenatal care
Utilization & Cost:
• Higher acute care hospitalizations per 1,000 population
Quality:
Licensed Physicians with a Hawaii Primary Address
per 1,000 Population by County (2011)
4.0
Licensed physicians per 1,000 population
3.5
3.4
3.0
2.5
2.4
2.0
2.2
2.1
1.5
1.0
0.5
0.0
Hawaii County
City & County Of
Honolulu
Chart: North Hawaii Outcomes Project - September 2011
Maui County
Kauai County
Source: Numerator from Department of Commerce and Consumer Affairs –
July 27, 2011
*Denominator from U.S. Census 2010
** Licensed physicians may or may not be active.
Hawaii Island
Increasing Provider Shortages
700
600
500
400
331
157
300
200
Supply
100
Demand
0
2010
2012
2014
2016
2018
Source : JABSOM Workforce Study, Kelly Withy
2020
What Healthcare Providers
Are Doing
• Collaboration to improve:
– Hawaii Island Healthcare Alliance– Hawaii Island Beacon Community
• Health information exchange
• Clinical transformation, care coordination
– Hawaii Island Trauma Committee
– Hawaii Island Perinatal Collaborative
– Long Term Care Hui / Aging Resource Center,
• Island wide, voluntary, collaborative group of
stakeholders
• Goal: Improve health & healthcare in Hawaii
County by increasing healthcare workforce
• Friends of the Future is 501(c )(3) Fiscal Agent
Supports
Growing Our Primary Care Workforce
Family Practice Residency Program in Hilo
Growing effective use of mid-level providers
Improving recruitment & retention of providers
Increase effective use of technology - Beacon
Collaboration and leveraging resources
Regional planning
Aligning high leverage policy change.
HAWAII ISLAND FAMILY HEALTH CENTER
Current Health Training site
Health Workforce Shortages are in a
Larger Economic Context
Negative Impact
• Health Disparities are
Partly a Result of poorer
rural economy
AND
Opportunity
• Growing the health
workforce is an
OPPORTUNITY to
stimulate economy
• Health Workforce
shortages are a Barrier
to productivity &
economic growth
• Job multiplier effect of
Physicians is ~1 to 5
Healthcare is 3rd Largest Employer in
Hawaii County (DBED Nov 2011)
Growing Healthcare sector is part of
economic development for Hawaii Island
Employment sector
1. Government
2. Retail trade
3. Healthcare/social assistance
4. Accommodations
5. Food and beverage services
# of Employees
12,000
8,000
6,900
5,500
5,200
What Hawaii County Can Do
• Approach policy decisions through a health lens:
“How will this policy impact the health of our
community-- now & in future ?”
• Support Hawaii County economic development
of the science, energy, education & healthcare
sectors
• Add community health improvement to Criteria
for Community Development Conditions
• Advocate for State health data to be analyzed by
County and Sub- county to better track needs &
progress
How can HCC support economic
growth of the Health sector?
• What health careers are expected to
grow?
• What additional training is needed for
existing health professions?
• What partnerships/ resources can help
answer these questions?
Future Health Care?
Address “silver tsunami” & shortages
•
•
•
•
More team care
More allied personnel
More “care coordination”
More integration with behavioral health
– Lifestyle coaching
• More use of population health data
• More use of info systems
What health careers are
expected to grow?
• Health Workforce Information Center
http://www.hwic.org/topics/professions.php
• Virtual Career Network - health care- a
project of the American Association of
Community Colleges
http://www.vcn.org/healthcare/careergrid/wo
rktypecode/mdn/score/high
On line courses
Health Careers Expected to Grow
•Audiologists
•Dietitians and Nutritionists
•Health Aides, Assistants and Guides
• Community Health Workers
• Health Educators
• Home Health Aides
• Medical Assistants
• Nursing Aides
• Patient Navigators
• Personal and Home Care Aides
•Health Information and Informatics Occupations
• Chief Information Officers
• Chief Medical Information Officers
• Health Informaticians
• Health Information Administrators
• Health Information Technicians
Health Careers Expected to Grow
•Health Technologists and Technicians
• Cardiovascular Technologists and Technicians
• Diagnostic Medical Sonographers
• Medical Appliance Technicians
• Nuclear Medicine Technologists
• Radiologic Technologists and Technicians
• Surgical Technologists
•Laboratory Professionals
• Phlebotomists
•Medical Interpreters
•Pharmacy Occupations
• Pharmacy Technicians and Aides
•Speech-Language Pathologists
•Vision Care Occupations
• Optometric Assistants and Technicians
10 Hot Careers in the Health
Industry
Dental Assisting
2. Information Management
3. Health Care Administrator
4. Medical Assistants and Nurses
5. Massage Therapy
6. Medical Transcriptionists
7. Billing and Coding
8. Medical Imaging
9. Pharmacy Techs
10. Occupational Therapists
1.
http://www.healthdegrees.com/10-hot-careers-in-the-health-industry
Top Ten (10) Fastest Growing
Allied Health Careers
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Medical Assistants:
Cardiovascular Technologists
Diagnostic Medical Sonographers:
Physician Assistants:
Respiratory Therapists and Technicians:
Athletic Trainers:
Surgical Technologists:
Clinical Laboratory Technologists:
Medical and Health Services Managers:
Dietitians and Nutritionists:
Source: Bureau of labor statistics 8/2011
What additional training
for existing professionals?
• Leadership & Change Management
– Mentoring
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•
•
•
•
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Healthcare Finances
Performance monitoring/Program evaluation
Effective use of data
Mediation/Negotiations
Communications
Billing & coding
What partnerships/ resources can
help answer these questions?
• Hawaii Workforce Development Council
To support and facilitate the development of a skilled
workforce that meets the needs of business and
industry, enhances workplace productivity, and
increases opportunities for employment and
entrepreneurship.
•
Contact:
dlir.workforce.council@hawaii.gov
808.586.8670
Benefits of Developing Hawaii Island
Health Workforce- Health lens
• Improved Access
– Timely care & decreased suffering
– More recommended screenings
•
•
•
•
More prevention & better lifestyles
Better outcomes & quality of life
Improved productivity of workforce
Improved economy - job creation
• Decreased healthcare costs
• Lower hospital/ER utilization
Benefits of Developing Hawaii Island
Health Workforce- Education lens
•
•
•
•
•
•
•
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Increased educational attainment
Increased economic potential of individuals
Can afford better living conditions, lifestyle
Increased health literacy
Better outcomes & quality of life
Improved productivity of workforce
Improved economy - job creation
Decreased healthcare costs
Improving Health & Healthcare for
our community Is Our Kuleana
Contact info
vitousek@nhop.org
www.nhop.org
www.hawaiihealthcarealliance.org
Tools for policy makers
Average Percent Unemployed
2010
12.0%
10.0%
9.8%
8.0%
8.3%
8.7%
6.0%
5.6%
4.0%
2.0%
0.0%
Hawaii County
City & County of Honolulu
Chart: North Hawaii Outcomes Project - January 2012
Maui County
Kauai County
Source: American Community Survey 2010
Population at or Below 200% Federal Poverty
- 2010
50.0%
45.0%
40.0%
35.0%
35.0%
28.4%
30.0%
State - 24.6%
26.5%
21.9%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
Hawaii County
City & County of Honolulu
Chart: North Hawaii Outcomes Project - October 2010
Kauai County
Maui County
Source: U.S. Census Bureau, ACS 2010