Hawaii Primary Care Association

TO IMPROVE THE HEALTH OF COMMUNITIES IN NEED BY ADVOCATING FOR, EXPANDING ACCESS TO, AND SUSTAINING HIGH QUALITY CARE THROUGH THE STATEWIDE NETWORK OF COMMUNITY HEALTH CENTERS.

TRAINING AND TECHNICAL ASSISTANCE - THE OBJECTIVE OF THE TRAINING AND TECHNICAL ASSISTANCE (TTA) COMPONENT OF THE HPCA IS TO PROVIDE CONSISTENT, TIMELY, AND RELEVANT SUPPORT TO THE COMMUNITY HEALTH CENTERS (CHC) IN THEIR ONGOING EFFORTS TO ATTAIN EXCELLENCE IN ALL ASPECTS OF THEIR HEALTHCARE DELIVERY SYSTEM. TO KEEP HPCA'S TTA SUPPORT RELEVANT, WE STRIVE TO CONDUCT TTA ASSESSMENTS ON AN ANNUAL BASIS WITH ALL MEMBER CHCS. THE ASSESSMENT FINDINGS ARE USED TO REVISE THE HPCA'S TTA WORKPLAN TO ASSURE THAT TTA SERVICES PROVIDED ARE ALIGNED WITH CHCS NEEDS AND REMAIN RELEVANT. TTA ACCOMPLISHMENTS ARE MEASURED AND TRACKED IN TWO MAIN WAYS: (1) THROUGH DATA COLLECTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION'S (HRSA) UNIFORM DATA SYSTEM (UDS), AND (2) BY EVALUATION PROCESSES EMBEDDED INTO OUR WORKPLAN ACTIVITIES.AT THE START OF THE COVID PANDEMIC (MARCH 2020) WE WERE FORCED TO RAPIDLY RETHINK MANY OF OUR PLANNED TTA ACTIVITIES. MANY ACTIVITIES WERE PLACED ON HOLD OR WERE SHIFTED TO MEET THE IMMEDIATE AND URGENT NEEDS OF THE CHCS AS THEY RE-INVENTED THEMSELVES TO DEAL WITH THE PANDEMIC HEAD-ON. OVERNIGHT, CHCS WERE FACED WITH DRAMATIC DROPS IN FACE-TO-FACE PATIENT VISITS, SEVERELY IMPACTING REVENUES. CHCS HAD TO IMMEDIATELY FIGURE OUT HOW TO PROVIDE PRIMARY CARE TO THEIR PATIENTS IN A SAFE AND MEANINGFUL WAY. IN A MATTER OF WEEKS, CHCS DEPLOYED THE USE OF TELEHEALTH TO PROVIDE A VIABLE MEANS OF COMMUNICATING WITH THEIR PATIENTS. PIVOTING TO TELEHEALTH POSED MANY SIGNIFICANT CHALLENGES TO THE CHCS AND PATIENTS. CHCS DID NOT HAVE PREVIOUS EXPERIENCE TO RELY ON. WE QUICKLY RECOGNIZED THE NEED TO RE-FOCUS OUR TTA EFFORTS TO FILL THIS COLLECTIVE GAP IN KNOWLEDGE AND EXPERIENCE. THIS RESULTED IN THE HPCA RAPIDLY STANDING UP A TELEHEALTH LEARNING AND SHARING FORUM THAT PROVIDED AN ONGOING VENUE FOR CHC STAFF (CLINICAL, TECHNOLOGY, FISCAL, ADMINISTRATIVE) TO COME TOGETHER AND TROUBLESHOOT CHALLENGES AND SHARE PROMISING AND BEST PRACTICES IN THE AREAS OF TECHNOLOGY, REIMBURSEMENT, AND PATIENT CARE. VIRTUAL MEETINGS WERE HELD WEEKLY AT FIRST, EVENTUALLY TAPERING OFF AS KNOWLEDGE AND EXPERIENCE INCREASED, EVENTUALLY REACHING A STEADY STATE. WE WORKED IN CLOSE PARTNERSHIP WITH THE PACIFIC BASIN TELEHEALTH RESOURCE CENTER TO PROVIDE TTA, FACILITATE JOINT TRAININGS, AND CONVENE POLICY FORUMS. ATTENDANCE AT THESE TTA EVENTS TENDED TO BE VERY HIGH, AT TIMES REACHING OVER 60 PARTICIPANTS REPRESENTING A MAJORITY OF HAWAII'S CHCS. STARTING AROUND DECEMBER 2020, AND CONTINUING INTO 2021, OUR TTA FOCUS SHIFTED TO THE FEDERAL/STATE COVID VACCINE CAMPAIGN. THE HPCA WAS HEAVILY INVOLVED IN ASSISTING THE DOH AND CHCS RAPIDLY ORGANIZE AND DEPLOY HAWAII'S VACCINE CAMPAIGN EFFORTS. WE PLAYED A SIGNIFICANT ROLE IN KEEPING THE CHCS UPDATED AND INFORMED OF THE VACCINE ROLLOUT. IT WAS NECESSARY FOR THE HPCA TO PROVIDE TTA TO THE CHCS ON A REAL-TIME BASIS TO KEEP PACE WITH THE CONSTANTLY EVOLVING STATEWIDE EFFORT. AS STATED EARLIER, ALL 15 HAWAII CHCS ENROLLED AS VACCINE PROVIDERS, AND CONTINUE TO PROVIDE ALL THREE TYPES OF THE FEDERALLY AUTHORIZED (FULL FDA APPROVAL OR EUA) VACCINES TO THEIR PATIENTS AND COMMUNITIES.DURING THE SUMMER OF 2021, OUR COVID RESPONSE EFFORTS BEGAN TO GRADUALLY TAPER OFF COINCIDING WITH THE WANING PANDEMIC. ALL OF THAT CHANGED DURING THE TWO SURGES. WE HAD TO RE-INVEST MORE OF OUR LIMITED RESOURCES TOWARD OUR COVID RESPONSE EFFORTS AT THE EXPENSE OF SOME OF OUR ON-GOING ACTIVITIES. IN ADDITION, WE WERE ALSO DEALING WITH A STAFFING SHORTAGE DUE TO RECENT DEPARTURES. AS WITH OUR CHCS, WE STRUGGLED WITH SIGNIFICANT WORKFORCE FATIGUE AND BURNOUT. AS A RESULT, WE TEMPORARILY LOST THE INTERNAL BANDWIDTH NEEDED TO DRIVE SOME OF OUR TTA ACTIVITIES TO COMPLETION IN A TIMELY MANNER DURING THIS PERIOD (4/1/2021-3/31/2022).

COMMUNICATIONS AND POLICY- THE OBJECTIVE OF THE COMMUNICATIONS AND POLICY COMPONENT OF THE HAWAII PRIMARY CARE ASSOCIATION (HPCA) IS DEMONSTRATING THE VALUE OF HAWAII'S COMMUNITY HEALTH CENTERS (CHC) AND THE HPCA IN IMPROVING HEALTH EQUITY FOR HAWAII'S VULNERABLE POPULATIONS AND BRINGING TO LIGHT THE IMPACT OF SOCIAL FACTORS ON INDIVIDUAL AND COMMUNITY HEALTH. A MAJOR STRATEGY WE CONTINUE TO EMPLOY TO THIS END IS THE FOSTERING AND SUSTAINING OF STRONG PARTNERSHIPS WITH HEALTHCARE AND PUBLIC HEALTH STAKEHOLDERS OUTSIDE OF MEMBERSHIP. WE ARE CONSTANTLY AND INTENTIONALLY INVESTING TIME AND EFFORT TO SOLIDIFY AND STRENGTHEN OUR SUCCESS IN THIS AREA. THESE ENDURING PARTNERSHIPS PROVED CRUCIAL DURING THE CRITICAL PHASES OF HAWAII'S COVID PANDEMIC RESPONSE. OUR PARTNERSHIP WITH THE HAWAII DEPARTMENT OF HEALTH (DOH) PLAYED A CRITICAL ROLE HELPING TO ESTABLISH HAWAII'S CHCS AS AN ESSENTIAL COMPONENT OF HAWAII'S PUBLIC HEALTH INFRASTRUCTURE. FOR EXAMPLE, HAWAII'S CHCS RAPIDLY STOOD UP COVID TESTING SITES ACROSS THE STATE TO CONTRIBUTE TO HAWAII'S OVERALL COVID TESTING CAPACITY. WHEN PCR TESTING TRANSITIONED TO AT-HOME TESTING, HAWAII'S CHCS ACTIVELY PARTICIPATED IN MASS DISTRIBUTION EFFORTS ACROSS THE STATE. HAWAII'S CHCS CONTRIBUTED TO THE DISTRIBUTION OF TENS OF THOUSANDS OF AT-HOME TESTS STATEWIDE. IN ADDITION, HAWAII'S CHCS PLAYED A MAJOR ROLE IN CONTACT TRACING DURING THE FIRST SIGNIFICANT SURGE DURING THE SUMMER OF 2020 AND AGAIN DURING THE DELTA (LATE 2021) AND OMICRON (EARLY 2022) SURGES. AT THE BEGINNING OF 2021, ALL 15 OF HAWAII'S CHCS SIGNED UP AS COVID VACCINE PROVIDERS AND ARE STILL PROVIDING VACCINES TO THEIR PATIENTS AND COMMUNITIES. CHC PUBLIC HEALTH RESPONSE CAPACITY THAT WAS STRENGTHENED DURING THE INITIAL WAVE OF THE PANDEMIC PLAYED A CRITICAL ROLE DURING THE TWO VARIANT SURGES IN 2021 AND 2022. WE CONTINUE TO NURTURE AND EXPAND OUR PARTNERSHIPS WITH THE UNIVERSITY OF HAWAII (JOHN A. BURNS SCHOOL OF MEDICINE DEPARTMENT OF GERIATRICS, OFFICE OF PUBLIC HEALTH STUDIES, CENTER ON AGING, PACIFIC BASIN TELEHEALTH RESOURCE CENTER, CANCER RESEARCH CENTER) AND THE HAWAII PUBLIC HEALTH INSTITUTE. FINALLY, WE HAVE STRONG RELATIONSHIPS WITH THE PRIVATE SECTOR AS WELL. FOR EXAMPLE, THE HPCA CONTINUES TO PARTNER WITH THE HAWAII HEALTH INFORMATION EXCHANGE, KAISER PERMANENTE COMMUNITY BENEFIT PROGRAM AND ALOHACARE ON SEVERAL INNOVATIVE INITIATIVES.

SPECIAL PROJECTS - MAUI COUNTY CHC MEDIA CAMPAIGN: DURING THE EARLY AND MORE RECENT SURGES OF THE COVID PANDEMIC, THE MAUI COUNTY CHCS (MALAMA IKE OLA, HANA HEALTH, MOLOKAI COMMUNITY HEALTH CENTER, AND LANAI COMMUNITY HEALTH CENTER) FELT IT WAS CRITICALLY IMPORTANT TO LET THEIR COMMUNITIES KNOW THAT THEY WERE ALL STILL FULLY OPERATIONAL AND CONTINUING TO PROVIDE COMPREHENSIVE MEDICAL, DENTAL, BEHAVIORAL, DRUG, VISION, AND OTHER SERVICES TO OVER 18,000 MAUI COUNTY RESIDENTS. THEY WANTED TO ASSURE THEIR COMMUNITIES THAT THEY WERE ON THE FRONT LINES OF THE COVID CRISIS, AND SERVED ANYONE WHETHER THE PERSON HAD PRIVATE INSURANCE, MEDICARE, MEDICAID, OR NO INSURANCE AT ALL. THE MAUI COUNTY CHCS TURNED TO THE HPCA FOR EXPERTISE AND TECHNICAL SUPPORT TO LAUNCH THEIR SOCIAL MEDIA CAMPAIGN THROUGH A COMBINATION OF COMMUNICATION OUTLETS.WELLNESS CHALLENGE: AS STATED EARLIER, CHC AND HPCA STAFF WERE DEALING WITH SIGNIFICANT BURN-OUT AND STRESS BECAUSE OF THE PANDEMIC. THIS PROMPTED US TO PARTNER WITH A LOCAL HEALTH INSURER TO SPONSOR A WELLNESS CHALLENGE FOR ANY CHC AND STAFF TO PARTICIPATE IN. WE ENDED UP WITH 119 PARTICIPANTS, MAKING UP 15 TEAMS, FROM A TOTAL OF FIVE CHCS AND THE HPCA. THE AIM WAS FOR TEAMS TO WALK TO FIVE BLUE ZONE CITIES COLLECTIVELY AND VIRTUALLY IN FIVE COUNTRIES OKINAWA, JAPAN, SARDINIA, ITALY, NICOYA PENINSULA, COSTA RICA, LOMA LINDA, UNITED STATES, AND IKARIA ISLAND, GREECE.NATIONAL POLICY ADVISOR: THE PURPOSE OF THIS PROJECT WAS TO RETAIN STRATEGIC EXPERTISE TO ADVANCE THE ABILITY OF COMMUNITY HEALTH CENTERS (CHC) AND PRIMARY CARE ASSOCIATIONS (PCA) TO NAVIGATE A RAPIDLY CHANGING AND COMPLEX POLICY AND REGULATORY ENVIRONMENT. BY WORKING COLLECTIVELY TO RETAIN THIS CAPACITY, IT WAS THE INTENTION OF PCAS ACROSS THE COUNTRY TO SUPPLEMENT EFFORTS WITH THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC) CAPACITY IN THESE CORE AREAS. THIS PROJECT WAS INTENDED TO BE SUPPORTIVE OF THE HEALTH CENTER PROGRAM OVERALL AND TO MAINTAIN A COLLECTIVE APPROACH TO THESE RESOURCES TO PREVENT SPLINTERING AMONG THE STATES AND REGIONS. NOT ALL PCAS WERE ABLE TO CONTRIBUTE AT THE INAUGURATION OF THIS PROJECT; YET THE BENEFITS WILL INURE TO ALL PCAS AND HEALTH CENTERS ACROSS THE COUNTRY. THIS PROJECT WILL CONTINUE INTO 2023.LEGAL CONSULTATION: DURING NORMAL TIMES, CHCS MUST MANAGE MANY REGULATORY COMPLEXITIES AS THEY PROVIDE CARE TO THEIR PATIENTS AND COMMUNITIES THEY SERVE. DURING THE PANDEMIC, THESE COMPLEXITIES ROSE EXPONENTIALLY. THIS WAS A RESULT OF THE RAPIDLY CHANGING POLICIES AND REGULATIONS THAT WERE ENACTED DURING THE FEDERAL AND STATE PUBLIC HEALTH EMERGENCIES (PHE). THESE REGULATORY CHANGES WERE DESIGNED TO PROVIDE THE NECESSARY FLEXIBILITIES AND WAIVERS (LIFTING OF RESTRICTIONS/LIMITATIONS) TO (1) ALLOW PROVIDERS TO RAPIDLY DEPLOY COVID MITIGATION STRATEGIES, (2) STILL PROVIDE ESSENTIAL MEDICAL SERVICES UNDER EXTREME CONDITIONS, AND (3) MINIMIZE LIABILITY. HOWEVER, BECAUSE MANY, IF NOT ALL THE REGULATORY CHANGES WERE NEVER TESTED BEFORE AND BECAUSE THEY WERE SO RAPIDLY DEPLOYED, CHCS FOUND THEMSELVES IN CHAOTIC AND UNCHARTED WATERS ON MULTIPLE LEVELS. MANY OF THE REGULATORY CHANGES WERE AMBIGUOUS. AT THE SAME TIME, TELEHEALTH AND TELEPHONIC COMMUNICATION SUDDENLY BECAME THE MAIN LINE OF COMMUNICATION FOR MOST PATIENTS AND THEIR CHC PROVIDERS. THIS WAS NEW AND FOREIGN TO THE HEALTHCARE INDUSTRY AND PATIENTS ALIKE. THE USE OF TELEHEALTH DID TAPER OFF IN 2021, BUT IT WAS STILL BEING USED BY MANY CHC PROVIDERS. IN ADDITION, MANY OF THE OUTREACH EFFORTS THAT WERE DEPLOYED DURING THE PEAK OF THE PANDEMIC WERE BEING UTILIZED. AS A RESULT OF THE RAPIDLY CHANGING HEALTHCARE REGULATORY LANDSCAPE COUPLED WITH THE WAY CARE WAS BEING DELIVERED, WE ENLISTED THE HELP OF LEGAL COUNSEL ON SEVERAL ISSUES TO ASSURE THAT CHC OPERATIONS, BOTH CLINICAL AND ADMINISTRATIVELY, REMAINED COMPLIANT WITH EXISTING AND NEW STATE AND FEDERAL REGULATIONS.CHC COMPENSATION & BENEFITS SURVEY: HAWAII'S CHCS ARE CONSTANTLY CHALLENGED WITH WORKFORCE SHORTAGES AND COMPETITION FROM OTHER ENTITIES WITHIN AND OUTSIDE OF THE HEALTHCARE SECTOR. THE PANDEMIC SERVED TO SIGNIFICANTLY WORSEN THESE WORKFORCE CHALLENGES. TO ASSIST THE CHCS IN THEIR QUEST TO REMAIN COMPETITIVE, WE ENGAGED WITH THE THIRD PARTY HUMAN RESOURCES CONSULTANT TO CONDUCT A CHC COMPENSATION AND BENEFIT SURVEY. THE AGGREGATED, DE-IDENTIFIED RESULTS OF THE SURVEY WERE SHARED WITH THE PARTICIPATING CHCS AS A TOOL IN ASSESSING THEIR SALARY RANGES.