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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 Alliancewww.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
764.0
670.8
668.4
603.8
0
100
200
300
400
500
600
700
800
900
1000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Age
-Adj
ust
ed D
eath
Ra
te p
er 1
00,0
00 p
opul
atio
nAll Causes - Age-Adjusted Death RateHawaii County Compared to the State
Chart: North Hawaii Outcomes Project - April 2011 Source: Office of Health Status Monitoring, 1999-2011
Hawaii County
State
153.4
Hawaii CountyHawaii County
93.4HP 2020 - 100.8
124.3
State 77.6
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
180.0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Age
-adj
uste
d ra
te p
er 1
00,0
00 p
opul
atio
nCoronary Heart Disease - Death RatesHawaii County compared to State (1999-2009)
Chart: North Hawaii Outcomes Project - May 27, 2011 Source: Hawaii State Department of Health - Office of Health Status Monitoring 1999 - 2009
75.5
Hawaii County
42.7
61.9
State39.1
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Ag
e-a
dju
ste
d r
ate
pe
r 10
0,0
00
po
pu
lati
on
Chart: North Hawaii Outcomes Project - May 31, 2011
Cerebrovascular(Stroke) Disease - Death RatesHawaii County compared to State (1999-2009)
Source: Department of Health - Office of Health Status Monitoring, 1999 - 2009
Healthy People 2020 Target - (33.8)
172.7
156.3151.9
140.7
0
20
40
60
80
100
120
140
160
180
200
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Dea
ths
per 1
00,0
00 a
ge-a
djus
ted
popu
latio
nOverall Cancer - Death Rate
Hawaii County Compared to the State - (1999-2009)
Chart: North Hawaii Outcomes Project - May 31, 2011 Source: Office of Health Status Monitoring, 1999-2009
State
Hawaii CountyHealthy People 2020 Target - 160.6
Institute of MedicineFramework for Population Health
Social and Physical Environment
Social, Economic & Physical Environment
(Socioeconomic Determinants)
Health-Related Behaviors
Health Systems
(Access to Care)
Population
Health Outcomes
9.8%
5.6%
8.3% 8.7%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
Hawaii County City & County of Honolulu Maui County Kauai County
Average Percent Unemployed 2010
Chart: North Hawaii Outcomes Project - January 2012 Source: American Community Survey 2010
$22,713
$28,629 $27,767
$24,774
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
Hawaii County City & County of Honolulu Maui County Kauai County
Per Capita Income - 2010
Chart: North Hawaii Outcomes Project - October 2011 Source: U.S. Census, ACS 2010
35.0%
21.9%
28.4% 26.5%State - 24.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Hawaii County City & County of Honolulu Kauai County Maui County
Population at or Below 200% Federal Poverty - 2010
Chart: North Hawaii Outcomes Project - October 2010 Source: U.S. Census Bureau, ACS 2010
25.0%
18.0%
12.5%11.0%
State - 13.9%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Hawaii County Maui County Kauai County C & C of Honolulu
Youth Below 100% Federal Poverty Level 2010
Chart: North Hawaii Outcomes Project - October 2011 Source: U.S. Census, ACS 2010
21.2% 21.9%
25.2%
28.4%
State - 22.5%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Hawaii County City & County of Honolulu Maui County Kauai County
Chart: North Hawaii Outcomes Project - October 12, 2011 Source: U.S. Census Bureau, ACS 2010
Population 25+ years With Some College, but no Degree (2010)
0
100
200
300
400
500
600
700
800
1994 1995 1996 1997 1998 1999 2000 2001 2002 *2003 *2004 *2005
Ag
e A
dju
ste
d D
ea
th r
ate
pe
r 1
00
,00
0 p
op
ula
tio
n
Less than 12 yrs of school 12 yrs of school 13 yrs of school or more
13th Year of School Associated with Lower Death Rates
U.S. Age-adjusted per persons 24 - 65 years of age
Chart: North Hawaii Outcomes Project - February 2010 Source: Health, United States 2008
*Reporting areas that have adopted the 2003 revision of the U.S. Standard Certificate of Death are excluded because educational attainment data based on 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.
Health Disparities - Hawaii CountyHealth Related Behaviors- 2010
Behavior State Hawaii County
Smoking 15% 20%Obesity 26.3 23.1
Binge Drinking 17.9 17.7
Adults no leisure physical activity
19.2 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:
2.1
3.4
2.22.4
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Hawaii County City & County Of Honolulu
Maui County Kauai County
Lic
en
sed
ph
ysic
ian
s p
er 1
,000 p
op
ula
tio
n
Licensed Physicians with a Hawaii Primary Address per 1,000 Population by County (2011)
Chart: North Hawaii Outcomes Project - September 2011 Source: Numerator from Department of Commerce and Consumer Affairs –July 27, 2011
*Denominator from U.S. Census 2010 .may or may not be active** Licensed physicians
Hawaii Island Increasing Provider Shortages
2010 2012 2014 2016 2018 20200
100
200
300
400
500
600
700
SupplyDemand
157331
Source : JABSOM Workforce Study, Kelly Withy
What Healthcare ProvidersAre 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
SupportsGrowing Our Primary Care Workforce
Family Practice Residency Program in HiloGrowing effective use of mid-level providersImproving 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 CENTERCurrent 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
• Health Workforce shortages are a Barrier to productivity & economic growth
Opportunity• Growing the health
workforce is an OPPORTUNITY to stimulate economy
• 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 # of Employees
1. Government 12,000
2. Retail trade 8,000
3. Healthcare/social assistance 6,900
4. Accommodations 5,500
5. Food and beverage services 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/worktypecode/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
1. 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
http://www.healthdegrees.com/10-hot-careers-in-the-health-industry
Top Ten (10) Fastest Growing
Allied Health Careers1. Medical Assistants:
2. Cardiovascular Technologists
3. Diagnostic Medical Sonographers:
4. Physician Assistants:
5. Respiratory Therapists and Technicians:
6. Athletic Trainers:
7. Surgical Technologists:
8. Clinical Laboratory Technologists:
9. Medical and Health Services Managers:
10. Dietitians and Nutritionists:
Source: Bureau of labor statistics 8/2011
What additional training for existing professionals?
• Leadership & Change Management– Mentoring
• 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 CouncilTo 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:[email protected]
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
• 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
www.nhop.org
www.hawaiihealthcarealliance.org
Tools for policy makers
9.8%
5.6%
8.3% 8.7%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
Hawaii County City & County of Honolulu Maui County Kauai County
Average Percent Unemployed 2010
Chart: North Hawaii Outcomes Project - January 2012 Source: American Community Survey 2010
35.0%
21.9%
28.4% 26.5%State - 24.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Hawaii County City & County of Honolulu Kauai County Maui County
Population at or Below 200% Federal Poverty - 2010
Chart: North Hawaii Outcomes Project - October 2010 Source: U.S. Census Bureau, ACS 2010