Aloha from our Chapter President, Jen Chahanovich, FACHE

Aloha,
I attended the 2012 Congress on Healthcare Leadership in March – it was inspiring and motivating. More than 4,500 healthcare executives attended Congress. The buzz words this year from attendees were ACO and PHO.  

The tradition for the past six years is for the Chapter President and the Regent to host a dinner for our members during Congress. This year we had a great dinner and fellowship with a group from Hawai‘i and Guam.

I was honored this year at Congress to volunteer in the Career Center as a Career Counselor – more than 900 Congress attendees went through the Career Center for Resume Review and Career Counseling services. I am happy to report there are so many qualified early careerists ready to take on the challenging careers in healthcare.

The goals for 2012 for our Chapter include refocusing our efforts on supporting our members in their advancement to Fellow status while simultaneously increasing our membership enrollment and participation in educational meetings. The Chapter plans to support its members by having advancement seminars as well as having study guides for members to use.

I hope to see you soon at our next educational meeting planned for July 11 at 7:00 a.m. Please do not hesitate to contact me with any questions or comments regarding our chapter activities at jen.chahanovich@palimomi.org.

Jen H. Chahanovich
485-4434

Get to Know Your Regent: Coral Andrews, FACHE

By MAJ Charlotte L. Hildebrand

What are your goals for your new role as the Health Insurance Exchange Executive? My goals are to enable the mission of the Hawaii Health Connector in creating a marketplace for small businesses and uninsured individuals to access affordable health coverage; to reach out to varied groups of stakeholders who want to learn about and engage in supporting the work of the Connector; and to foster partnerships between the public and private sector in areas that support the sustainability of Hawaii’s healthcare delivery system.

How has ACHE contributed to your success as a healthcare executive? ACHE has been a steady and valued resource to me throughout all stages of my career. Whether or not I was in need of information to foster skill development as a mid-level manager or focused on honing my skills at the executive level, I found that I could access resources and/or individuals who could help me. Lifelong learning is essential to maintaining relevance in this ever-changing healthcare environment. As a core value, leaders should invest in remaining relevant.

What do you expect will be the new challenges for healthcare executives in the region? I think we are already seeing new challenges emerging. Examples include adapting new business strategies that incorporate the  redesigned models of care following ACA; preparing for the expansion of Medicaid concurrently with the shifting base of revenue streams; and continuing to deliver a high level of service to the customer, but more efficiently.

What additional skills will healthcare executives need to meet these challenges? The skills should include: adaptability in new situations, success in diverse leadership experiences, be a systems thinker, and understand the imperative of keeping the customer at the center of the business strategy and design.

Throughout your career, what has been your most rewarding experience? My most rewarding career experience…that’s tough. There are so many. The one that stands out in my mind was the opportunity to contribute to the Southeast Asia tsunami relief effort in 2004. The diversity of the stakeholders involved in the effort, whether governmental, private sector, nonprofit, NGO, intergovernmental, etc., there was one common mission of helping those who were affected by the tragedy. I find parallels in this to the change that we are undergoing in our healthcare delivery system following the passage of federal health reform. It necessitates that we develop new ways of looking at problems, that we redefine our partnerships, that we work collectively to stay focused on a common mission for the overall goal of helping others.

What attracted you to the healthcare management field given your background in nursing? Transitioning from direct care service to healthcare management seemed very natural. I was attracted to the opportunity to develop and influence policy decisions in order to effect change in a broader way. By starting out my career at the point-of-service, I have found that I am better able to anticipate what impact a policy decision may have on components of the healthcare system. 

How does ACHE Hawai’i Pacific Chapter help you and other healthcare executives on the island address professional challenges? I’ve had the privilege of participating in ACHE events in Hawaii since it convened as Elua Alii in the early ‘90s. For me, I have found that the Chapter provides a networking forum to draw support and knowledge from colleagues in the field. Getting out-and-about and talking to others in the healthcare field is an important part of ongoing professional development. We need to continue to make efforts to outreach to our Neighbor Island and Guam members to insure that they, too, have access to the information needed to foster professional growth.
 

Ready to Become a FACHE?

By Joanne Reid, FACHE and Charlotte Hildebrand

Are you interested in advancing to ACHE Fellow this year? We have more than 100 members who are in the window for advancement; that is more than half of our Chapter! We are committed to supporting your efforts to take the next step in your ACHE membership and are gathering a group of those who would be interested in an advancement seminar, Board of Governors exam study group, and/or individualized help with completing the Fellow Application. We want to take an organic approach tailored to your needs.

Requirements for advancement include:
* Be in a healthcare management position and have five years of healthcare management experience.
* Have three years tenure as an ACHE Member, Faculty Associate or International Associate (ACHE student tenure does not count toward meeting the FACHE requirements).
* Earn 40 hours of continuing education, at least 12 of which are ACHE Face-to-Face Education hours during the five years before you become a Fellow. The remaining 28 hours can be ACHE Qualified Education hours. * Participate in two healthcare and two community/civic activities during the three years before you become a Fellow.
* Masters or other post-baccalaureate degree. (Submit a copy of your degree.)
* Current healthcare management position and at least two years of healthcare management experience. (Submit organizational chart, job description and resume.)
* Include the names of your three references on your application. (The completed reference forms can be submitted by your references after you submit an application.)
* Successfully pass the Board of Governors Exam

Many resources exist to assist advancement through the College to include:
* Chapter Advancement Seminar 6/7 at 6:30 PM at HAH Headquarters, Honolulu
* Chapter-Sponsored, Loaner ACHE BOG Self Study 4 Book Sets (worth $240)
* Exam online community (on-going)
* Advancement webinars (6/7, 9/6, 12/6)
* Exam review course (onsite, Chicago, biannually): $1,290
* Online BOG tutorial 8/13 - 11/2: $495

Additionally, if you register to take the BOG exam by 6/30/12, $200 of the $250 fee is waived. Your scores are good for three years as you complete the remaining requirements for advancement. If your interest is piqued, please contact either Joanne Reid at reidj1@ah.org or MAJ Charlotte Hildebrand at charlotte.hildebrand@us.army.mil for inclusion in local chapter efforts designed to help you advance. Five members of our Chapter became Fellows this year and our strategic goal for the chapter is to advance six more next year!

Advancement Seminar: 7 June, 6:00 p.m.-7:30 p.m.

The Advancement Seminar is scheduled for Thursday, June 7, 2012 from 6:00 p.m. - 7:30 p.m. at the Board Room in the Queens Conference Center at

 510 S. Beretania St.
 Honolulu, HI 96813

Guests may park in the structures for Physician Office Building I or II on Lusitana Street. Parking is also available in the Miller St. structure, but Queens asks that we use this as a last resort, as they try to reserve this structure for outpatients and inpatient visitors.

If you are interested, please contact either Joanne Reid at reidj1@ah.org to RSVP for the seminar and for ongoing inclusion in local chapter efforts designed to help you advance. We hope to see you there!

Welcome New Members

The Hawai’I- Pacific Chapter of ACHE would like to recognize our new Chapter Members who have joined since January 1, 2012:

Nancy Wilson, RN- Koloa, HI
Karen Seth- Honolulu, HI
Maureen Flannery- Kailua, HI
Travis Clegg- Kailua, HI
Justin R. Lumen- Pearl City, HI Student Associate
Richard Giardina- Aiea, HI
Derek Akiyoshi- Honolulu, HI
Claire P. Santos, RN- Honolulu, HI Student Associate
Jack W. Taitague- Barrigada, GU
Wendi Barber, CPA- Kailua, HI
Garan K. Ito- Honolulu, HI
Nemy Membrere- Waipahu, HI
Sophia T. Mesa, RN- GU Student Associate
John Ilao- Tamuning, GU
Virginia Walker- Honolulu, HI
Kristopher Dung- Kapolei, HI
Dianna Geck, RN- Honolulu, HI
LT George H. Sterns- Honolulu, HI
Selma Yamamoto, PharmD- Honolulu, HI Student Associate
Monica Adams- Hilo, HI
John Sarinas- Honolulu, HI
Nancy B. Valla, RN- Honolulu, HI
LT Neeta Darity- Santa Rita, GU Student Associate
Vance Mizuba- Honolulu, HI Student Associate
CAPT Steven Medina, FACHE- Carlsbad, CA Fellow
Capt Hiram J. Ortiz- Honolulu, HI
Orianna A. Skomoroch- Lihue, HI

ACHE Fellow at the Forefront of Historic Change in Guam

By LT Vince Deguzman, BCPS, CGP, MBA, Naval Hospital Guam

For more than a century, Navy Medicine has maintained a strong impact in the island of Guam. From the arrival of the first Medical Officer of the USS Yosemite in 1899 to the construction of the current Naval Hospital after World War II, Navy Medicine has delivered quality healthcare to military beneficiaries in the region and the community. In late 2013, the proud tradition of quality service and positive relations with the local population of Guam will continue in a new state-of-the-art facility that will replace the current hospital. 

The new Naval Hospital Guam will be built at a cost of $158 million and will replace the current facility built in 1954. The 282,000-square-foot facility replacement hospital will have 42 inpatient beds beautifully situated on the cliffs overlooking Agana and the Philippine Sea. The project includes a six-bed intensive care unit and the added capability of magnetic resonance imaging (MRI). Designed to be eco-friendly, the building will achieve the requirements for Leadership in Energy and Environmental Design (LEED) Silver certification when completed. 

At the forefront of the military construction is Lieutenant Commander (LCDR) Daren Verhulst, FACHE, who is a healthcare administrator by trade. As the Senior Health Facility Planner for the Military Construction Project in Naval Hospital Guam, he was directly involved in the pre-planning process and building design. He serves as Navy Medicine’s on-site customer representative during construction of the new facility, and is responsible for the initial outfitting and transition activities for the new facility. “My job is to help deliver a modern replacement hospital that will meet the medical facility needs of our patient population today and in the future, and allow Navy Medicine to continue to provide the full spectrum of patient and family centered medical and surgical care to our beneficiaries,” stated LCDR Verhulst. He has been in the Navy for 22 years and has been an ACHE Fellow for four years. 

 

HFMA Hawaii Chapter 2012 Annual Conference “Believe to Achieve”

By LTC Tanya A. Peacock, FACHE

The Hawaii chapter of the Healthcare Financial Management Association held their annual conference in Honolulu, HI. Titled “Believe to Achieve,” this conference focused on current issues in healthcare financing from a local perspective. ACHE participants received CEUs for attendance. The purpose of this article is to summarize the first two General Sessions of the conference to share healthcare knowledge with the Hawaii-Pacific Chapter of ACHE.

Frances Miller, JD, led the first General Session with her presentation on “Value for Money: Cost containment in an uncertain era.” She began her presentation with a discussion about reform and the current state of healthcare spending in the United States. The statistics regarding healthcare continue to be astounding. The United States is ranked #37 by the World Health organization. Eighteen percent of the population is uninsured, and the U.S. spent almost 18% of GDP on healthcare. (Defense spending is approximately 2%). Physician fees, scans and imaging, drug prices and hospital charges far exceed those of Canada and Europe. She postulates that healthcare prices are high in the United States due to the cost of drugs and devices, administrative overhead, the malpractice system, tighter regulations and technology.
Professor Miller tackled the subject of healthcare spending from the perspective of comparative effectiveness, personalized medicine, end of life care, and payment reforms. She suggests that these areas may be possibilities for cost containment.

Comparative effectiveness research examines the effectiveness of competing interventions. The Institute of Medicine estimates that sound scientific studies only support less than ½ of current treatment. Professor Miller cited the Dartmouth Atlas of Healthcare as a resource to analyze variations in treatment. The Dartmouth Atlas project has documented variations in the distribution of medical resources for over 20 years using Medicare data and can be found at http://www.dartmouthatlas.org/ Although the Patient Care Act specifically prohibits Medicare from making coverage decisions based solely on comparative effectiveness research, by emphasizing patient centered medicine and by using effectiveness data it is possible to provide better care at reduced costs. She cited Susan Dentzer’s article “Comparative Effectiveness: Coherent Health Care At Last?” in Health Affairs as an excellent overview of the topic http://content.healthaffairs.org/content/29/10/1756.full 

A second possible area for cost containment is personalized medicine. She highlighted that most prescription drugs are effective in only about 60% of patients. She cited a variety of treatments that are specific to an individual. For example, pharmacogenetics, (the way genes cause different drug responses) and Genetic testing (https://www.23andme.com/?gclid=CO2Z5cjq0K8CFQ2FhwodAxwiFw).
Another potential area for cost containment is end of life care. One–third of the Medicare budget is dedicated to end of life care. Although the average person would prefer to spend as much time in a home-like setting with pain control, over 55% of Medicare patients died in a hospital. Educating patients about advanced directives, medically futile treatment, and even palliative sedation is imperative. Although a controversial topic, she addressed patient assisted suicide as well. To date, Oregon, Washington, Montana, and Georgia have patient-assisted suicide laws. Opponents have argued that by legalizing patient assisted suicide, deaths will increase. Interestingly, only 1/5 of 1% of deaths in Oregon over the last 15 years was a result of Patient Assisted Suicide. 

Her final topic was payment reform. She cited numerous resources. The first was Pay for performance (P4P). Of particular interest was the data compiled by the Leapfrog group. The Leapfrog group focuses on reducing preventable medical mistakes, encourages transparency and rewards hospitals for quality, safety and affordability. Patient safety ratings for hospitals may be found at http://www.leapfroggroup.org/ Additional P4P resources can be found on the AHRQ website. Other reforms include Accountable care organizations, Global budgeting, and the Independent Payment Advisory Board http://www.cbpp.org/cms/index.cfm?fa=view&id=3702. She concluded in an upbeat manner with a quote from Alexis de Tocqueville about American progress “In the United States, things move from the impossible to the inevitable, never stopping at the probable.”

The second General session “Best practices in Adapting to local regulations, market and trends: A Panel Discussion” consisted of the following local leaders in healthcare: Dr. Ginny Pressler from Hawaii Pacific Health; Coral Andrews, Hawaii Connect Coordinator; Dr. Thomas Tsang, Governor’s Health transformation office; and Hilton Raethel, Hawaii Medical Service Association (Blue Cross Blue Shield of Hawaii).
The patient population of Hawaii is unique. Hawaii has an overall healthier population, lower rate of uninsured, and lower premium costs than the mainland states and attributes these figures to the Hawaii Prepaid Health Care Act. Hawaii also does not have a provider tax, however patients in acute facilities await placement in lower levels of care.

The most interesting initiative discussed by the panel members involved Hawaii State Act 205, otherwise known as the Hawaii Health Insurance Exchange Act. As part of the Federal Patient Protection and Affordable Care Act, the state of Hawaii will establish a health insurance exchange to connect buyers and sellers of health and dental insurance. It will also facilitate the sale of federally-qualified plans. The intent is to design a customer relationship management web-portal. Consumers would input personal information and then they will be provided with a menu of available health plans. To determine eligibility for health coverage, consumers would be required to meet certain criteria. For example, a consumer would consent to a criminal background check and an income, assets, and assessment verification by the IRS. The state received a federal grant in order to implement the exchange by 1 January 2014. More information can be found at http://www.hawaiihealthconnector.com/

In summary, I found this conference to be extremely informative. Because I recently arrived from the mainland, I found this conference especially helpful in highlighting healthcare issues that are specific to Hawaii. I was also pleased to note that the lunch presentation was given by LTC Dwight Kellicut, MD, a vascular surgeon from Tripler Army Medical Center, who provided an excellent overview of Army medicine from a historical perspective and sent a positive message about his two deployments to Iraq. 

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