H.B. NO.














relating to health.





     SECTION 1.  The legislature finds that there has been a downward trend in the number of doctors seeking to practice in the primary care field, with most new medical graduates looking instead to pursue non-primary care specialties.  Research shows that one driving factor in the decrease in primary care practitioners is that primary care physicians are compensated significantly less than physicians in other medical specialties.  Research has also shown a correlation between enhanced spending on primary care with improved health outcomes for populations.  It is therefore in the public's interest to establish a collaborative group within the department of health to study the State's current spending on primary care and develop recommendations on ways to optimize spending in primary care.

     The purpose of this Act is to establish a task force known as the primary care payment reform collaborative to:

     (1)  Examine current levels of primary care spending in the State;

     (2)  Explore primary care spending mandates in other states;

     (3)  Examine alternative methods and models of enhancing primary care spending;

     (4)  Explore data collection issues related to understanding the State's primary care spending, including the capture of non-claims based primary care spending; and

     (5)  Generate recommendations to the legislature.

     SECTION 2.  (a)  There is established in the department of health a task force known as the primary care payment reform collaborative (collaborative).

     (b)  The director of health, who shall serve as the lead chairperson of the collaborative, shall appoint representatives from the following groups to participate in the collaborative:

     (1)  Primary care clinicians;

     (2)  Health care consumers;

     (3)  Experts in primary care contracting and payment;

     (4)  Independent practice associations;

     (5)  Third-party administrators;

     (6)  Employers that offer self-insured health benefit plans;

     (7)  The MedQuest division of the department of human services;

     (8)  The insurance division of the department of commerce and consumer affairs;

     (9)  Health care service plans and health insurers;

    (10)  Mental and behavioral health professionals;

    (11)  A statewide organization representing community clinics;

    (12)  A statewide organization representing hospitals and health systems;

    (13)  A statewide professional association for family physicians;

    (14)  A statewide professional association for physicians;

    (15)  A statewide professional association for primary care clinicians;

    (16)  The federal Centers for Medicare and Medicaid Services;

    (17)  The chair of the house committee on health, or a designee appointed by the speaker of the house;

    (18)  The chair of the senate committee on commerce, consumer protection, and health, or a designee appointed by the senate president; and

    (19)  Any person or entity whose participation the director of health determines would be helpful.

     (c)  The collaborative shall develop annual recommendations to the legislature to strengthen the primary care system in the State.  The collaborative shall examine and report on the following:

     (1)  Payment reform;

     (2)  Value-based care;

     (3)  Workforce and recruitment;

     (4)  Directing resources to support and expand primary care access;

     (5)  Increasing integrated care, including for women's and behavioral health;

     (6)  The current percentage of medical expenses in the State allocated to primary care;

     (7)  Primary care spending mandates in other states, including an assessment of methods for establishing a minimum primary care spending percentage or dollar amount;

     (8)  Data collection issues regarding primary spending in the State and its potential impact on data submitted to Hawaii's All Payer Claims Database; and

     (9)  Potential standard definitions of "primary care" that may be used in future related legislation.

     The collaborative may use data submitted to Hawaii's All Payer Claims Database to assist in the above examination.  The collaborative may request similar data from health insurers who are not required to submit claims data to Hawaii's All Payer Claims Database.  All data received by the collaborative shall be kept and maintained in the same confidential manner established by section 323D-18.5, Hawaii Revised Statutes, except as necessary to make recommendations and reports to the legislature.

     (d)  It is not the intent of the legislature to authorize a person or entity to engage in or conspire to engage in an activity that constitutes a per se violation of state or federal antitrust laws, including, but not limited to, an agreement among competing health care service plans or health insurance companies as to the price or specific level of payment for a health care service.

     (e)  For the purposes of this Act:

     "Primary care" means health care services delivered by clinicians specializing in family medicine, general internal medicine, or general pediatrics; or any other clinician whose practice primarily focuses on prevention, wellness, and treatment for common illnesses.

     "Primary care clinician" means a physician or other health professional licensed or certified in Hawaii whose clinical practice is in the area of primary care.

     (f)  The collaborative shall convene no later than September 16, 2019.

     (g)  The collaborative shall serve until it has accomplished the objectives of this Act or twenty days prior to the convening of the regular session of 2024, whichever occurs first.

     SECTION 3.  The collaborative shall submit a report of its findings and recommendations, including any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2020, and then successively no later than twenty days prior to the convening of the regular sessions of 2021, 2022, 2023, and 2024.

     SECTION 3.  This Act shall take effect on July 1, 2019.








Report Title:

Primary Care Spending; Payment Reform; Primary Care Payment Reform Collaborative



Establishes the Primary Care Payment Reform Collaborative task force in the Department of Health to examine issues related to primary care spending and data collection and to develop recommendations to the legislature.




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