SCR159.DOC

WHEREAS, the health care industry, nationally and statewide, is undergoing tremendous reform and changes prompted by the passage of the federal Patient Protection and Affordable Care Act; and

WHEREAS, the development of accountable care organizations, which are composed of doctors, hospitals, and other health care providers, are included in these reforms and changes; and

WHEREAS, accountable care organizations are formed to provide coordinated, high quality primary care to patients while avoiding unnecessary duplication of services and preventing unnecessary hospitalizations; and

WHEREAS, the development of direct primary care or "concierge medicine," which is the practice of financing direct primary care through direct payments by consumers, usually in the form of monthly fees, and the billing of patient health insurance plans, has also grown nationally and in this State; and

WHEREAS, currently, 238,000 Hawaii residents, constituting 18.7 per cent of Hawaii's total population, are aged sixty or older, and by 2030, this age group is projected to constitute more than one-fourth, or 27.4 per cent, of the State's population; and

WHEREAS, while Hawaii's population is expected to increase by 21 per cent between 2000 and 2030, the number of people sixty years or older is expected to increase by 93.8 per cent and the number of people eighty-five years or older is expected to increase by 174.7 per cent during the same period; and

WHEREAS, the large aging population is having, and will continue to have, a major impact on the organization and delivery of health care, with a shift from acute to chronic illnesses, such as heart disease, cancer, stroke, chronic lower respiratory diseases, Alzheimer’s disease, and diabetes; and

WHEREAS, Medicare is the national health insurance program that offers coverage for outpatient health care services, such as primary care doctor visits and certain preventative services, for the majority of the population aged sixty-five or older, or younger than age sixty-five with a qualifying disability or illness; and

WHEREAS, as of December 2015, over 338,000 individuals were enrolled in the State's Medicaid program and Children's Health Insurance Program; and

WHEREAS, enrollees of Hawaii's Medicaid program and Children's Health Insurance Program receive access to health and medical services, including critical primary and acute care services, through managed care plans contracted by the State's Med-QUEST Division; and

WHEREAS, the Department of Commerce and Consumer Affairs performs a variety of functions for the benefit of consumers, businesses, and the general population of the State; and

WHEREAS, the department's Insurance Division is responsible for overseeing the insurance industry in the State and ensuring that consumers are provided with insurance services, including services relating to health care, that meet acceptable standards of quality, equity, and dependability at fair rates; and

WHEREAS, the Insurance Division is uniquely positioned to help identify problems and devise improvements to the delivery of health care in the State; now, therefore,

BE IT RESOLVED by the Senate of the Twenty-eighth Legislature of the State of Hawaii, Regular Session of 2016, the House of Representatives concurring, that the Insurance Division of the Department of Commerce and Consumer Affairs is requested to conduct a survey of the medical professional community that identifies the extent to which:

(1) Accountable care organizations providing primary care services have developed in this State;

(2) Health care providers, in terms of their numbers and types, are participating in accountable care organizations;

(3) Patients, in terms of their numbers and the type of insurance plan covering them (i.e., private insurance, Medicare, or Medicaid), are being served and provided primary care through accountable care organizations;

(4) Direct primary care, or "concierge medicine," has penetrated the Hawaii healthcare marketplace;

(5) Health care providers, in terms of their numbers and types, are participating in direct primary care, or "concierge medicine," arrangements;

(6) Patients, in terms of their numbers and the type of insurance plan covering them (i.e., private insurance, Medicare, or Medicaid), are being served and provided primary care through direct primary care, or "concierge medicine," practices; and

(7) Accountable care organizations and direct primary care, or "concierge medicine," have either increased or decreased the access of Medicare or Medicaid patients to primary care services in the State; and

BE IT FURTHER RESOLVED that the Insurance Division is further requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days before the convening of the Regular Session of 2017; and

BE IT FURTHER RESOLVED that a certified copy of this Concurrent Resolution be transmitted to the Director of Commerce and Consumer Affairs and the Insurance Commissioner.

	OFFERED BY:	_____________________________

Report Title:

Accountable Care Organizations; Direct Primary Care

THE SENATE	S.C.R. NO.	159
TWENTY-EIGHTH LEGISLATURE, 2016
STATE OF HAWAII