SB1238.DOC

SECTION 1. The legislature finds that health disparities are most pronounced in Hawai‘i's rural Hawaiian communities with Native Hawaiians having higher morbidity and mortality rates for the leading causes of death, including diabetes, cardiovascular disease, and cancer as reported by the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11701), the Office of Hawaiian Affairs, Papa Ola Lokahi, department of health, University of Hawaii department of Native Hawaiian health; and the Moloka‘i General Hospital community health needs assessment (2013). The island of Moloka‘i, with a population 7,345 of which thirty-two per cent are of Native Hawaiian ancestry, is a federally designated medically underserved area with limited medical services and a shortage of healthcare providers. The proportion of residents living below poverty is 17.8 per cent, which is higher than the state proportion of 9.6 per cent. The proportion of households with cash public assistance income was double the state rate and unemployment rates are almost triple the state rate. These economic indicators are added challenges to a community with disproportionately higher rates of chronic diseases.

Evidence-based patient navigation services at Moloka‘i General Hospital were initiated in 2006, and resultant research successfully demonstrated statistically significant increases in cancer screening rates and effective coordination for cancer patients who are referred off-island to cancer treatment care that is unavailable on Moloka‘i.

In addition to Moloka‘i, Hana has a disproportionately high incidence of chronic diseases and mortality which are strongly associated with lifestyle and risk factors. Of all racial groups living in Hawai‘i, Native Hawaiians are the racial group with the highest proportion of risk factors leading to illness, disability, and premature death. Native Hawaiians experience high rates of circulatory disease and malignant tumors, particularly respiratory and digestive types. Native Hawaiians living in the Hana district have a high risk health profile resulting in the onset of preventable chronic health conditions and premature death. Sixty-two per cent of Hana Health patients have been identified as high risk for diabetes and hypertension. These statistics are exacerbated by high rates of unemployment, underemployment, and poverty.

The legislature further finds that this Act is consistent with the state senate policy known as Ola Lehulehu, or people and communities, to provide funding for Native Hawaiian health care communities. In the area of health care, the policy focuses on:

(1) Essential social and cultural determinants that improve health outcomes amongst Hawai‘i's indigenous population of Native Hawaiians as well as Pacific Islanders;

(2) Providing options to improved health care for keiki and residents in rural areas; and

(3) Supporting collaborative efforts to provide better dental care for keiki and adults.

Patient navigation services support access to timely care, and patient navigation is now being applied to manage other chronic disease care. The Queen's Medical Center also successfully utilizes cancer patient navigators and are applying this discipline to support patients with chronic disease.

The purpose of this Act is to make an appropriation for a patient navigation program based at Moloka‘i General Hospital.

SECTION 2. (a) There is established a two-year temporary patient navigation program based at Moloka‘i General Hospital.

(b) The patient navigation program shall:

(1) Collaborate with The Queen's Medical Center and ‘Ahahui O nā Kauka (Association of Native Hawaiian Physicians);

(2) Have a goal of improving medical outcomes for patients with chronic disease in rural medically underserved areas;

(3) Focus on increasing access to care for patients with chronic diseases in medically underserved rural communities;

(4) Demonstrate a cost effective protocol to increase timely access to quality medical care for patients with chronic disease in medically underserved rural communities;

(5) Use trained patient navigators of the Kukui Ahi program at Moloka‘i General Hospital and The Queen's Medical Center; and

(6) Apply the positive impact of patient navigation to improved access to medical services, reduce costly sequelae to untreated or undertreated chronic disease, reduce hospital admissions, and promote improved patient outcomes for patients with chronic disease in medically underserved rural communities.

(c) The results of the patient navigation program shall be shared with and tested by other rural Hawaiian communities such as Hana, island of Maui, that face similar challenges and may benefit from initiatives to improve access to health care that is too costly to establish and maintain within their home community.

SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $200,000 or so much thereof as may be necessary for fiscal year 2017-2018 and the same sum or so much thereof as may be necessary for fiscal year 2018-2019 for a two-year temporary patient navigation program based at Moloka‘i General Hospital.

The sums appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 4. This Act shall take effect on July 1, 2017.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	1238
TWENTY-NINTH LEGISLATURE, 2017
STATE OF HAWAII