Reading Room Blog
Op-eds, policy briefs, research notes and news from the Task Force on Hawaiʻi payment reform, provider networks, workforce and prior authorization.
All articles
- One Health Hawaiʻi: What the Evidence Shows and What the Applicants Must Prove — The evidence on hospital-physician integration points to higher costs and inconsistent quality gains. Hawaiʻi should not approve common control between HMSA and HPH without proof of a public benefit.
- Hawaiʻi’s Longevity Is Predictable: Why Population Health Should Not Be Mistaken for Healthcare Performance — Hawaiʻi Life Expectancy and Healthcare Rankings | Task Force Report { "@context": "https://schema.org", "@type": "Report", "headline": "Hawaiʻi’s Longevity Is Predictable", "alternativeHeadline": "Why
- Buckle Up — Medicaid is changing. New rural health money is arriving on a clock. The state already says the Big Island blew them away. Four things every clinician can do now, and why this island should lead.
- Twenty-Five Years, Then Laser-Focused — People tried for 25 years to stop Hawaiʻi from taxing doctors for Medicare and Medicaid care. It passed when we got narrow, got together, and stayed visible. Here is the method.
- You're Not Alone This Time — When a storm hit Kaʻū, doctors whose own practices were struggling organized care within days. Local doctors, local aunties, and a county partnership. The people with the least to spare showed up.
- They Know What They Lack — On Oʻahu, we read the state's numbers and move on. On Hawaiʻi Island, people pick up the list and start calling names. 783 listings, 194 practicing clinicians, and an island that checks its own count.
- Resources That Don't Go Together — A Hilo radiologist asked for breast cancer data on July 12. He had it on the 14th. By September, an independent practice and the public hospital had a tentative plan to keep screening in East Hawaiʻi.
- What One Health Hawaiʻi Has Not Yet Shown — Most of One Health Hawaiʻi’s promised benefits do not require integration. Before approval, HMSA and HPH should show what common governance uniquely adds and how it will expand care.
- Hawaiʻi Island Has Enough Mammography Machines. What It Does Not Have Is a Way to Reach Them. — Hawaiʻi Island has more certified mammography facilities per resident than Oʻahu. It has 28 times fewer per square mile. Five facilities, three towns, 4,028 square miles. The shortage is reach.
- Invisible Twice: The Behavioral Health Network Hawaiʻi Never Measured — The State's own quality review excluded seriously mentally ill patients from its network calculations. We measured what was never counted: the beds, the clinicians, and the arithmetic underneath Hawaiʻi's homelessness c…
- One Health Hawaiʻi and the Medical Loss Ratio Question — One Health Hawaiʻi should be reviewed by economic substance, not label, because HMSA’s MLR treatment may show whether insurer-provider payments remain independent or stay inside one enterprise.
- Trust Is Not Evidence | One Health Hawaiʻi, HMSA, HPH, and the Burden of Proof — Trust is not evidence. One Health Hawaiʻi’s backers should prove, with independent evidence, that consolidation will help patients instead of raising costs.
- Hawaii’s Health Insurers Began Differently. Are They Ending Up in the Same Place? — Hawaiʻi's health insurers were founded with different missions. Their governance and conduct are converging. Here is the record.
- Meet Your New Healthcare Provider — When insurance policies push Hawaiʻi’s doctors out, patients are left with an algorithm. Primary care is not a substitute input.
- Primary Care Is Not a Substitutable Input — Hawaiʻi's largest insurers, and now an HMSA partner, are treating primary care as a substitutable input that AI can replace. The HHTF lays out the record and says the relationship is not for sale
- Policy Brief: Payer Administrative Responsibility in Prior Authorization — Attempts to limit prior authorization quantity and scope have faced enormous push back. This brief puts forth a different path - shift administrative burden to the companies who create it.
- Medical Debt Is Not the Disease; It Is a Symptom — Hawaiʻi's medical debt relief bill helps 50,000 families. But debt is the symptom, not the disease. The largest study of this model found it doesn't improve health or finances. Treat both.
- Insurance Is Not Access: Hawaiʻi Needs to Stop Counting Healthcare It Cannot Deliver — You have insurance. Your doctor refers you to a specialist. The specialist is not on your island. The appointment is on Oʻahu. The airfare is yours. The missed work is yours.
- Redefining Corporate Insurance Conduct as Healthcare’s Unpoliced Engine of Inefficiency, Deception, and Wrongdoing — Hawaiʻi has 12,688 physicians licensed in the state. Only 3,647 are providing active patient care, representing 3,044 full-time-equivalent physicians. Official workforce modeling places the statewide
- Small Clinics, Broad-Scope Primary Care, and the Real Measure of Efficiency — Small clinics may look less efficient, but broad-scope primary care can lower avoidable use and total cost when paid and supported properly.
- Hawaiʻi Medicaid Community Engagement, the Informal Workforce, and a Small Business Compliance Transition Plan — Publication Summary Hawaiʻi should implement federal Medicaid community engagement requirements with flexible documentation for informal work and a time-limited small business compliance transition pr
- The Primary Care Capacity Test A Policy Framework for Measuring Real Access Before Major Payment, Network, or Merger Changes in Hawaiʻi — Executive Summary Hawaiʻi should not approve major payment, contract, network, or merger-related changes unless those changes preserve or improve real primary care capacity. The state’s access problem
- When Restricted Utilization Becomes the Baseline: Why Health Care Spending and Workforce Models Need Access-Constraint Review — Historical utilization and spending can understate true need when access is constrained. Hawaiʻi should test for restricted access before using current use as a baseline.
- Physician Workforce Collapse in Hawaiʻi: Structural Causes and Policy Remedies — Hawaiʻi's physician workforce is short 833 FTE when geography counts. A clinician-led brief on the structural causes — GET, Medicare GPCI, housing — and five policy remedies.
- Prior Authorization Is Not a Clinical Tool — 81.7% of denied prior authorization appeals that reach review get overturned. More than four out of five patients who appeal prior authorization denials are successful. This high reversal rate indicat
- After Payment Transformation: The Fee-for-Service and Capitation Crossroads — Primary care payment reform is now caught between two partial solutions. One tries to improve fee-for-service by paying for work it historically ignored. The other tries to move away from fee-for-serv
- When Provider Contracts Become Health Policy — Most patients never see the contracts between insurers and clinics. Yet those contracts help decide whether a clinic can hire staff, keep panels open, answer patient messages, remain in-network, or su
- Questions for HMSA After “Shaping Hawaiʻi’s Healthcare Future” — HMSA’s leaders spoke with members of the Hawaiʻi Medical Association during “Conversations at HMA” about the future of health care in Hawaiʻi and the end of Payment Transformation. The conversation wa
- The Rise and Fall of HMSA Payment Transformation — HMSA’s Payment Transformation was Hawaiʻi’s major primary care payment experiment from roughly 2016 to 2026. It began with an appealing promise: move away from fee-for-service, pay for value, support
- Geography Is Not a Billing Code — While the system attributes this to geography, it is fundamentally a pricing issue. This scenario occurs frequently in Hawaiʻi: a patient on Kauaʻi is referred to an endocrinologist, but none are avai
- You Are 644 Doctors Short and Getting Shorter — Hawaiʻi does not have a physician pipeline problem. It has a retention problem it has been misdiagnosing for decades. What the Numbers Actually Show Of the 12,688 physicians licensed in Hawaiʻi, only
- The Directory Is Lying to You — What ghost networks actually cost Hawaiʻi patients and why no one is held accountable. You have insurance. You open your plan's provider directory and see dozens of physicians near your zip code. You
- Unequal Bargaining Power in Healthcare: Lessons from the Nitta Ruling — The recent Nitta ruling highlights the significant imbalance in Hawaii's healthcare contracting system. In this case, physicians argued that the standardized contracts from HMSA were unfair and that t
- Hawaiʻi Cannot Recruit Its Way Out of System Instability — Hawaiʻi’s healthcare crisis is frequently described as a workforce shortage. The most recent statewide physician workforce analysis estimates that Hawaiʻi faces a deficit of more than 800 physicians w
- The Price You Don’t See: How Pharmacy Benefit Managers Shape Hawai‘i’s Healthcare Costs — By David Isei , Executive Director, Hawai‘i Healthcare Task Force Editor’s Note: This article is part of the Task Force’s series on the economic factors affecting Hawai‘i’s healthcare access. Executiv
- HCR 137 & Hawaiʻi's Clean Claims Statute: Why Timely Payment Matters — Hawaiʻi already requires timely payment of clean health care claims under HRS § 431:13-108. The House adopted the companion HR 129 in final form in April 2026; HCR 137 was not finally adopted.
- Nitta v. HMSA: A Turning Point for Hawaii's Healthcare Providers — A legal challenge exposes how one-sided contract terms and restrictive arbitration clauses threaten Hawaii's provider workforce and patient access, drawing high-profile support and prompting calls for legislative action.