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Hawaiʻi Healthcare Shake-Up: Insurer and Hospitals Unite
25 Feb
Summary
- HMSA and Hawaiʻi Pacific Health propose a new system called One Health.
- The plan aims to reduce rising healthcare costs and insurance premiums.
- Concerns exist about the impact on vulnerable patients and existing services.
Lawmakers in Hawaiʻi are examining a significant proposal to reshape the state's healthcare landscape, introduced by HMSA, the largest health insurer, and Hawaiʻi Pacific Health, a major hospital network. This initiative, dubbed One Health, seeks to address the ongoing healthcare crisis by creating a new umbrella organization.
Proponents, including HMSA CEO Dr. Mark Mugiishi and Hawaiʻi Pacific Health CEO Ray Vara, assert that the current healthcare system is unsustainable. They propose a major shift towards value-based care and risk-sharing models, aiming to decrease escalating health insurance premiums and overall medical expenses.
In 2025, Hawaiʻi Pacific Health reported an operating loss, and all health systems in the state experienced financial difficulties. HMSA also reported a substantial operating loss of $117.4 million in 2024, despite high member premiums, highlighting the financial strain on providers.
The One Health proposal includes a new data-sharing system to reduce administrative burdens for doctors and potentially lower costs through better care coordination, such as steering surgeries to less expensive centers. This move aims to foster greater trust and cooperation between insurers and providers.
Despite assurances that patients could still choose their doctors, concerns have been voiced by The Queen's Health Systems, fearing that profitable procedures might be siphoned off, potentially impacting the availability of less profitable but essential services like behavioral health.
The plan is currently undergoing regulatory review by the U.S. Department of Justice and state health officials. This scrutiny is essential as stakeholders weigh the potential benefits of cost reduction against worries about access to care and the financial stability of existing health services for Hawaiʻi residents.
