Establishing Successful Patient-Centered Medical Homes in Rural Hawai'i: Three Strategies to Consider.

The challenges to healthcare delivery posed by Hawai'i's unique geography, physician shortages, and dispersed population are of particular importance in light of implementing the Affordable Care Act (ACA). This study draws on central goals laid out in the ACA - to decrease costs, increase access, and improve patient outcomes. The use of the Patient-Centered Medical Homes (PCMHs) is a care model that has the potential to meet all three goals. How to identify the most effective way to develop PCMHs in the specific context of Hawai'i is the focus of this study. To provide recommendations for effective PCMH formation, a qualitative review of previously compiled data from the Hawai'i/Pacific Basin Area Health Education Center (AHEC) and phone interviews with six primary care providers throughout the islands were conducted. The results broadly suggest three paths towards the effective implementation of PCMHs in Hawai'i. The first recommendation is to create a PCMH template or business model for physicians in order to ease the complexities of implementing such an elaborate system of care. The second two recommendations actually veer away from PCMH towards general interventions to increase care in rural Hawai'i. Thus, the second recommendation is to create a specific track for becoming a rural practitioner at the John A. Burns School of Medicine (JABSOM) to increase the retention of physicians in underserved areas. And the final recommendation is to increase utilization of telemedicine techniques to overcome physician shortages and geographic challenges by allowing rural physicians to network with specialists on neighbor islands. These three strategies are all possible to accomplish with commitment and could be implemented to benefit the providers and rural population of Hawai'i.