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Reintegration of Public Health and Healthcare
Living Well Hawaii Project:
Innovative Healthcare for Adults with Serious Mental Illness
Integrating public health and primary care can both improve quality of care for a population and lower
health costs. Both components of the health system share a common goal of health improvement, have
similar funding streams and resources, and share many partnerships. If aligned, public health and primary
care working together could achieve lasting, substantial improvements in individual and population health in
the United States. State and territorial health agencies can make a significant impact in this area by
decoding the key elements for successful integration, which can then be shared with others to promote
further integration efforts, increase healthcare quality, lower costs, and improve overall population health.
The Living Well Hawaii project, a new partnership between a Federally Qualified Health Center (FQHC)
and the Hawaii Department of Health, will utilize a patient-centered healthcare model to improve health
outcomes for adults with severe mental illness.
BACKGROUND
It is well documented that adults with serious mental illness die, on average, 25 years earlier than the
general population. More than half of these premature deaths are due to comorbid medical conditions,
including obesity and chronic diseases such as diabetes, cardiovascular disease, and chronic obstructive
pulmonary disease. Past research and evaluation efforts in other states have shown that providing
access to culturally and linguistically sensitive, integrated, comprehensive,
collaborative care will improve the quality of care and health outcomes for
Aim of the Integration:
those served.
The Hawaii Department of Health’s Adult Mental Health Division (AMHD)
provides comprehensive, integrated mental health services to more than
12,000 adults with severe and persistent mental illness.1 Services are
provided in state-owned and -operated facilities (community mental health
centers located statewide and Hawaii State Hospital on Oahu) and through
state-developed contracts with private providers.2
To improve the physical
health status of people
with severe and
persistent mental illness
and chronic, comorbid
medical conditions.
OVERVIEW OF THE INTEGRATION EFFORT
Hawaii Gov. Neil Abercrombie and Hawaii Department of Health Director Loretta Fuddy, ACSW, MPH,
are committed to eliminating health disparities and improving the health of all Hawaii residents. When
Abercrombie took office, he developed a comprehensive plan to invest in education and rebuild Hawaii’s
economy. The “A New Day in Hawaii” plan includes a vision for patient-centered models of healthcare
that focus on prevention and address social determinants of health.
With strong support from Abercrombie, Fuddy brought together representatives from AMHD, the
Hawaii Primary Care Association, Kalihi-Palama Health Center, and Kalihi-Palama Community Mental
Health Center to create the Living Well Hawaii project. The Living Well Hawaii project will utilize a
collaborative integrated care management team to embed primary care services into Kalihi-Palama
© Association of State and Territorial Health Officials 2013
202-371-9090
2231 Crystal Drive, Ste 450, Arlington, VA
www.astho.org
Reintegration of Public Health and Healthcare
Community Mental Health Center. Adults with severe mental illness who choose to participate in the
Living Well Hawaii project will have access to a comprehensive and culturally informed array of services
delivered in a manner consistent with patient-centered medical home standards and expectations.
Kalihi-Palama, an urban, inner-city community, is home to approximately 63,820 residents, many of
whom are lower-income individuals of Asian, Native Hawaiian, and Pacific Islander descent.3 KalihiPalama Health Center is a private, nonprofit FQHC located in the heart of Kalihi-Palama. The Living Well
Hawaii project management team will consist of primary care staff employed by the Kalihi-Palama
Health Center and behavioral health staff from the Kalihi-Palama Community Mental Health Center, who
are employed by the department of health. The Kalihi-Palama Community Mental Health Center was
renovated to include a separate exam room where primary care services will be provided. The KalihiPalama Health Center hired an additional physician and nurse practitioner to support the project. The
physician and nurse practitioner will work four hours a day at the Community Mental Health Center
alongside a full time medical assistant to provide primary care services to patients in the program. The
program is voluntary and available to anyone with a targeted chronic condition (diabetes, obesity,
hyperlipidemia, tobacco use, and hypertension). The project will also target adults without a primary
care provider (PCP) or adults at risk for chronic conditions who rarely see a PCP. No additional funding
has been obtained for this project, but staff are actively looking for grants for funding sources.
Effective communication between PCPs and community mental health center providers has presented
difficulties in the past. Communication is key to ensure that prescribed medications are correctly
included in patient health records. Even with the use of electronic medical records, certain medications
can have duplicate entries or misinformation can be provided by the patient. The integrated care
management team aims to solve this problem through daily morning meetings and daily followup. While
time consuming, this is an important step toward care coordination that will hopefully alleviate the
miscommunication of prescribed medication, treatment history, and recommended follow-up
laboratory work and consultations.
RESULTS/BENEFITS
Services for the Living Well Hawaii project are scheduled to begin in August 2013, with current health
center patients included in this first pilot. Thirty-nine adults are currently enrolled, with the capacity to
serve up to 240 adults.4 Once the project begins, staff plan to evaluate participants’ specific health
indicators, including blood pressure, BMI, lipid profile, and Hemoglobin A1c. As previously mentioned,
the target population for this project is adults with serious or persistent mental illness who have also
been diagnosed with certain chronic conditions (i.e., diabetes, obesity, hyperlipidemia, tobacco use, and
hypertension) as well as those without a PCP or those at high risk of the previously stated chronic
diseases who rarely see their PCP. Staff plan to conduct surveys every six months to assess patients’
satisfaction and experience working with the care team, as well as their perception of care. Annually,
the team intends to analyze the access and service utilization data of enrollees, looking for changes in
their rates of PCP visits, behavioral health visits, ER visits, and hospitalizations.
INFRASTRUCTURE TO SUPPORT COLLABORATION AND SUSTAINABILITY
While the project has been well received by Hawaii’s primary care and public health communities, there
are still many unknowns about how the project will work once up and running. Project staff, however,
are fairly confident in the program’s success and have run simulations with patients currently enrolled at
both the Kalihi-Palama Community Mental Health Center and the FQHC to gain a general sense of how
© Association of State and Territorial Health Officials 2013
202-371-9090
2231 Crystal Drive, Ste 450, Arlington, VA
www.astho.org
Reintegration of Public Health and Healthcare
the program will work. To pilot-test brochures and patient enrollment videos, staff enlisted an advisory
group of consumers from the community mental health center and the FQHC who provided valuable
feedback that has increased program enrollment. Currently, AMHD and Kalihi-Palama Health Center
staff are discussing expansion of the project to Central Oahu Community Mental Health Center.
Abercrombie and Fuddy’s leadership has been crucial to the initation of the project. Fuddy supervised
an oversight group, and the Living Well Hawaii project manager reports directly to Lynn Fallin, deputy
director of behavioral health under Fuddy. “This outstanding collaboration between the Department of
Health, Primary Care Association, and Kalihi-Palama Health Center will lead the way toward improved
patient-centered integrated services that support health equity,” said Fuddy in a press release about the
project.4 By providing improved access to culturally sensitive, collaborative, and integrated care for
individuals with severe and persistent mental illness, it is hoped that the Living Well Hawaii project will
lead to better quality of life and improved health for those served.5
For more information:
Kimberly Fuke
Program Manager
Kalihi-Palama Community Mental Health Center
[email protected]
Phone: (808) 832-5800
1
Hawaii Department of Health. Adult Mental Health Division. Hawaii.gov. Available at:
http://health.hawaii.gov/amhd/. Accessed 07-17-13.
2
Ibid.
3
Kalihi-Palama Health Center. Quick Facts. Kalihi-Palama Health Center 2012. Available at http://kphc.org/aboutus/quick-facts. Accessed 06-03-13.
4
Okubo J, Fuke K. Living Well Project Provides Innovative Healthcare to Adults with Serious Mental Illness. News
Release: May 29, 2013. Hawaii Department of Health. Available at http://hawaii.gov/health/about/pr/2013/13032.pdf. Accessed 6-14-13.
5
Kalihi-Palama Health Center. Quick Facts. Kalihi-Palama Health Center 2012. Available at http://kphc.org/aboutus/quick-facts. Accessed 06-03-13.
© Association of State and Territorial Health Officials 2013
202-371-9090
2231 Crystal Drive, Ste 450, Arlington, VA
www.astho.org