Healthcare Champions 2024

The Queen’s Health System | HMSA

The Queen’s Health System

For 165 years, The Queen’s Health System has been committed to providing high quality, compassionate care to fulfill the mission of its founders, Queen Emma and King Kamehameha IV, to provide in perpetuity quality health care services to improve the well-being of Native Hawaiians and all the people of Hawai’i.

Across our health system, our more than 10,000 caregivers working in a variety of clinical and non-clinical areas are our greatest asset. They work tirelessly to provide comfort and healing to those in need.

One of our many outstanding teams is The Queen’s Medical Center – West O’ahu’s Emergency Department, a recent Po’okela Award recipient. The Queen’s Health System’s Po’okela Awards is a program that recognizes and rewards exceptional caregivers and teams who advance the organization’s mission, make significant contributions to the organization and our community, and are committed to excellence.

With the growing demand for health care services in the West region, Queen’s – West O’ahu serves as a vital resource for the community with services ranging from imaging, orthopedics, women’s health, cardiology, cancer care, and much more. Specifically, the Emergency Department, one of the busiest in the state, takes an interdisciplinary approach to emergency care and consists of more than 100 caregivers in a variety of roles including nursing, social work, dietary, and much more.

On average, the Queen’s – West O’ahu Emergency Department sees 160-180 patients a day. Despite the volume, each caregiver is committed to providing a high level of care to all those in need of assistance. The team embraces challenges, working cohesively to come up with innovative and creative solutions with the goal of enhancing patient care. Their strong work ethic, resilience, professionalism and compassion make them an incredible team of caregivers deserving of recognition.

1301 Punchbowl St.
Honolulu, HI 96813
(808) 691-1000
www.queens.org

HMSA

Jay Fujimoto and Lori-Ann Davis

A Time for Action: HMSA’s Response to the Change Healthcare Cybersecurity Incident

In February, health care in Hawaii nearly came to a halt.

Change Healthcare – one of the largest payment networks in the industry, electronically connecting doctors’ offices, pharmacies, and hospitals with health insurers – was the victim of a significant and far-reaching cyberattack that forced their systems offline nationwide.

In Hawaii, the cybersecurity incident affected the health care system payment ecosystem. Providers and health systems were unable to submit claims and receive payment from insurers as they normally would, which had the potential to disrupt cash flow, payroll, and business operations.

Lori-Ann Davis and Jay Fujimoto, leaders from HMSA‘s provider areas, led the charge to engage affected providers and health system partners to work quickly and tailor solutions to keep their operations going.

HMSA departments, including Provider Services, Information Technology, Finance, Business Continuity, and others, supported these efforts.

Lori-Ann Davis

Davis, who grew up in Waimanalo, is the assistant vice president of Provider Experience and has been with HMSA for 30 years. In her role, she supports the largest health care provider network in the state and leads key provider operations areas, including the provider call center, contracting, and credentialing.

“We’re really proud of the work we do to support our 7,500 physicians, health systems, and other health care providers,” Davis said. “Our job is to provide the best support we possibly can and partner with the provider community so we can improve care and outcomes for their patients and members.”

Fujimoto, who grew up on the Big Island, is the assistant vice president of Provider Contracting and Initiatives and has been with HMSA in various roles for nearly five years. In his current role, he supports clinical integration with health systems, which includes initiatives like revenue cycle support and programs that improve the exchange between providers and insurers.

“The only way we can move the health market where it needs to be is to work in collaboration with the providers,” Fujimoto said.

Davis and Fujimoto understood how important it was to support providers in responding to the Change Healthcare incident.

“If our providers couldn’t make payroll, the impact would have been catastrophic. Everybody came together to make sure that they would have a way to continue working and submitting their claims,” Fujimoto said.

Identifying and Implementing Solutions Quickly

Several important steps were needed to solve the payment issue.

First, Davis and Fujimoto identified the providers that were not able to submit claims to HMSA due to the Change Healthcare incident. They then worked with the providers with the highest claims volume. Hawaii Pacific Health (HPH) and The Queen’s Health System, on alternative solutions for electronically submitting claims to HMSA.

Jay Fujimoto

Fujimoto worked with HPH and Queen’s, and Davis focused on supporting other providers, including federally qualified health centers and individual practitioners, especially on the Neighbor Islands.

The next steps varied based on the provider’s situation and needs. Many large providers needed advance payments while they figured out how they were going to work with a new clearinghouse (aggregators of electronic claim information, which scrub claims for errors and securely transmit them to payers) or wait for Change Healthcare to repair their clearinghouse services or provide a solution.

Ohana Pacific Health, which provides care services primarily to kupuna, is grateful for the support HMSA provided following the cybersecurity incident.

“The local insurance companies have really stepped up during this crisis with Change Healthcare. We, at Ohana Pacific Health, have been so grateful for HMSA’s quick response and cooperation. Lori-Ann at HMSA has been nothing short of amazing, working with us to find alternative solutions and helping to secure an advance that will provide us with some financial reprieve during this dilemma,” said Wes Lo, chief executive officer of Ohana Pacific Health.

“Thanks to the support, we can continue to provide critical services and care for the kupuna we serve across the state,” Lo said.

Davis adds, “We knew we had to be there as Ohana Pacific Health’s partner just as they have been for us and our members. Ohana Pacific provides an essential service to our community through their skilled nursing facilities, which are so hard to come by. We’re glad we could help Wes and his organization stay open and continue to service our members.”

818 Keeamoku St.
Honolulu, HI 96814
hmsa.com