PDF - HMSA.com

Aloha,
We’re sometimes tempted to look back at the past through
employers and health care providers throughout the state to
warm, sepia filters. We imagine yellowed pages in musty
keep our members in good health.
archives, chuckle at quaint period attire, or hear the strains of
nostalgic music.
A Message
from the
President
and
Chairman
Rising health care costs associated with the increased utilization
of those technologies, medical procedures and drug therapies
In truth, however, the good old days weren’t always good for
have been a persistent challenge for the health care system in
everyone. During the 1930s, for example, many residents of
Hawaii and, indeed, across the nation. To help contain costs,
what was then the Territory of Hawaii struggled to cope with
HMSA has assumed a leading role in promoting healthy lifestyles
the everyday effects of the Great Depression. Many found
through our health education classes, disease prevention and
themselves unable to afford basic health care. Against this bleak
management programs, and large-scale multimedia campaigns
backdrop, a social worker named Margaret Catton brought
promoting regular physical activity and good nutrition.
forward a proposal for a nonprofit member association that
would allow people to pay for their medical costs by pooling
their money.
In addition, HMSA has invested more than $163 million over
the past 10 years to help improve the quality and safety of the
health care system in Hawaii. These programs and initiatives
Catton’s forward-looking proposal led to the establishment of
are an essential part of our commitment to the health and well-
HMSA. Our doors opened for business on June 1, 1938, with
being of our members and all the people of Hawaii.
671 charter members – mostly teachers and social workers –
who welcomed the chance to secure affordable health care.
We got our start in 1938, thanks to the vision and determination
of some forward-thinking individuals. Seventy years later, amid
This year, HMSA celebrates its 70th anniversary. As the most
constant challenges and changes in the health care industry,
experienced health care coverage provider in Hawaii, we offer
HMSA remains committed to working for a healthier Hawaii.
our members a choice of quality, affordable health plans.
We also uphold the same spirit of service, compassion and
excellence that motivated those determined nurses, teachers
and social workers so many years ago.
Needless to say, much has changed. Thanks to advances in
medical research and technology, our health care system is
fighting disease and illness better and we are enjoying longer,
fuller lives. We remain committed to working together with
HMSA A nnual R eport 2007
Robert P. Hiam
Allan R. Landon
President and Chief Executive Officer
Chairman of the Board
1930s
Photo: Bishop Museum
• 1938 – HMSA opens for business on June 1, 1938. The
charter membership consists of 671 people, mostly
teachers and social workers, who paid $3 a month for up
to $300 in coverage per year.
• 1939 – HMSA moves into the Hawaiian Trust Building on
South King Street.
• 1939 – World War II begins in Europe.
1940s
• 1941 – Japanese forces
attack Pearl Harbor. The
United States enters World
War II.
From the day we opened our doors for
• 1945 – World War II ends.
business in 1938 through today, HMSA
• 1946 – HMSA office moves
to Bishop Street.
has been dedicated to providing quality,
affordable health care coverage for the
people of Hawaii.
Seventy years of service. Seventy years of
excellence. Seventy years of working for a
healthier Hawaii. That’s the heart of HMSA.
Photo: Hawaii State Archives
Honoring
the Past,
Charting the
Future
Factoid: Employee count: 3 (1938).
• 1946 – HMSA joins the Blue Shield Association,
formed by nine Mainland medical plans.
• 1946 – “Our first claim – a tidal wave victim” (Hilo
office poster).
During the post-war years, HMSA expands to the Neighbor Islands: Kauai
in 1945, the Big Island in 1946, and Maui in 1947. The Hilo office opens on
April 1, 1946, the same day a tsunami hits Hilo and claims 96 lives.
Factoid: HMSA membership
grows to 30,000 (1948).
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HMSA A nnual R eport 2007
1960s
1950s
• 1955 – HMSA introduces
its major medical benefit.
For the first time,
members are protected
from the expense of a
catastrophic illness or
injury.
• 1957 – The Soviet Union
launches Sputnik, the
world’s first man-made
satellite.
• 1959 – Hawaii becomes
the 50th state.
• HMSA seeks new ways to contain health
care costs in an era marked by rampant
inflation and skyrocketing living costs.
• 1965 – The first U.S. combat
troops arrive in Vietnam.
• 1966 – HMSA begins serving
as the fiscal intermediary for
Medicare. That same year,
it unveils its 65-C Medicare
Supplemental Plan. Within
four days, more than 700
people enroll in the plan.
• 1972 – HMSA introduces its first HMO
plan, the Community Health Program.
hits 155,000 (1958).
• 1973 – Elvis Presley performs live via
satellite from Honolulu for a worldwide
audience.
HMSA employees sorted
and processed claims
manually until the mid1960s. With its growing
membership, HMSA turns to
computers to accommodate
the tremendous volume of
claims.
• 1973 – Oil prices triple from $3.50 a barrel
to $10 a barrel.
• 1974 – Hawaii passes the landmark
Prepaid Health Care Act, guaranteeing
employer-sponsored health coverage for
the state’s full-time workers.
• 1978 – A second oil shock occurs when
prices spike from $11 a barrel to more
than $30 a barrel.
• 1966 – HMSA office moves to the top
two floors of the C.S. Wo building on
Kapiolani Boulevard.
• 1967 – The number of tourists visiting
Hawaii reaches the 1 million mark for the
first time.
Factoid: Membership
• 1970 – HMSA’s Kona office opens in the
Marlin Plaza (now the Kona Marketplace).
• 1963 – John F. Kennedy is
assassinated.
• 1959 – Ala Moana Center
opens.
• 1959 – With the arrival
of statehood, HMSA
expands its benefit
offerings to meet the
needs of Hawaii’s
growing population.
1970s
• 1962 – HMSA introduces Plan 65, a
comprehensive health plan for Hawaii’s
seniors, and the Hawaii Public Employees
Health Plan.
• 1979 – Americans taken hostage in Iran.
Factoid: Enrollment hits 500,000, more
than half the state’s population (1978).
• 1968 – Martin Luther King Jr. and Robert F.
Kennedy are assassinated.
• 1968 – Hawaii Five-O debuts.
Factoid: Employee count: 150 (1963).
Factoid: Enrollment
reaches 350,000 (1968).
During his 40-year career with HMSA, Don Keliinoi worked in
Statistics, Underwriting, Quality Control, Personnel and Marketing.
He served as vice president of Marketing, vice president of Business
Development and Special Accounts, and chief executive officer of
WorkComp Hawaii Insurance Co., an HMSA affiliate company.
Keliinoi retired in 1997.
I started as a statistical clerk. My job was to post all the claims
records in summary and keep track of all the income and benefits
that were paid out. It was kind of like a financial ledger.
When I first started, there were 50-something employees. The
office was located on Bishop Street in the French Alsup Building.
Donald Y. Keliinoi
Retired HMSA vice president
The whole organization was very close. Everybody would help each
other out. Sometimes, when the claims processing fell behind,
we’d all go upstairs and process claims manually.
It was a very, very cohesive bunch of employees.
We started a softball team, in 1961 . . . or ’62. I guess I was
1980s
With the unprecedented escalation
of health care costs, HMSA begins
health care resources.
As far as I’m concerned, HMSA is the best benefit in town.
When you consider the benefit structure, the participating
providers that you have, and the rates that HMSA charges,
it’s the best in town. You can’t beat it.
HMSA has a good product. It has good employees. It has
good executive staff. And as far as I know, it’s been that
way for years and years and years. And it’s got a good
board, a very mixed board. And that makes the company
very solid.
• 1982 – Hurricane Iwa hits Kauai, killing two
people and causing $250 million in damages.
features into its plans to eliminate
promote the responsible use of
All of the bosses I had were good to me. And then all of the
people who worked for me became my boss eventually. I
trained them to take my place. That’s a good thing: When
I look back at all the people I trained, they all succeeded
in life.
• 1980 – HMSA’s affiliate, Health Plan Hawaii,
is certified as a federally qualified HMO.
to integrate more managed care
costly duplication of services and
in charge. I was like the self-appointed athletic director.
We used to have intramural basketball and volleyball,
with departments playing each other. And we’d enter the
financial leagues.
In 1983, HMSA’s Honolulu
offices are consolidated at the
HMSA Center on Keeaumoku
Street.
• 1985 – The Hokulea sails to Aotearoa
(New Zealand), Tahiti, the Cook
Islands, Tonga, and Samoa.
• 1986 – HMSA introduces 65C Plus,
the nation’s first federally certified
Competitive Medical Plan.
• 1986 – The space shuttle Challenger
explodes after take off, killing its
entire crew, including Hawaii-born
astronaut Ellison Onizuka.
• 1986 – HMSA Foundation is
established.
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HMSA A nnual R eport 2007
1990s
• 1990 – HMSA joins the Blue
Cross Association and becomes
the Blue Cross and Blue Shield
plan of Hawaii.
• 1990 – HMSA introduces its
Preferred Provider Plan, which
offers members cost containment
through contracted provider
discounts and broad freedom of
choice. The PPP would become
HMSA’s most popular plan.
• 1991 – Iraq’s invasion of Kuwait
leads to the first Persian Gulf
War.
• 1991 – Dissolution of the
Soviet Union.
• 1992 – Hurricane Iniki hits
Hawaii, causing $1.8 billion
in damages.
• 1994 – HMSA joins the state’s
pilot QUEST program.
• 1994 – HMSA develops the Hawaii
Health Information Network, one
of the state’s first private telehealth
initiatives, giving physicians
convenient access to HMSA and
other health care resources.
In 1996, renovation
is completed on
the HMSA Center,
including an
additional 100,000
square feet of office
space.
Factoid: Employee count: 1,200 (1991).
• 1987 - HMSA introduces employer
benefits, including the Employee
Assistance Program, Flexible Spending,
COBRA Administration, and Drug
Assistance Program.
Factoid: Enrollment increases to
620,000 members (1991).
• 1989 – HMSA introduces HealthPass,
an innovative health-risk assessment
program designed to help members
achieve and maintain good health.
• 1989 – The Berlin Wall falls.
Factoid: Enrollment reaches
558,000 (1988).
• 1996 – HMSA develops
the Community Health
Initiative, working
closely with members
and their doctors in
areas such as preventive
care and chronic disease
management.
• 1996 – The HMSA web
site (hmsa.com) is
launched.
• 1997 – Control of Hong
Kong reverts from Britain
to China.
• 1998 – HMSA is one of
the nation’s first health
plans to recognize
PPO providers’ quality
performance through
the initiation of the
Practitioner Quality
Service and Recognition
program. In 2000, HMSA
initiates its Hospital
Quality Service and
Recognition program to
recognize and reward
facilities delivering
efficient, quality care.
2000s
• 2001 – On Sept. 11, terrorists hijack and crash passenger
jets into the World Trade Center, the Pentagon, and in
Pennsylvania.
• 2001 – HMSA implements its Member Protection
Program, a one-time health coverage allowance, to help
members and local businesses cope with the economic
impact of the Sept. 11 attacks.
• 2001 – HMSA’s PQSR program wins a Best of Blue
award from the Blue Cross and Blue Shield Association
for sustained health management.
• 2002 – HealthPass wins the prestigious C. Everett Koop
National Health Award for achieving improved health
and decreased medical costs among members.
• 2002 – HMSA begins a partnership with AllScripts
HealthCare Solutions, a leading health care electronics
technology company, to provide electronic prescribing
tools for physicians.
• 2004 – A massive earthquake triggers
a series of tsunamis, killing 200,000
people in South Asia.
• 2005 – HMSA launches the
far-reaching go campaign
to encourage members and
the general public to make
physical activity part of
their regular routine, as a
key element in achieving a
healthy lifestyle.
• 2003 – HMSA launches its Health Care Cost Campaign
to address continued rising health care costs – up 11
percent in 2001, up 14 percent in 2002.
• 2005 – Hurricane Katrina
kills 1,800 people and causes $81
billion in damages in Louisiana and
neighboring states.
• 2003 – HMSA’s HQSR program wins a Best of Blue
award that recognizes innovations and best practices
in medical and pharmacy management.
• 2006 – A major earthquake and
powerful aftershocks hit the Big Island.
• 2003 – Second Persian Gulf War begins.
• 2003 – An outbreak of severe acute respiratory
syndrome (SARS) infects 8,000 people in North and
South America, Europe, and Asia before
being contained.
6/7
The 5 A Day Friends, HMSA’s fruit
and vegetable mascots, were popular
ambassadors for the 5 A Day campaign,
making public appearances to remind
children and adults to eat five servings
of fruits and vegetables every day.
HMSA A nnual R eport 2007
• 2006 – The HMSA Initiative for
Innovation and Quality is launched,
committing a total of $50 million over
three years to fund improvements in
participating acute care hospitals and
to help participating physicians acquire
electronic medical record systems.
From its inception, HMSA
Quality Programs
has been committed to
HMSA’s continuing efforts to ensure quality in Hawaii’s health care system include
ensuring quality care for
the following programs and initiatives:
its members. Since 1998,
• HMSA’s Practitioner Quality and Service Recognition (PQSR) program
evaluates and rewards physicians who maintain a high level of patient care
and service based on best practice guidelines. In 2007, HMSA paid $10 million
to 2,500 practitioners who participated in the PQSR program. Since 1998,
Hawaii physicians have received $73 million in payments for meeting program
measures for health care quality, patient safety, patient satisfaction, and
efficiency.
HMSA has committed
$163 million to physicians
and hospitals above and
beyond their regular
reimbursements and
annual fee adjustments
70 Years of
Quality Care
to help improve the
quality of Hawaii’s health
care system.
• HMSA’s Hospital Quality and Service Recognition (HQSR) program
recognizes facilities that deliver efficient, quality care, focusing on patient
safety and physician and patient satisfaction. In 2007, 17 participating hospitals
received $6 million in awards through the HQSR program. Over the course of
the program, Hawaii hospitals have received $40 million in awards for meeting
program measures.
• HMSA’s Quality and Performance (Q&P) Evaluation program evaluates the
quality of care and service delivered by practitioners in HMSA’s HMO plans.
HMSA’s continuing
investment in quality
programs and initiatives
is an important part of our
commitment to producing
the best outcomes for
patients and assisting
•The HMSA Initiative for Innovation and Quality (HI-IQ), introduced in 2006,
provides financial assistance to help Hawaii hospitals and physicians implement
technological solutions to make the state’s health care system more effective
and efficient. In each award year, grants totaling $10 million are awarded to
eligible hospitals to support improvements in patient care and outcomes. The
program also committed $20 million – approximately $20,000 per provider – to
help independent HMSA participating physicians statewide acquire electronic
medical record (EMR) systems. By the end of 2007, HI-IQ helped fund the
installation of 295 EMR systems.
hospitals and physicians
In 2007, HI-IQ won an Editor’s Choice Award at the 3rd Annual World Healthcare
with adopting best
Innovation and Technology Congress in Washington, D.C. The annual awards –
practice guidelines to
provide quality care.
presented to hospitals, group practices and payers for setting new standards in health
care innovation – are co-sponsored by Health Data Management magazine and the
World Health Innovation and Technology Congress.
Cervical Cancer
Screenings
Colorectal Cancer
Screenings
HMSA’s quality
programs have
improved clinical
outcomes for
HMSA members
in a number of
important areas. The
following quality
improvements are
part of the PQSR
program:
Graphs indicate median scores
for appropriate screenings,
based on current data
available (2006).
100%
100%
100%
80%
80%
80%
60%
60%
60%
40%
40%
40%
20%
20%
20%
0%
1997
2006
1997
2006
0%
100%
100%
80%
80%
80%
60%
60%
60%
40%
40%
40%
20%
20%
20%
0%
0%
2006
1997
2006
1997
2006
ACE Inhibitor Use for
Patients with Heart Failure
Retinal Eye Exams for
Patients with Diabetes
100%
1997
HMSA A nnual R eport 2007
0%
Varicella Immunizations
for Children
0%
8/9
Breast Cancer
Screenings
1997
2006
National Accreditation
HMSA’s commitment to quality health
care includes a voluntary and thorough
Thelma Tsutsumi
evaluation by the National Committee
Longtime HMSA member
for Quality Assurance. NCQA’s high
accreditation standards encourage
health plans to continually enhance their
quality. NCQA reviews a broad range of
performance measures related to patient
satisfaction, access to care, physician
credentialing, disease management, and
preventive health screening rates.
HMSA remains the only plan in Hawaii
to offer PPO and HMO plans that have
earned the highest levels of NCQA
accreditation.
HMSA’s Health Plan Hawaii currently
holds Excellent Accreditation.
“Excellent” is the highest level of NCQA
accreditation for HMO plans, granted for
I’ve been an HMSA member ever since it became
known around town.
Today, with so many different kinds of products
on the market, if someone doesn’t inform you
what’s happening out there and what’s best
for you, you’re really at a loss unless you have
somebody who’s kind, informative and patient.
I had a little problem with my mail-order
prescription. They said I had to call HMSA. When
I spoke to [Customer Service representative]
Cha Sanchez, she was able to help me right off.
I was very happy that she was able to help me
solve my dilemma of how to get the medication.
She was patient with me – she didn’t rush me –
and she was sweet.
HMSA informs us about where the flu shot
clinics are going to be held, and all the different
dates and times, so I can go whenever and
wherever is most convenient for me.
I sure appreciate HMSA.
service and clinical qualities that meet or
exceed NCQA’s rigorous requirements
for consumer protection and quality
improvement.
“Full” is the highest level of accreditation for PPO plans that meet
strict NCQA standards for continuous quality improvement. The
following HMSA plans have earned Full Accreditation from NCQA:
• Preferred Provider Plan
• CompMED
• Federal Employee Health Benefit Program
• State of Hawaii Employer Union Trust Fund Plan
• 65C Plus
NCQA is an independent, nonprofit organization dedicated to
assessing and reporting on the quality of health care in the United
States. NCQA’s accreditation status is widely regarded as an evaluator
of quality, accrediting about half of the HMOs in the United States.
High Member Satisfaction
HMSA’s annual Membership Satisfaction Survey is the state’s largest
survey of health care consumers. It has served as a reliable measure
of the quality of health care and health care coverage in Hawaii since
1998. Last year’s survey again indicated that HMSA members are
satisfied with the service they receive from HMSA and their HMSA
participating physicians.
10 / 11
HMSA A nnual R eport 2007
Of those surveyed in 2007, 96 percent said that if they had to
choose a health plan again, they would select their current HMSA
plan. Respondents also gave high marks for access to care,
physician skills, medical services, and health care outcomes.
Participating Provider Network
HMSA members have access to the largest network of health care
providers and HMO health centers in the state. More than 5,100
physicians, dentists, hospitals, pharmacies, and other health
care providers in Hawaii participate in HMSA’s network. HMSA’s
participating providers complete our credentialing process, meet
specific criteria for providing quality care, file patient claims,
and agree to accept our member’s copayment and HMSA’s
reimbursement as payment in full.
Working Together
Last year, 149 health care professionals volunteered their time
and expertise to help ensure that HMSA members can count
on affordable access to quality care. Through their service on
HMSA’s board of directors and provider advisory committees,
these providers help review and formulate policies related to
health plan benefits, medical policy, and pharmacy guidelines.
They also discuss issues related to quality improvement, health
promotion and prevention, and disease management.
HMSA values the knowledgeable leadership these professionals
provide, including the eight board members who represent
Hawaii’s health care providers.
With a wide variety of health plans to accommodate our members’ range of
circumstances, financial resources, and health care needs, HMSA provided
access to quality care, service and support for 701,100 people last year. The
largest number of HMSA members comes from our employer groups. In 2007,
16,400 employer groups provided coverage for 561,100 members. More than
424,000 employees were in one of HMSA’s free choice plans, and 139,900 were
in HMO plans.
In 2007, 59,100 members were covered by an HMSA plan for people who are not
eligible for coverage through employer group plans. Last year, HMSA individual
plans provided coverage for 38,800 senior citizens, 3,200 students, 1,700
children, and 15,400 self-employed members.
Health
Plan
Choice
Now in our 13th year of participating in the statewide Hawaii QUEST program,
a managed care program for Medicaid beneficiaries, 80,800 HMSA members
are covered under the HMSA QUEST medical plan.
Most of our members also receive supplemental benefits through HMSA health
plan coverage. In 2007, 539,000 members received prescription drug coverage,
410,400 were enrolled in a vision rider, 89,100 in a chiropractic rider, and 4,700
in a complementary care rider for alternative health services. In addition, 218,000
members received dental coverage through our preferred provider dental plan
and HMO dental network.
HMSA also contracts with self-insured employer groups to process claims.
Through these arrangements, HMSA paid 2.1 million claims in 2007, totaling
$262 million in benefits for 176,700 people.
12 / 13
HMSA A nnual R eport 2007
Our Coverage Travels with You
HMSA Health Plan Membership
HMSA members can have peace of mind if they need
medical attention while traveling outside Hawaii. HMSA
belongs to the Blue Cross and Blue Shield network of
Employer Group Plans
Senior Plans
(In thousands)
Student Plans
(In thousands)
health care providers in the United States, Puerto Rico,
and U.S. Virgin Islands. HMSA is the only health plan in
600
40
5,000
540
36
4,500
preferred provider and HMO programs.
480
32
4,000
All HMSA plans cover emergency care services, and our
420
28
3,500
360
24
3,000
300
20
2,500
Hawaii that offers nationwide provider networks for both
'05
'06
'07
'05
'06
'07
Guest Membership program covers HMO plan members
temporarily living on the Mainland. With 278,500 primary
care physicians, 485,700 specialists, and 5,700 hospitals
nationwide, HMSA members can rely on the BlueCard
'05
'06
'07
program for access to the nation’s largest network of
providers for care outside Hawaii. In 2007, the BlueCard
Other Individual Plans
HMSA Children’s Plan
1,800
program saved our members $76 million in out-of-pocket
QUEST
(In thousands)
expenses.
(In thousands)
95
20
1,700
1,600
15
1,500
1,400
80
A Tradition of Servicing Our Members
65
With a commitment to service and excellence, HMSA
10
1,300
Customer Service representatives statewide are trained
50
1,200
5
1,100
to provide timely, accurate service to help our members
understand their benefits and coverage. In 2007, they
35
responded to 24,000 walk-in visits, 6,000 written inquiries,
1,000
900
20
0
'05
'06
'07
'05
'06
'07
'05
'06
'07
and 1.4 million phone calls from our members.
HMSA relies on skilled staff and current technologies to
process claims accurately, efficiently and promptly. Every
working day last year, HMSA’s claims system handled
68,100 claims. Overall, HMSA processed a total of 17.2
million member claims in 2007.
HealthPass
HealthPass is HMSA’s award-
HealthPass participants have lower
health care costs
(Adjusted for gender, age, 2002 morbidity level, and 2002 total costs.)
winning health-risk assessment
and screening program.
$3,500
Professional health consultants
$3,000
measure members’ blood pressure,
cholesterol, blood sugar levels, and
body fat percentage. They guide
$2,000
members through a review of their
$1,500
current lifestyle, health habits, and
family medical history. And they
create a personal health action plan
to help members reduce their risk
Health and Wellness
Programs
need to do to stay healthy. The challenge
significantly improve their health.
The findings identified the
HMSA places so much emphasis on
• Lower blood pressure, glucose
and cholesterol levels.
$3,000
• Lower body fat percentages
and body mass indexes.
$2,500
• Lower rates of cigarette
smoking.
$2,000
2005 Non-HealthPass
Participants
HealthPass
Participants
$3,397
$3,500
$3,150
• Fewer incidents of depression.
$2,873
$2,811
$2,449
0
1
2
3
4
Number of Years
The more times a member participates in HealthPass, the more their
health care costs decrease.
Source:
HMSA A nnual R eport 2007
2004
$4,000
habits amid our busy lives. That’s why
14 / 15
2003
Members who continue using
HealthPass enjoy increased savings
HealthPass participants:
to maintain healthy lifestyles.
$1,821
The average HealthPass participant saved
more than $500 on health care costs in the
year following their first HealthPass visit.
following healthy changes among
members with the information and tools
$2,227
2002
is making sure that we maintain healthy
preventive care. We strive to provide
$2,409
$0
participants and nonparticipants
program helped participants
$2,762
$2,618
$2,377
$ 500
A study of HMSA HealthPass
over a four-year period between
$2,933
$1,000
for diseases.
2002 and 2005 found that the
Today, we know more about what we
$2,500
$3,376
HMSA HealthPass Program: Return on Investment: 2002-2005,
Victor J. Strecher Ph.D., M.P.H.; Steven M. Schwartz; and Chun Wang.
HMSA members who participated in HealthPass were found to have lower overall
health care costs than nonparticipants. On average, participants saved more than
$500 on health care costs in the year following their first HealthPass visit. And the
more times they participated, the more their health care costs decreased.
Care Connection
HMSA’s Care Connection program provides members with support and disease
management tools to help them understand and manage their chronic conditions.
Care Connection staff works closely with members and their physicians to help
An HMSA plan benefit, HealthPass is conveniently offered at HealthPass offices
ensure that members follow the treatment plan recommended by their doctor and
and 160 worksites across the state. In 2007, HealthPass helped 26,200 HMSA
enjoy an improved quality of care. In 2007, 114,500 members received support for:
members.
Health Education Programs
HMSA members have access to more than 35 health education workshops and
classes that focus on prevention. In 2007, 8,300 people took part in HMSA’s health
• Asthma and chronic obstructive pulmonary disease.
• Behavioral health conditions, such as stress, anxiety, depression or substance
abuse.
• Diabetes.
education programs. Classes include:
• Heart disease.
• Body Power, on basic aerobic and weight training exercises.
• Kidney disease.
• Engaging in Aging, on physical changes that occur as we age, exercise
opportunities, and the importance of a positive attitude.
Ready, Set, Quit!
• Mission: Nutrition, on understanding eating habits and making healthy
eating choices.
• Stress Master, which features stress-reduction strategies.
HMSA’s personalized smoking cessation program helps members become smokefree through telephone counseling, assistance with setting and preparing for a
quit date, strategies to deal with cravings and weight gain, education on nicotine
Employer workshops include Germ Busters!, on preventing and treating the
replacement therapy and stop-smoking aids, and referrals to community resources.
common cold and flu; Think Fit, with basics on aerobic exercise, strength training
Last year, 614 members enrolled in the Ready, Set, Quit! program and 17 percent of
and flexibility; and Food for Thought, with the latest nutrition guidelines.
them have remained smoke-free for at least 12 months.
RSVP
Flu Shot Clinics
Regular preventive screenings and vaccinations are keys to the prevention, early
To help our members avoid getting the flu, HMSA provided flu shots at no cost to
detection and successful treatment of potentially serious illnesses. HMSA’s
members at clinics throughout the community and in workplaces on Oahu, Maui,
Reminder for Screening & Vaccination Program (RSVP) sends members birthday
Kauai, and the Big Island. Last year, 44,500 people received flu shots through this
greetings and reminders to make appointments for these preventive care measures.
program.
HMSA also sends physicians corresponding lists of their patients and the services
they need. In 2007, RSVP sent out 214,700 reminders to HMSA members.
The Good Pregnancy - He Hapai Pono
HMSA Kaimana Awards & Scholarship Program
He Hapai Pono offers prenatal care education to HMSA members.
Promoting physical activity in young people can help instill healthy habits that
Pregnant women are provided with support and receive a
last a lifetime. The HMSA Kaimana Awards & Scholarship Program recognizes
complimentary pregnancy or infant care book. Registered nurses
all-around accomplishments by high schools, rewards individual student athletes
answer questions and can provide referrals to community
with scholarships, and supports excellence in coaches’ education.
programs. The program provides special interventions for those
with high-risk factors, such as diabetes, high blood pressure,
substance abuse, domestic violence, and smoking. In 2007,
He Hapai Pono offered assistance to 6,300 expectant mothers.
Healthy Lifestyle Programs and Events
As part of our mission to improve community health and well-
At the 2007 Kaimana Awards & Scholarship Program luncheon, three student
athletes were honored with distinguished scholarships valued at $3,000 each,
and 18 student athletes were awarded scholarships worth $2,000, for achieving
excellence in community service, sportsmanship, athletics and academics. In
addition, 29 Hawaii public and independent high schools received unique crystal
Kaimana Awards for achieving the highest program scores in their interscholastic
league and division.
being, HMSA sponsors innovative programs and events for
The Kaimana Awards represent HMSA’s strong partnership with the Hawaii High
Hawaii residents of all ages. Throughout the year, we participate
School Athletic Association, which administers the program.
in, support or reach out with community events that encourage
healthy lifestyles and emphasize the importance of physical
activity and nutrition.
HMSA Teen Video Awards Contest
Each year, HMSA invites students from Hawaii’s public and independent schools
HMSA Island Fresh Festival
to create video public service announcements focusing on fitness and nutrition
or drug-free, tobacco-free, and underage drinking prevention. The contest helps
Now in its second year, the HMSA Island Fresh Festival has
foster students’ creative talents and promotes healthy lifestyles. Last year, up-and-
become a popular community event highlighting HMSA’s ongoing
coming student video producers submitted a total of 244 entries. The winning
efforts to encourage families to eat a healthy, nutritious diet. The
videos aired on local television stations and are viewable on hmsa.com and HMSA
festival featured a full day of healthy cooking demonstrations by
Now, digital cable channel 344. HMSA sponsors the contest along with the Hawaii
local chefs, a farmers’ market with delicious local produce, food
booths, keiki activities, and live entertainment. Several thousand
families attended this year’s event at Kakaako Gateway Park.
The festival was supported by Aloun Farms, the University of
Hawaii College of Tropical Agriculture and Human Resources,
the Hawaii Department of Agriculture, and the Pacific
Handcrafters Guild.
16 / 17
HMSA A nnual R eport 2007
Department of Education, Sassy/G Magazine, and Mothers Against
Drunk Driving (MADD).
HMSA’s go Campaign
HMSA’s Web Site
In 2007, HMSA launched a new and improved web site entirely
redesigned from top to bottom. In addition to a fresh new look
and feel, hmsa.com now provides access to personal health plan
HMSA sponsored or supported events across the state throughout
information and offers expanded functionality. Members can
the year to reinforce the importance of regular physical activity.
access information on their own health plan or general health
Our efforts included the following events:
and wellness information, and use an enhanced provider search
• HMSA’s go Walk @ Lunch. More than 200 people gathered
on the grounds of the Hawaii State Capitol to participate in a
fun walk organized by HMSA. The event was part of National
Walk @ Lunch Day, a nationwide Blue Cross and Blue Shield
Association health initiative.
• HMSA’s goTumble. HMSA’s goTumble Program offers exercise
classes at no cost to Oahu Head Start preschools and other
participating schools in low-income communities. Last year,
the TumbleBus, a colorful “gym on wheels,” brought lessons to
enhance children’s physical and motor development to 2,200
preschool children.
function. HMSA members with prescription drug coverage can
also enter specific drug names to see descriptions and medication
interactions.
HMSA Now
Since the debut of HMSA Now in 2005, members and the general
public have viewed 117,600 free videos on HMSA’s on-demand
digital TV channel, the nation’s first interactive, statewide health
channel. HMSA Now – on digital cable channel 344 – was created
as a community service to help people learn more about health
in an engaging, easy-to-use format. Viewers can access over 320
Health Information and Resources
videos on a wide variety of health topics and browse an extensive
medical video library.
HMSA is committed to providing our members with the information
they want and need – from member-specific plan benefit information
to videos and features on timely health issues, fitness, wellness and
Island Scene Magazine and Island Scene Online
healthy recipes. We disseminate our health messages in print,
In 2007, HMSA celebrated Island Scene magazine’s 15th
on television and
anniversary. The quarterly magazine and its online companion,
radio, and online.
Island Scene Online (www.islandscene.com) provide features
on health and fitness, healthy recipes, health plan information,
and other timely topics for members and the community. Since
its debut in 1992, Island Scene staff members and freelancers
have garnered more than 60 awards for excellence in design,
illustration, journalism and photography. In 2007, Island Scene
was distributed to 325,000 households every quarter to reach
HMSA’s 701,100 members.
Reaching out. Changing lives.
HMSA Foundation
Making a difference. One of
The HMSA Foundation was established in
HMSA’s founding principles is
program’s efforts to improve
1986 to broaden HMSA’s commitment to
provider compliance with
a commitment to benefit the
providing access to cost-effective health
quality standards to manage
care services; health promotion, education
costly testing and reduce
and research; and the promotion of social
medical errors.
community by promoting social
welfare. From the beginning, part
their own health care. The
funding will also assist the
welfare. Since 1997, the Foundation has
of our mission has been to improve
made strategic community investments to
Supporting basic dental care.
the health and well-being of all of
improve the health, wellness and quality of
The Office for Social Ministry
life for the people of Hawaii.
was awarded a $50,000 grant to
Hawaii’s people. That’s why we
support programs that make the
Islands a better place to live.
Community
Involvement
support the Mobile Care Health
In 2007, the HMSA Foundation committed
Project, which provides primary
$1.5 million in grants to 43 organizations.
dental care to low-income,
The following are examples of
uninsured and underinsured
organizations supported in key areas:
Big Island residents.
Attracting physicians to the Neighbor
Helping children develop.
Islands. The HMSA Foundation awarded
Imua Family Services received
a three-year $535,000 grant to the John
$25,000 to support the Early
A. Burns School of Medicine’s Family
Childhood Development
Medicine Residency Program’s Rural
Demonstration Project, which
Training Program at the University of
provides therapeutic services
Hawaii. The grant will help expand the
to children who do not meet
program by bringing physicians to Hilo to
age-appropriate developmental
do their residencies. This is an important
milestones.
step toward increasing the number of
family physicians in Hawaii’s rural and
Supporting people
underserved areas.
overcoming substance abuse.
Hale Naau Pono Hookaulike
18 / 19
HMSA A nnual R eport 2007
Improving quality of life for kidney
Project received a $50,000
disease patients. The National Kidney
grant to increase opportunities
Foundation of Hawaii received a $55,000
for substance abuse treatment
grant to help chronic kidney disease and
for native Hawaiians in the
dialysis patients become more active in
Waianae community.
Carol Ignacio
Director, Office for Social Ministry
Mobile Care Health Project
Since the late ‘80s and early ‘90s here on the Big
Island, access to dental services for the uninsured,
the poor, and people with disabilities has been
lacking. Mobile Care is the only safety net for
dental access on the west side of the island.
Currently, our two vans cover the entire West and
North Hawaii areas. One is kind of stationary in
Hamakua and that serves the Waimea-Hamakua
area, and our other van travels to Kohala, Kona,
up and down and all the way to Ocean View.
The people we see are all urgent care cases. We’d
get someplace at 8 o’clock, and there’d be lines
of people that had been waiting from 6:30 in the
morning.
We ran clinics for school kids who were uninsured,
and our dentists could not believe what they
were seeing. There were 9- and 10-year-olds
who hadn’t seen a dentist. The kids that the
dentists saw, some of them had had toothaches
for months.
I think HMSA and the HMSA Foundation have
been real partners with us. They’ve been our
major source of funding from the time we put
the first van on the road. They’ve understood
the need, and we haven’t had to jump through
hoops to get their support.
Last year, we didn’t receive our state grant-inaid funding, and one of the hardest things we
had to do was to begin to start cutting clinics
in October. We were ready to close, and it was
HMSA’s emergency grant funding that allowed
us to keep our doors open.
Community Giving
United Way
Hawaii Foodbank
For all the changes that have occurred over the past 70 years,
The United Way touches the lives of thousands of
Last year, teams of HMSA employees on
the same spirit of caring and community that gave rise to
people in Hawaii every year, and HMSA employees have
Oahu, Kauai, and the Big Island challenged
HMSA remains a vital part of the company’s culture today.
supported the United Way for more than 28 years. Last
each other through a friendly competition to
HMSA is committed to its mission of improving the health
year, HMSA employees gave more than $240,000 to Aloha
collect food items and monetary donations
and well-being of the people of Hawaii. We have a proud
United Way on Oahu. The pledge card campaign brought
to help the Hawaii Foodbank serve those
tradition of giving to the community as well as supporting
in more than $193,000. Other events organized to benefit
who depend on it. Overall, HMSA employees
activities, programs and partnerships that promote good
AUW included a craft fair, White Elephant Sale, silent
donated $15,300 and 7,800 pounds of canned
health for Hawaii’s families.
auction, and bake sale.
goods and other nonperishable foods to the
Hawaii Foodbank during Thanksgiving to
Last year, HMSA was proud to support 223 nonprofit and
community-based organizations with $752,300 in monetary
Blood Bank of Hawaii
contributions, sponsorships, donations, and in-kind
HMSA recognizes the vital role the Blood Bank of Hawaii
services. And throughout the years, HMSA employees have
plays to help save lives. In 2007, HMSA sponsored five
consistently answered the call to lend a helping hand to
blood drives at the HMSA Center, where employees
worthy causes.
donated a total of 407 pints of blood.
help alleviate hunger over the holidays.
HMSA Operations
Since our establishment in 1938, HMSA
Annual operating gains and losses should be
has operated as a nonprofit, community
viewed in the context of HMSA’s long and stable
service association. We feel strongly that
financial history. This history of good years and
this financial structure best serves our
bad years is described by insurance actuaries as
members. Our goal as a nonprofit is to
the underwriting cycle.
operate at a break-even level while providing
our members with a high level of health
care benefits. Throughout our long history,
an average of 93 cents of every dollar paid
to HMSA has gone directly to physicians,
hospitals, pharmacists and other providers
to pay for our members’ care. On average,
Operational
and Financial
Strength
In 2007, HMSA applied 97.5 percent of dues
to member benefits, such as payments for
physicians, hospitals and prescription drugs; 6.5
percent covered general administrative expenses;
and 4.0 percent was the net operating loss applied
to the reserve.
only 7 cents goes to run the association. This
HMSA paid $2 billion in benefits, equaling $7.9
is one of the highest benefit returns of any
million each working day. Of benefits paid,
health plan in the country.
hospital costs accounted for 45 percent, 34 percent
HMSA Operating Gains and Losses, 1982-2007
(Percent of Revenue)
5.0%
2.5%
0.0%
-2.5%
-5.0%
20 / 21
HMSA A nnual R eport 2007
'82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07
went to professional services, 19
percent covered prescription drug
Revenue and Expenses, 2005-2007
reserve came from years of prudent investments.
(In millions)
HMSA members can take comfort in knowing that
costs, and 2 percent for vision,
dental and chiropractic costs.
their health plan has adequate resources in times of
Electronic Claims Processing
$1600
Last year, 88 percent of HMSA
$1400
claims were filed and processed
electronically. This is just one
example of how technology helps
HMSA, our members, participating
physicians and employer groups
emergency. As the past few years have shown, Hawaii
$1800
is vulnerable to natural disasters, including heavy rains
and flooding, even earthquakes. Because the state
is both the gateway to the Asia-Pacific region and a
popular visitor destination for travelers from around
$1200
the world, Hawaii residents also could be exposed to
$1000
$800
new and drug-resistant viruses or illnesses with no
effective treatment.
'05
'06
'07
Financial Credit Rating
keep pace with advancements and
changes related to health care.
Every year, HMSA follows appropriate regulatory
standards and seeks an independent third-party review
Security
State law, the Blue Cross and Blue
by Standard & Poor’s (S&P). Based on credit and
Benefit Distribution, 2007
financial strength, S&P awarded HMSA an “A” rating
Shield Association, and regulatory
in 2007. This rating reflects HMSA’s stability, assets,
groups require HMSA to maintain
liquidity, and leading market position.
an adequate reserve to help
Financial Statements
moderate increases, strengthen
financial viability, and protect
Professional
Services
34%
our members with sufficient
financial resources in the event
of sudden or unexpected health
and economic challenges. In 2007,
HMSA reinvested 100 percent of the
investment income from its reserve.
The HMSA reserve is the result of
Cross and Blue Shield Association to offer a selection of
health care products and services under the Blue Cross
Hospital
45%
and Blue Shield brand names. HMSA is governed by a
Prescription
Drugs
19%
board of directors and is solely responsible for its own
debts and obligations.
A complete audited financial report for HMSA is
investment income generated since
our founding in 1938. The entire
HMSA is a mutual benefit society licensed by the Blue
available upon request.
Vision/Dental/Chiropractic
2%
Condensed 2007 HMSA Balance Sheet
Statutory Basis (in thousands)
What HMSA Owns
Cash and short-term investments
Investments
Bonds, at amortized cost
$222,397
Mutual funds
422,624
Marketable securities
829
Real estate
40,876
Investment in subsidiaries
52,474
Other
15,273
$36,538
Total investments
754,473
Receivables
Electronic data processing equipment, net
Other
56,070
9,432
18,755
Total assets
Condensed 2007 Statement of Operations
$875,268
What HMSA Owes
Estimated member claims outstanding
Membership dues collected in advance
General expenses accrued
Provision for experience rating
Premium deficiency reserve
Deferred taxes
Other liabilities
Total liabilities
$123,647
26,348
64,925
28,388
29,400
10,465
22,998
306,171
Resources Available for the Protection
of Members
Total resources available for the protection of members
569,097
$875,268
22 / 23
Total liabilities and resources
HMSA A nnual R eport 2007
Statutory Basis (in thousands)
Member dues $1,646,869
Member benefits
Medical and hospital claims
$1,554,079
Claims adjustment expense
51,965
Total member benefits
1,606,044
General administrative expense
106,506
Total expenses 1,712,550
100.0%
94.4%
3.2%
97.5%
6.5%
104.0%
Net operating loss
(65,681)
-4.0%
Net realized investment
and other income
Loss before tax benefit
Income tax benefit 41,045
(24,636)
2,048
2.5%
-1.5%
0.1%
Net loss $(22,588)
-1.4%
Michael J. Cheng
Senior Vice President
Richard S. Chung, M.D.
Senior Vice President
Robert P. Hiam
President & Chief Executive Officer
Cliff K. Cisco
Senior Vice President
Senior
Executive
Staff
Michael A. Gold
Executive Vice President, Chief Operating
Officer & Assistant Treasurer
Gwen S. Miyasato
Executive Vice President & Assistant Secretary
Steve Van Ribbink
Executive Vice President, Chief Financial Officer
& Treasurer
Alfred J. Fortin, Ph.D.
Senior Vice President
Georgiana Y. Fujita
Senior Vice President
Gordon R. Hilton
Senior Vice President &
Chief Information Officer
Linda J. Katagiri
Senior Vice President
Directors
Officers
Chairman
Allan R. Landon
Chairman of the Board & Chief
Executive Officer
Bank of Hawaii
Vice Chairperson
Board of
Directors
Carla J. Nip-Sakamoto, M.D.
Oahu physician
Secretary
Edwin M. Montell, M.D.
Hawaii physician
Treasurer
Steve Van Ribbink
Executive Vice President,
Chief Financial Officer &
Treasurer
Hawaii Medical Service
Association
Lorraine H. Akiba, Esq.
Partner
McCorriston Miller Mukai
MacKinnon LLP
Gene I. Awakuni
Chancellor
University of Hawaii‑West
Oahu
Andrew I.T. Chang
Vice President
Government Relations
Hawaiian Electric Industries,
Inc.
Michael J. Chun, Ph.D.
President
Kamehameha Schools
Ann H. Chung
Director
Economic Development
City and County of Honolulu
Daniel L. Colin
President
Territorial Savings Bank
Paul T. Esaki, M.D.
Kauai physician
Rochelle Lee Gregson
Chief Executive Officer
Honolulu Board of REALTORS
24
HMSA A nnual R eport 2007
Robert P. Hiam
President & Chief Executive
Officer
Hawaii Medical Service
Association
Louise K.Y. Ing, Esq.
Vice President & Director
Alston Hunt Floyd & Ing
Gary K. Kajiwara
President & Chief Executive
Officer
Kuakini Health System
Howard H. Karr
Retired
Former Vice Chairman
First Hawaiian Bank
Whitney M.L. Limm, M.D.
Oahu physician
Della M. Lin, M.D.
Oahu physician
Lisa M.K. Sakamoto
Vice President
Finance
Catholic Charities Hawaii
Michael R. Savona, M.D.
Maui physician
Michael H.T. Sia, M.D.
Oahu physician
Ronald I. Taketa
Financial Secretary & Business
Representative
Hawaii Carpenters Union,
Local 745
Luke Y. Teruya, D.D.S.
Oahu dentist
Roger J. Wall
Vice Chairman & Chief
Administrative Officer
Foodland Super Market, Ltd.
Rev. Msgr. Terrence A.M.
Allan Los Banos
Program Specialist/Safety
Coordinator
Masons’ Training Office,
Local 1 and Local 630
Beverly C. Nagy
Retired
Former Senior Vice President
Theo H. Davies & Co., Ltd.
Watanabe
Pastor
Holy Family/Saint Philomena
Parish
Robert W. Wo
President
C.S. Wo & Sons, Ltd.
The Hawaii Medical Service Association is a nonprofit, mutual benefit
coverage in the state. HMSA is a member of the Blue Cross and Blue Shield
Association, an association of independent Blue Cross and Blue Shield plans.
HMSA is dedicated to helping control Hawaii’s health care costs by providing
quality, affordable health plans, employee benefit services, and worksite
wellness programs. We are also committed to improving the health and
well-being of our members and all the people of Hawaii through a variety of
health promotion and education programs and other community services.
HMSA Annual Report 2007
(03) Comm1015-1064 4:08 GO
association founded in 1938. It is the most experienced provider of health care