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Tackling Health Disparities in the Aloha State


Hawaii ranks as the healthiest state in the nation, as it has for much of the last decade, according to America’s Health Rankings. Overall, it has low rates of obesity, the lowest rates of preventable hospitalizations and among the lowest levels of children in poverty. And with its agreeable climate and high levels of income, it might be easy to see this health care story as a relatively simple one.

The reality, however, is more complex. In order to get the full picture, you have to dig deeper. You’ll discover stories from people like Belinda*, a single mother who lives with her children out of their van on Oahu. 

Belinda is among the 6,530 homeless people living in the state in 2018, and though it’s gone down slightly from previous years, that’s still one of the highest per capita rates in the nation. What’s more, Hawaii has one of the highest costs of living in the United States — particularly for housing — which means the state minimum wage of $10.10 an hour carries a lot less buying power than in other states. 

A fragmented transportation system also makes it more difficult for low-income Hawaii residents to meet basic needs like going to a job interview or the doctor. 

These disparities can be particularly difficult for native Hawaiians and Pacific Islanders — who are more likely than others in the state to be affected by chronic diseases like diabetes, obesity and the effects of smoking. 

How can these disparities be addressed? With the help from a $4.5 million award from the Centers for Medicare and Medicaid Services (CMS), UnitedHealthcare has implemented the Accountable Health Communities Model on the island of Oahu, home to roughly 70 percent of the state’s residents. The goal of the program is to assess and connect eligible individuals to social services when they enter an emergency room or clinic at three partner providers on the island. In turn, the program will help answer: how does meeting these social needs help people be healthier and affect total health care costs?

Take Belinda. When she went to the local ER, she took the project’s survey on a tablet and made a connection with a care navigator. 

Although she had no phone, the care navigator for the program was still able to build trust with her and schedule follow up appointments. Ultimately, the navigator was able to successfully connect Belinda with the homeless outreach agency in her area so the family could find shelter together. 

They are now living in a shelter and on track for a permanent home. 

“This project connects health care and human services,” said Katherine Keir, UnitedHealthcare Hawaii state director. “We know that an individual’s social barriers impact their ability to maintain good health. Things like housing instability and quality, food insecurity, interpersonal safety, lack of transportation and affordable utilities. And the Model will help us identify and address those needs.”

An example of the self-administered survey available at providers on the island.


The award runs until 2022, with a goal of 75,000 comprehensive screenings of eligible Medicaid and Medicare recipients every year. Importantly, they do not need to be UnitedHealthcare members to participate. On an island of about 975,000 people, the goal of everyone involved in the project is to make sure that the “Healthiest State in the Nation” is healthy for as many people as possible. 

The project described was supported by Funding Opportunity Number CMS-1P1-17-0010 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

*Belinda’s name was changed in order to protect her identity.