Honolulu’s healthcare landscape continues to be driven by the 1974 Hawaii Prepaid Health Care Act that requires employers to provide insurance coverage. This has resulted in high rates of commercial enrollment. Honolulu’s low uninsured rate and the dominance of carrier Hawaii Medical Service Association mean that the health plan sector sees little change. The market’s health systems are highly consolidated, operating as large integrated delivery networks, and have been expanding outpatient operations throughout Oahu while driving value-based care through risk-bearing accountable care organizations. Honolulu’s independent practice physicians are creating their own capitated primary-care network to take on risk and gain greater leverage with payers.

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