In Hawaii, we live an average of 81 years— longer than almost anywhere else in the world. But when it comes to successful aging, the key is to not only live longer, but to live longer as a healthy individual. The way to better health is taking care of ourselves as we age, which helps prevent the decline of our physical and mental abilities. And although any doctor would agree with that, the health care industry has traditionally emphasized treatment over prevention. But things are changing. A new model of health care is emerging—the Medical Home. It focuses on preventive, patient-centered care and has been gradually taking shape nationwide. Dr. Rio Banner, medical director at AlohaCare, tells us about this fundamental shift in our health care system and how it may contribute to a healthier you. As a preventive health specialist, he also gives us a rundown of ways to stay healthier, including cutting-edge therapies that some believe may help to restore a more youthful health.
GM: Can you begin by telling us a little bit about your background in the medical field?
RB: Of course. I received my medical degree in 1970 and have a master’s degree in public health, which I earned from the University of Hawai‘i at Mānoa. My interest in medicine was inspired by my cousin, who was a medical missionary in India while I was in high school. After my training, I chose to study public health in Hawai‘i because of its cultural diversity. My 16 years at Wai‘anae Coast Comprehensive Health Center (WCCHC)— first as a staff physician, then additionally as medical director—were so exciting because I was helping everyone from Native Hawaiians to immigrant Southeast Asian families. What a great experience.
GM: Now you’re the medical director at AlohaCare. How did that come about?
RB: Back in 1994, the state decided to take bids for the managed care of QUEST, which is Hawai‘i’s Medicaid care for low-income families. At WCCHC, which serves a majority of QUEST recipients, we were concerned that our patients’ care would be diminished, depending on who won the bid. So, we decided to partner with several Hawai‘i community health centers and individual health care providers to create a self-governed, island-wide, non-profit, managed health care plan called AlohaCare that would serve this population best. I left WCCHC at that point to be medical director of AlohaCare and have been here ever since. I’m also an internal medicine consultant at Kahi Mohala Behavioral Health Psychiatric Hospital.
GM: Can you explain to us what’s happening in health care today? Seems preventive care is a major component of the paradigm shift.
RB: That’s right—it is. You know, we take preventive measures in other aspects of our lives all the time without thinking about it. For example, most of us understand that changing our car oil periodically will help our car run better and longer. And, it can cost less than fixing the problems that could otherwise develop. Same with people! So this is the direction health care is heading. The recent Health Care Reform is said to be based on the philosophy of prevention.
GM: Can you outline the foundations of this new health care model?
RB: It’s called the Medical Home model, and it’s been developing since at least the 1960s—in fact, Hawai‘i’s community health centers have been using core aspects of it for years. In a nutshell, it’s a fully interactive, team-based approach to care.
Who’s on the team? To begin with, you are. You are the center of the team. You know yourself best, and you are the only person who can make healthy lifestyle choices for yourself. Supporting you are health care providers, such as a primary care provider, nurses, specialists and insurers; other experts, such as behavioral health specialists, dietitians and outreach workers; and, if you choose, your family members. Your team works together, creating a web of health care knowledge about you and supporting your optimal health, both when you’re well and when you’re not.
GM: What do you mean when you say “your team works together”?
RB: First of all, a major component to teamwork is sharing information. Organizations are going electronic with health records, enabling providers to pull up a patient’s medical history, including pharmaceuticals, on the spot. That means your entire Medical Home team—including you—will be able to easily review your complete medical records and make better health care decisions because of it.
Second, the way we interact with our doctors is going to change. You’ll still have a “home” doctor, or primary care provider. But instead of just seeing one doctor at a time, as we typically do today, you may sometimes see several providers—say, for example, your primary care provider, a nurse practitioner and a specialist—all together in the same room during your appointment to talk about your care. G
GM: For those of us in our older years, how’s this new model of care going to be a benefit?
RB: Seniors will find this team-oriented health care approach helpful for many reasons. According to the U.S. Census, about 80 percent of older Americans have at least one chronic health condition, and 50 percent have two or more. Naturally, then, they tend to spend more time at the doctor and take more medications than younger folks. It becomes increasingly difficult to navigate the health care system and track prescriptions, follow-up appointments, test results, etc. But the new system keeps dots connected and you at the center of the action. The result? Better care and ultimately better health.
GM: Intuitively speaking, this sounds really great. But what’s it going to cost us?
RB: What’s expensive is fixing a car after it breaks down, instead of taking better care of it in the first place. That’s what the U.S. is doing now, and costs are through the roof. Of course, that’s a simple answer to a complex question. Sometimes this kind of care may cost a bit more, depending on a patient’s situation. Other times it may cost far less, especially when preventive care is embraced. Numerous studies and pilot programs have been done on the Mainland, even by private employers such as Boeing, with overall results showing a huge cost savings.
GM: In the meantime, what can we “older folks” start doing to improve healthy longevity?
RB: I want to say this loud and clear: It’s never too late to improve your health. I hope your readers take this to heart and really start living these suggestions today. Eat nutritious, diverse foods. Exercise every day and maintain a healthy weight. Control your cholesterol level. Take calcium. Drink plenty of water. Always use sunscreen. Get medical screenings on time, such as for prostate cancer, colorectal cancer and glaucoma. Wear your seatbelt. Set up your household to be free of things you can trip over, slip on or fall from.
GM: Will do. And you promised you’d have something “revolutionary” in the area of anti-aging. What is that?
RB: That’s right. I’m the father of 13-year-old twin girls, so I have good reason to want to be at my best for as many years as possible. As AlohaCare’s medical director, one of my roles is to research innovative solutions for better health care. And I’ve become very excited about two emerging preventive care opportunities that may soon revolutionize not only the way we think about aging, but literally how we age.
The first is the explosion of knowledge about our genes—the “information” packets found within the center of each cell in our body. Since the chemical structures of the human chromosome were discovered about 60 years ago, scientists are finding not only the molecular causes of disease, but also the specific treatments for them. Because each person’s genetic code is unique, we’re on the verge of understanding a specific personal prevention, prescription or treatment for each of us to best face age-old challenges such as diabetes, arthritis or cancer. This will be truly personalized care.
A second opportunity is optional hormone replacement therapy. I’m not referring to certain controversial name-brand hormones currently prescribed for menopause. Rather, they are natural hormones that are exact matches to our body’s hormones, not synthetic molecules. As men and women age, the levels of our natural hormones, such as estrogen, progesterone, testosterone, melatonin, thyroid and Vitamin D, gradually decrease. The more they drop, the more they result in bodily deterioration, which includes anything from fatigue and loss of skin tone to depression, osteoporosis and cancer. By boosting our hormone levels to our younger levels, we can actually improve our immunity and nervous system, and slow deterioration, thereby helping prevent injury and illness.
GM: Wow. As you continue your research on these subjects, we hope you’ll drop by Generations Magazine again and tell us more.
RB: I certainly will!
About AlohaCare – AlohaCare was founded in 1994 by local community health centers to provide managed health care for Hawaii’s most needy and under-served individuals. The non-profit organization has since grown to Hawai‘i’s third largest health care insurer, providing Medicaid (QUEST) and Medicare coverage for more than 75,000 members across the state. AlohaCare contributes to the health of Hawai‘i’s communities by improving access to health care; promoting quality care and disease prevention; and supporting health partnerships, projects and education.