Some days the Lānaʻi Community Health Center acts as medical clinic, a communications hub, and a veritable travel agency all at once.
Besides seeing patients coming for regular appointments, staff may plan to have a patient come in for a telehealth visit with a specialist on another Hawaiian island. Yet another patient may need help getting an appointment with a doctor on Maui and traveling there, while a pregnant mom will want to arrange to deliver her baby on Oahu.
That mom is likely to take advantage of the health center’s tele-OB services before traveling to another island in time for the delivery.
Some of Lānaʻi's rural residents do not have stable internet access. So patients typically come to the health center for the telehealth visits, and staff stay with them to ensure a good internet connection and provide follow-up, said Jared Medeiros, the center’s Associate Medical Director.
“It’s a very different model of telemedicine,” he said.
The center also coordinates telehealth visits for other specialty services, including cardiology, dermatology, pediatrics, and psychiatry.
Lānaʻi is stunningly beautiful but smaller in size and population than most Hawaiian Islands, with about 3,300 residents. Prices of some goods are high, and Lānaʻi does not have some of the amenities available on the larger islands, making it difficult to attract full-time medical specialists, Medeiros said.
“Milk is $9 a gallon; there’s no Starbucks,” he said.
The center has 12 providers who fly over regularly to see patients at the center before flying back.
Patient travel is another challenge. Two small airlines serve Lānaʻi, but residents have learned that cancellations and other disruptions often interfere with travel plans.
“One of the airlines (the only one that Medicaid will book patients on) has been notoriously delayed or has canceled flights,” Medeiros said.
Health center staff sometimes juggle making referrals, setting up appointments and getting authorizations from insurance providers for both the appointments and associated travel expenses. Airfare recently averaged $320 for a round trip between Lānaʻi and nearby Maui.
Pregnant patients often must arrange to be on Oahu for several weeks before their due dates to ensure they are on the right island—where full OB-GYN services are available—when the baby arrives.
And while Medicaid will pay for necessary travel and lodging, other insurance plans may not, creating a financial burden for patients.
Cindy Figuerres, the center’s executive director, noted that staff have managed to adapt to their unique circumstances, creating deep ties with the community.
“This year marks our 20th anniversary.”