Francoise Culley-Trotman is the CEO of AlohaCare, which serves Hawaii’s QUEST Integration Medicaid and Medicare beneficiaries. AlohaCare recently partnered with Papa Ola Lōkahi to launch Ke Aloha Mau, where members can receive new Native Hawaiian health services, such as hula and lomilomi massage, as a no-cost benefit. 

AlohaCare’s initial utilization target for these services is 25 members each at six to eight sites, serving a total of about 200 people across six islands in the first year. In partnership with Papa Ola Lōkahi, AlohaCare looks to build up its capacity to serve more than 2,000 members in the initial rollout. 

In this Q&A, Culley-Trotman discusses AlohaCare’s vision for providing culturally informed health benefits to their members, as well as next steps to prepare for upcoming Medicaid redeterminations at the end of the federal public health emergency (PHE). 

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State of Reform: Can you explain the process that led to Ke Aloha Mau’s development?

Francoise Culley-Trotman: “We’ve always had a commitment to making sure that the services that we provide are culturally relevant. The pandemic presented the perfect opportunity, because it shone a light on different groups that were just experiencing disparities. It really motivated us to want to bring this to fruition. 

We started by reaching out to the community to really ask what they wanted and what their needs were, and getting their input on what would be beneficial to improving their health. We did listening sessions and a few community meetings, and we did additional research. Then we really started to envision and plan a culturally responsive way to support the health of our members. 

At the same time, we were expecting our QUEST Integration contract implementation to kick off. As we started coming out of the RFP and thinking about implementation, we identified a few key stakeholders who could help to achieve our goals. Papa Ola Lōkahi is not just a great partner, but their goals are so aligned with us. They’ve spent pretty much the lifetime of that organization just thinking about how we create better solutions for Native Hawaiians and other people who live on the island. 

As this was happening during the pandemic, all of us in Hawaii understood that this type of collaboration is really instrumental in reaching those who need us the most. It took about a year to solidify the relationship. As you can imagine, it wasn’t just about the contracting, the pandemic slowed things down considerably. I’m proud to say, thanks to both of our tenacity, we were able to build something based on a shared commitment to improve the health and wellness of Native Hawaiians and other Hawaii residents.” 

SOR: These new services aren’t currently covered by Med-QUEST, but AlohaCare is providing them without additional cost to the member. Do you see the servcies potentially being covered by Med-QUEST in the future?

FCT: “These particular services are known as value-added services. Value-added services are not included in the Medicaid core benefits package that the state covers. The health plans cover value-added services and for us, we use that opportunity to really create something that addresses a core need. 

We do see the services as central to the direction of health care our organization is moving towards. It’s no longer enough to just coordinate health care or to deliver a standard benefit package. We have to make it targeted to making a difference in someone’s overall care. For us, it’s a long-term investment in caring for our members and the whole-person health model. Native Hawaiian healing is just one component of that. 

Another good example would be the dental coverage that we’ve covered these past few years. It’s just recognizing where there’s a critical need that, without coverage, would be a barrier to someone taking care of their overall health and addressing that. Typically if we identify a need, we talk to the community and make sure that they feel it’s beneficial to their overall health. Then we look for the right partners for the solution. As far as the commitment, this is not a pilot for us. The current benefit package is covered through our contract period, but long term, we have this commitment to making sure that services are delivered in a culturally responsive way.”

SOR: Do the services differ depending on the island a member lives on?

FCT: “It does depend and it will vary from island to island, and I will say even from community to community. We have Hula, Lomilomi, Ho‘oponopono, and ‘Ai Pono. These communities tend to be unique and their needs are based on what’s happening in the environment … But we definitely have considered that as we designed a program. For example, we haven’t restricted anyone in a particular community to only being able to use a particular benefit. They’re all available. But in our rollout, what we’ve looked at is what is that community’s most immediate need.”

SOR: Regarding the upcoming end of the PHE, how will AlohaCare work with Med-QUEST and other partners to ensure smooth, continuous coverage for members during the redetermination process? 

FCT: “Right, they extended [the PHE], but [redeterminations are] coming. One of the things that we discovered during the pandemic is as health plans, we work well together, and we certainly coordinate really closely with Med-QUEST. We all want the best outcomes for our residents. What we discovered during the pandemic, though, is community-based organizations really stepped up to the plate, and they were embedded in their communities and really advocating for those communities. 

We’ve started working even closer with those community-based organizations to create a plan that will be approved by Med-QUEST of course, to really get the word out to help affected enrollees understand what they will need to do as the state starts to roll out their own redetermination processes. As I mentioned before, we are working alongside Med-QUEST and the other plan is to make sure that the messaging to our residents is consistent, that it’s clear. We want to minimize confusion and to make sure people feel supported throughout this process. Med-QUEST has started some of that work. So we’ll continue to work closely with them to make sure that no one that is currently covered gets mistakenly or unintentionally disenrolled.”

SOR: What other health issues will AlohaCare prioritize in the coming months?

FCT: “We’ve adopted the philosophy that whatever programs and benefits that we’re designing, we want to ensure that they address a core need. They’re helping to move not just our health articles for health outcomes forward, but they’re helping to advance our community. We know that in our state overall, there are certain common areas that are challenges for us. Whether that’s diabetes or substance abuse, we’re making sure that the programs we design are not just responses to the health outcomes, but that they’re culturally responsive. The pandemic has just really demonstrated our ability to impact overall care and to impact the health and wellness of our state really depends on how the individuals in our community respond to us, and their willingness to embrace those programs. 

We’ve increasingly found that communicating with someone in their preferred language, understanding their norms and culture, etc. really sets us up for success. We’re looking forward to doing that overall.”

This interview was edited for clarity and length.