Mike Sayama: Establishing a Coherent Business Model With MACRA


As Executive Director of Community First, one of NRHI’s two member Regional Health Improvement Collaboratives (RHICs) in Hawaii, and Vice President and Executive Director of Learning Health Homes at Pono Corporation, Mike Sayama works to create a sustainable health care system through payment reform, information integration, care coordination, and community engagement.

During the July MACRA Peer to Peer event, he calmly, yet passionately, called for an understandable, sustainable business model to allow providers to be successful under MACRA.

“When you think about it, our doctors are islands operating on islands,” is how he described the small, rural practices that are members of his RHIC. By necessity, they are innovative and flexible in terms of the care they give, interconnected with social service agencies, and closely involved in helping patients to figure out insurance coverage and affordability.

“I believe that the direction that MACRA is going is correct – value over volume,” says Mike. “But what makes it impossible is that if they have to deal with MACRA plus other commercial plans which have different payment structures. That just creates an impossible situation for them to manage all that.”


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