Empowering Hawai‘i’s Healthcare Future: A Physician-Led Path Forward

Hawai‘i is blessed with extraordinary natural beauty and a strong sense of community, but our healthcare system faces challenges as vast as the Pacific that surrounds us. Physician shortages, geographic isolation, rising costs, and corporate-driven care threaten access, quality, and sustainability. It is time for an approach rooted in local values—one that restores healthcare decision-making to the people who know our communities best: Hawai‘i’s physicians.

The Physician Mutual and MSO Model: Local Control, Lasting Impact

A new model is actively forming through a joint venture between the Kenji MSO and Hawai‘i physicians to create a physician-led Risk-Bearing Entity (a To-Be-Named Physician Mutual), alongside a contracted MSO that provides scalable administrative support. The margin generated from the MSO will be used to raise the capital needed to finance the launch, with potential investment from physicians, strategic vendors, state and federal grants, and traditional capital providers.

This model is intentionally designed to keep outside investors at bay. All benefits flow back to Hawai‘i’s clinical workforce, ensuring that jobs, resources, and decision-making remain here in the islands—for Hawai‘i, by Hawai‘i. The MSO generates margin to finance growth, but those resources are reinvested locally rather than siphoned off to mainland corporations or private equity firms.

The Mutual keeps healthcare decisions in the hands of physicians, while the MSO provides the tools, capital, and infrastructure to put those decisions into practice. Together, they form a balanced system—grounded in clinical autonomy yet capable of operating at scale for Hawai‘i’s communities.

Physicians have already signed on and are actively helping shape the governance and structure. With approximately 3,000 Medicare beneficiaries still attributed in the 2025 class, the initiative is poised for meaningful impact. At the upcoming Hawai‘i Health Workforce Summit, physicians will be invited to help shape the next phase of development and explore participation options.

The discovery phase continues through August 2025, with physicians making a determination in September and finalizing participation agreements by December 2026. This timeline ensures thoughtful, values-aligned decision-making and avoids the rushed choices that have too often undermined healthcare innovation.

Why This Model Matters

Unlike corporate healthcare, where distant shareholders dictate priorities, Physician Mutuals are owned and governed by practicing physicians. The MSO provides the administrative backbone—billing, compliance, technology, and contracting—so doctors can focus on what they do best: caring for patients.

This isn’t just about efficiency. It is a return to the principle that healthcare decisions should be made by those who actually provide care, not executives thousands of miles away who have never set foot in our communities.

Benefits for Patients, Physicians, and Communities

Patients gain:

• Longer, more personal appointments

• Coordinated treatment across specialties

• Transparent pricing and fewer barriers to care

• Care rooted in cultural competency and local values

Physicians gain:

• True clinical autonomy

• Shared ownership and stability

• Relief from administrative burdens

• Protection from the commoditization of medical practice

Hospitals & FQHCs gain:

• Stronger referral pathways and reduced readmissions

• Improved specialty access in rural areas

• Shared quality-improvement initiatives

• Sustainable partnerships in value-based care

Home Care & Aging Populations gain:

• Direct physician oversight of care plans

• Expanded remote patient monitoring

• Safer, standardized care for seniors

• Stronger Medicare Advantage opportunities

Rural Hawai‘i Advantage

Rural and neighbor island communities stand to gain the most. With shared coverage models, telemedicine integration, and local reinvestment, physician-led organizations can address workforce shortages, expand access to specialists, and keep healthcare dollars circulating locally.

By reinvesting in our communities, we strengthen not just our health but also Hawai‘i’s economy and resilience. Physician-owners also bring cultural understanding, whether it’s honoring Native Hawaiian healing traditions or addressing the needs of immigrant families. Programs like telehealth for diabetes management, mental health outreach in isolated communities, and rotating specialist coverage are possible only when physicians have ownership and decision-making authority.

A Call to Action

The physician mutual and MSO model is more than a business strategy—it is a reaffirmation of Hawai‘i’s values of community, sustainability, and aloha. It creates a system where physicians are not just providers, but stakeholders who live here, raise families here, and are accountable to the people of these islands.

We stand at a crossroads. We can continue down a path dominated by mainland corporations that treat Hawai‘i as a profit center—or we can embrace a locally governed, physician-led model that puts patients, physicians, and communities first.

For physicians, this is a chance to reclaim clinical autonomy, secure the stability of your practices, and lead the next chapter of healthcare in Hawai‘i. For state leaders and policymakers, this is an opportunity to safeguard Hawai‘i’s healthcare future by supporting a homegrown model that keeps resources, jobs, and decision-making local.

The work is already underway. The opportunity is real. The choice is ours.

Scan the below QR code and go to KenjiREACH and sign up and encourage your peers and colleagues to join.

Hawai‘i deserves healthcare designed by and for Hawai‘i. Physician Mutual and the Kenji MSO model offer just that—a future where care is guided by doctors, rooted in our communities, and sustained by our values.