About HHP


Population Health Services

Population Health Services comprises a comprehensive set of support services that make care delivery easier for both patients and physicians. These services are designed to maximize physicians’ quality scores, support the PCMH model, deliver an exceptional patient experience, create positive relationships with physician practices, encourage shared learning, maintain data integrity in Cozeva, and understand and address the needs of independent physicians.

The Population Health Services team assists members with:

  • Needs assessments for clinic workflow and patient outreach optimization
  • Patient outreach campaigns to follow-up with patients on scheduling regular exams and procedures, which includes cancer screenings, childhood immunizations and Well Visits
  • Requests for reconsideration to HMSA related to patient attribution and quality measures
  • Cozeva support and training
  • Cozeva interface to Epic EHR for outcome-based quality metrics
  • Care planning, resources and services for patients with complex medical conditions


Eleanor Naone
Eleanor Naone, Care Coordinator 
Ph: 808-535-0972
Aileen Crisostomo
Aileen Crisostomo, Care Coordinator 
Kelson Oshiro
Kelson Oshiro, Care Coordinator 
Ph: 808-535-0967
Brian McClendon
Brian McClendon, Care Coordinator 
Stephanie Nobriga
Stephanie Nobriga, Care Coordinator 
Ph: 808-522-4583
Victora Gualdarama
Victora Gualdarama, Care Coordinator 
Hazel Madueno
Hazel Madueno, Care Coordinator
Ph: 808-535-0976
Richie Valentin
Richie Valentin, Care Coordinator 
Ph: 808-522-4525 

Leticia Ruiz, Care Coordinator, Kaua'i
Ph: 808-246-2957 

Lerma Catiggay, Care Coordinator, Kaua'i 


ACO Analytics

ACO Analytics provides timely and accurate data gathering, analysis and reporting to support the business and clinical management of Hawaii Health Partners’ attributed patient population.

ACO Analytics staff assist with:

  • Population health data analytics and reports distribution
  • Support and facilitation of contracts, programs, initiatives and patient outreach through data processing and analysis
  • Identifying trends, opportunities, gaps in care and high-risk/high-cost patient populations


Melanie Nordgran, Supervisor
ACO Analytics Management
Ph: 808-522-4130
Clementine Tran Tang
Clementine Tran Tang, Analyst
Tyler Barnett
Tyler Barnett, MHSA, Analyst
Ph: 808-535-0966 


Managed Care Services

Managed Care Services provides referral management for HMSA patients, directs appropriate care coordination of patients, and serves as a resource guide for providers.


Martie Tibayan, RN, Manager
(HMO and health center referral management)
Ph: 808-535-7262

Georden Hirai, Specialist
Ph: 808-535-7263

Rachelle Gallegos, Specialist
Ph: 808-535-7261 
Charlotte Hakikawa
Ph: 808-535-7261 


Clinical Project Management

Sally Belles, MBA-HCM, RDN, CDE, Project Manager
Ph: 808-522-3490

Barry Major, MBA, Project Manager
Ph: 808-522-3340

Zeyana Saad-Jube, PhD, MPH, Project Manager
Ph: 808-535-0965



Vanessa Sim, Manager, Provider Communications
Ph: 808-522-3744

Jeruzel Gonzales, Network Coordinator
Ph: 808-522-4557

Charlotte Mattice, Office Clerk

Complex Care

The Complex Care services are designed for patients with two or more major medical conditions. Our goal is to give the best care possible to patients and their families, in a holistic approach, to achieve the best outcomes. The care team works closely with patients and their families and assist with scheduling medical appointments, understanding and following instructions for taking necessary medications, receiving health education and identifying and accessing community resources. This ensures patients receive the right care at the right time at the right place.

  • Assistance with patient’s who utilize the ER often, frequent hospitalizations and have multiple chronic medical or social conditions
  • Augmenting care delivery for high-need, high-cost patients who may require community resources, assistance in aging in place or assist in facilitating long-term care
  • Patient/Caregiver engagement with face-to-face visits to assist with having a greater understanding and control of health risks and conditions who are classified as high and very high risk


Laura Pladson, RN, Program Manager
Ph: 808-535-0980
Aileen Crisostomo
Geldilyn Ebbay, RN, BSN, Care Manager
Ph: 808-535-0981
Julie Van Poele
Julie Van Poele, RN, BSN, Case Manager
Ph: 808-535-0967
Ryan Yamane
Ryan Yamane, LSW, Social Worker
Julie Aurio
Julie Aurio, RN, BSN, Case Manager 
Ph: 808-535-0970 

Meinard Agraan, RN, BSN, Care Coordinator 

Carrie Hermosura, RN, BSN, Case Manager, Kaua'i
Ph: 808-246-2958 


HealthAdvantage CONNECT

HealthAdvantage CONNECT is an integrated, provider-based EHR and practice management system that provides seamless integration between registration, scheduling, clinical documentation and billing, as well as access to clinical quality programs, including integrated chronic disease registries and best-practice reminders for preventive care. A dedicated HealthAdvantage CONNECT team provides implementation services, practice support and training.

Anna Smolentzov, Business System Analyst
Ph: 808-522-4386