Waikiki Health, which provides free and low-cost medical services to more than 9,000 patients, is expanding its facilities in anticipation that demand could nearly double as the population grows and as more people are connected to medical services under the Affordable Care Act.

"Demand for our services has increased dramatically," said Bryan Tali­sa­yan, Waikiki Health’s chief operations officer. "We’re bursting at the seams."

The February opening of a long-awaited 10,000-square-foot, two-story administrative and medical building with on-site parking at 935 Maka­hiki Way is aimed at alleviating population growth at Waikiki Health’s six existing locations, which saw a 62 percent increase in patient usage from 2010 to 2012, said Kelly Joseph, Waikiki Health’s chief of marketing and development.

"On most days at our Ohua clinic, which serves 75 percent of our total patients annually, it’s standing room only with at least 25 people waiting to receive medical and behavioral health services, while all 15 exam rooms are filled," Joseph said.

Waikiki Health already has extended its hours and added additional providers. However, Joseph said patient growth and the need for dental services supports the $1.8 million expansion.

"Our patients are anxiously awaiting dental care," Joseph said. "We haven’t had the space to offer it to them before."

The Makahiki clinic will offer eight additional medical exam rooms and space to assess behavioral health. The new facility also will include seven dental chairs and a private room to accommodate pediatric clients or those who require more complex procedures.

"During the first 12 months of operation, we pro­ject the new clinic alone will provide 8,000 dental visits, 3,500 medical visits and 1,500 behavioral health visits," Joseph said.

Joseph said patient projections reflect demand for dental services as well as increases from people who are newly insured under the Affordable Care Act and are looking for reasonably priced health care providers. Waikiki Health expects volume at all of its clinics could range from 13,000 to 17,000 patients, she said.

What’s not clear is how many of the added clientele will be paying customers.

"We’ve always had the culture of providing access regardless of the patient’s ability to pay or insurance status," Tali­sa­yan said.

Fulfilling this mission last year meant more than a third of the 9,315 patients who visited Waikiki Health were uninsured, he said. However, once the state’s insurance marketplace, the Hawai‘i Health Connector, gains traction, Waikiki Health may see the number of uninsured patients drop, Tali­sa­yan said.

The volume of patients whose visits are covered through private insurance, Medicaid or Medicare also could rise.

"Previously if patients made too much money, they couldn’t get into the Medicaid system, and even if they could, it was a three-month wait," Tali­sa­yan said. "While we don’t know exactly what the Connector will look like yet, we expect that it will provide greater access to care for people."

Waikiki Health has hired two patient navigators to help raise public awareness of ACA changes and to encourage customers to enroll in qualified health plans and other health programs such as Medicaid and the Children’s Health Insurance Program.

"We will facilitate the selection of health plans and refer consumers to other programs when necessary," said Luisa Prea, Waikiki Health patient navigator. "The aim of ACA is to increase the quality and affordability of health insurance, to lower the number of people who are uninsured and reduce the overall costs of health care. There are many ways that this will increase coverage and affordability."

Prea said the law requires insurance companies to cover all applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or gender. Additional reforms aim to reduce costs and improve health care outcomes by emphasizing quality through increasing incentives, competition and regulation, she said.

Since costs to the insured are typically lower at community health centers than at private health care providers, Tali­sa­yan said Waikiki Health may get more patients as more Hawaii residents enroll in the Connector.

Under ACA, Waikiki Health will continue to play a key role in helping some of the most underserved populations in Hawaii by offering quality medical and social services to everyone, Prea said. However, she said navigators will focus on helping people get insured when they do not qualify for the Quest plans and currently cannot afford to pay for their own private plans.

"This will reduce costs for Waikiki Health and for the community," Tali­sa­yan said. "It also could cut down on the number of people who delay care until they get to the emergency room. Generally, we think people who have health insurance are more likely to seek out the services that they need."