1982 - SCF established as a 501c(3) nonprofit under the tribal authority of CIRI
1985 - SCF entered into its first self-management contract (dental and optometry), as authorized by the Indian Self-Determination Act
1987 - Assumed more of dental and optometry, and added behavioral health
1994 - Opened the first orthodontic clinic in Alaska for Native children; assumed psychiatric care and family medicine 1998 - Assumed management of the entire primary care system for the region 1999 - Assumed ownership and co-management of services for the Alaska Native Medical Center Today - 58,000 customer-owners; 1,400 employees; 60+ programs
Health care for indigenous peoples in the U.S. has been ‘prepaid’ by agreements related to land and resources- captured in numerous treaties and legislation. The organizational vehicle for fulfilling this obligation
is the Indian Health Service (IHS) Indian Self-Determination Act (1975) P.L.93-638
Efforts of “experts” who know what is best for Alaska Native people (healthcare professionals, missionaries, government officials) • Result has been loss of self esteem and confidence leading
to dependency • Healing and progress on the journey towards health only is
possible when the customer/owner takes control and leads the change.
SCF Services Primary Care Dentistry Optometry Physical Therapy Behavioral Health outpatient Residential Treatment for adolescents Residential Treatment for women Co-owner-manager of Alaska Native Medical Center
Our story Evidenced-based generational change reducing family
violence 50% drop in Urgent Care and ER utilization 53% drop in Hospital Admissions 65% drop in specialist utilization 20% drop in primary care utilization per patient 75-90%ile on most HEDIS outcomes and quality Childhood immunization rate of 93% Diabetes with 50% of HbA1c below 7% Employee Satisfaction 90% Customer overall satisfaction 91%
We asked Customer-owners Customer-owners said: • Unfriendly and rude staff • Guinea Pig for new doctors • Customers waited for everything Long waits for scheduled appointments, 4 to 6 hour waits in ER/Urgent Care common Long waits on phone, pharmacy, everywhere
• Little customer-owner input, not used in planning • Too much uncaring and inconsistent treatment • Risky place to go
What we did… We felt that the values were not aligned We understood that honor, dignity, respect, self confidence were critical We felt it critical to spend a lot of time in conversation with the Alaska Native community We felt it was critical to find ways to help the system think and act as one integrated system We felt strongly that the physical, mental, spiritual, and emotional well being needed to be put back together With out choices and values we:
Relationships between customer-owner, family and provider must be fostered and supported E mphasis on wellness of the whole person, family and community (physical, mental, emotional and spiritual wellness) L ocations convenient for customer-owners with minimal stops to get all their needs addressed Access optimized and waiting times limited T ogether with the customer-owner as an active partner I ntentional whole-system design to maximize coordination and minimize duplication Outcome and process measures continuously evaluated and improved Not complicated but simple and easy to use S ervices financially sustainable and viable Hub of the system is the family I nterests of customer-owners drive the system to determine what we do and how we do it P opulation-based systems and services S ervices and systems build on the strengths of Alaska Native cultures
Workforce Development • Up front training for Dental Assistants, Certified Medical Assistant and
Administrative Support • Alaska Native professional development • Hiring Practices – Same Day, behavioral based interviews, group interviews • Orientation and Mentoring intentionally • Development Center • Performance Development Plans, Job progressions, career ladders • RAISE Program, Summer and winter interns
Key – all staff trained to be expert in improvement
The key determinant of health (and success in education and finances) is Self Confidence Self Confidence draws from pride, honor, dignity, respect Outstandingly beautiful facilities are a key piece of improving
Goal: To end Domestic Violence Child Sexual Abuse and Child Neglect in this generation Objectives:
Call out the Warriors Methods to counter and break the silence Restructure systems Establish safe adults and environments Enhance existing resources and develop collaborations
Establish relationships with providers Continue to remove access barriers Relationship based on dignity, respect and trust Support customer-owner’s plan for health Evaluate success
Healthcare Provider Changes for Effective Relationships
No longer a hero but a partner Control does not equal compliance Replace blaming with understanding Give customer-owner options not orders Provide customer-owner with resources Make it simple
Advanced Access – appointments when the customer wants – same day primary care Service Agreements Behavioral Health Redesign Hospitalists in Pediatrics and Internal Medicine Information Technology services to support delivery of
