It is a system of care driven by direct feedback from Alaska Native people receiving services in the system -- referred to as customer-owners. And it is built on a foundation of long-term relationships, transfer of control to the customer-owner, integration of the mind, body and spirit, and a commitment to measurement and quality. This is SCF’s Nuka System of Care.
SCF is an Alaska Native nonprofit healthcare organization, established in 1982 by Cook Inlet Region, Inc., one of 12 Alaska Native regional corporations created by the Alaska Native Claims Settlement Act of 1971. SCF is an organization owned and managed by Alaska Native people.
The Indian Self-Determination and Education Assistance Act of 1975 put Tribes at the center of the choice whether or not to assume ownership and management of programs previously operated and administered by the Bureau of Indian Affairs and Indian Health Service. Alaska Native people chose to take on this responsibility and became “customer-owners” of their own healthcare delivery system through Compact agreements with the U.S. government. Through these alliances, and the paradigm shift from “professionals know best” to “customers know best” and the commitment to a relationship-based delivery system, SCF has redefined what it means to achieve wellness through health and related services.
The Nuka System of Care includes:
- The customer-owner is in the “driver’s seat” and voices needs and preferences through multiple feedback channels.
- Ownership is a shared responsibility.
- Operational Principles spell out R-E-L-A-T-I-O-N-S-H-I-P-S.
- By connecting with the same people at every visit, strong relationships can be formed with the teams that support you on your wellness journey. These teams get to know your values, goals, priorities and strengths.
- Promotes wellness beyond the absence of illness and prevention of disease.
- Addresses the physical, mental, emotional and spiritual dimensions of whole-person wellness.
Reflecting the values of the community they serve, customer-owners have the option of allowing their families to accompany them during visits with their primary care provider team in talking rooms, which are like living rooms with comfortable seating and no exam tables. The team includes a primary care provider, an RN case manager (who assists with care coordination and referrals, medication refills and test results), a certified medical assistant (who checks blood pressure, weight and height) and a case management support person who helps coordinate future appointments and navigate through the primary care center. The integrated care team’s members take pride in their ability to work together.
“Our community owns their healthcare system,” says SCF President/CEO Dr. Katherine Gottlieb. “Customer-owners become engaged by making personal behavioral choices on their journey of wellness.”
“SCF providers stop seeing themselves as the heroes who are going to save the patient, who do things to and for people,” Dr. Katherine Gottlieb explains. “Instead,” she says, “they partner with customer-owners on their journey to wellness.”
Many other health professionals are integrated into the primary care setting that make up a customer-owner’s wider integrated care team. For example, if customer-owners need to see a specialist, such as a nutritionist, behavioral health consultant or dietitian, these individuals rotate throughout the clinic teams to offer additional support to the customer-owner. Other medical specialists, such as cardiologists, are available on referral the same day at the Alaska Native Medical Center. Clinical options also include a Traditional Healing Clinic, which is available on a referral basis and encouraged as a complement to western medical treatment.
Strong and effective relationships are necessary across the organization to accomplish goals, objectives and work plans. Building a culture of trust, based on relationships, encourages shared decision-making and supports innovation and creativity. A three-day mandatory Core Concepts training, led by the president/CEO, helps employees understand how their relational styles impact others, how their experiences affect how they approach and build relationships, and how to articulate and respond to each story in everyday work and life.
While SCF’s employee and customer-owner satisfaction are well above national averages, the Nuka System of Care has reached a number of highly impressive outcomes since its inception in 1982:
- 50 percent reduction in emergency room and urgent care visits
- Cultural respect is 99.2 percent
- Three quarters of measures for illness prevention, screening, and chronic disease measurement are in the top 25 percent