April Kyle, VP of Behavioral Health Services, Southcentral Foundation, United States of America
Pressures are mounting on health care organizations today to provide better care while also controlling costs. Engaging people in their own health care can both result in better health outcomes for patients, and ease the burden on the medical system. Southcentral Foundation (SCF)’s Nuka System of Care serves as an example of what can be achieved through a system transformation focused on customer-ownership and relationships.
In 1998, Alaska Native and American Indian people took full ownership of their own health care, with SCF (an Alaska Native-owned and operated organization) taking responsibility for primary care. The previous system suffered from long wait times, provided ineffective care that did not focus on the overall wellness of the patients, and was not culturally appropriate. SCF received feedback and direction from the Native Community and implemented major changes to the health care system, establishing the Nuka System of Care. The system transformation focused on two major elements: customer-ownership and relationships.
SCF does not refer to the people it serves as “patients.” This term sounds passive and does not reflect the level of engagement that SCF’s providers and customers have with each other and the customer’s health care. Rather, since the Alaska Native and American Indian people SCF serves are both customers and the owners of the health care system, they are referred to as “customer-owners.” This is not just a change in nomenclature, it signifies a change in the relationship between customer-owners and their care providers. Unlike a traditional system in which the patient often has a minimal role in their diagnosis and treatment, our customer-owners work together—in relationship—with their care providers to achieve overall wellness.
These relationships are another central element of SCF’s whole system transformation. SCF recognizes that each individual has more control over his or her own health outcomes than providers, and that when providers build strong, long-term relationships with customer-owners, they can more effectively help customer-owners achieve wellness. These relationships are also a focus among all direct care workers. Care providers work in teams in a shared, open workspace; the provider sits with the nurse, the case management support, and the certified medical assistant. This helps the team seamlessly address customer-owner needs. Behavioral health providers have also been integrated into primary care, with two behavioral health providers in each clinic working in close proximity to the care teams. Customer-owners have same-day access to a Masters-level clinician who can connect them with the right level of services.
SCF’s whole system transformation has resulted in improved health outcomes for customer-owners while also managing costs. ER visits for customer-owners decreased by 23 percent from 2008 to 2015, and primary care visits decreased by 25 percent during that same period. Behavioral health care has also improved; integration has reduced wait times for behavioral health intake from an average of 42 days to 7 days. 93 percent of customer-owners report satisfaction with the system, and SCF has also achieved 93 percent employee satisfaction.
SCF can pass on several lessons learned from its system transformation. First and foremost, organizations must not be afraid to implement changes to their practices. Major change can be difficult, and can face organizational resistance, but the potential benefits are too great to ignore. Effective change management and navigating employees through change requires strategy, including communication plans, easy-to-apply methodology, and early adoption and implementation. Another lesson learned is that it is often better to start small. For example, when considering changes to integration, it is better to start with just one or two teams, and to collect and incorporate feedback from them before launching changes system-wide. Leadership buy-in for change is also crucial.
SCF continues to incorporate feedback from customer-owners to refine and improve services. The story of SCF’s system transformation can serve as a valuable example to organizations seeking to move from volume- to value-based care. Being willing to implement system-wide change, engage people in their own health care, and focus on relationships can realize benefits for both health care organizations and the people they serve.