The drivers behind the development of the model include:
- Management of services transitioned from federal management to management by the customer-owners.
- Doubling of Native population in ten years
- Long patient waits for health care services, including long waits for scheduled appointments, four to six hour long waits in ED, long waits on phone
- Lack of coordination among health care providers and settings
- System not designed around needs of the patient.
The goals of the model are a set of defined operational principles which are core to establishing and maintaining a system designed around effective relationships. For Southcentral Foundation (SCF), these principles are:
- Relationships between the customer/owner, the family, and provider must be fostered and supported
- Emphasis on wellness of the whole person, family, and community including; physical, mental, emotional, and spiritual wellness
- Locations that are convenient for the customer/owner and create minimal stops for the customer/owner to get all of their needs addressed
- Access is optimized and waiting times are limited
- Together with the customer/owner as an active partner
- Integration of services throughout all of SCF. No more islands
- One seamless system
- No duplication of services or roles and responsibilities
- Simple and easy to use systems and services
- Hub of the system is the family
- Interests of the customer/owner are placed first and the system is created around what works best for the customer/owner
- Population-based systems and services
- Services and systems are culturally appropriate and build on the strengths of Alaska Native cultures.
In 1975 the Indian Self-Determination and Education Assistance Act of 1975 Congress found “that prolonged federal domination of Indian services programs has served to retard rather than to enhance progress of Indian people and communities”. The Government recognized that “if the people receiving the health service are involved in the decision making processes, better, yet, if they own their own health care – programs and services have a potential for enhancement and the people and their health statistics will improve”. (P.L. 93-638)
Southcentral Foundation (SCF) began contracting services from the federal government in 1987 and completed the transition to a customer-owned system in 1999. Alaska Native leadership saw this as an opportunity to evaluate the health care system and to completely redesign the system to better meet the needs of the Alaska Native community. The entire health care system was redesigned based on the values and priorities of Alaska Native people under the leadership of Alaska Native individuals.
The first step in the redesign process was for Alaska Native leadership to define its business and its purpose. The leadership determined that its business was not about the delivery of tests, procedures and pills; it was about human beings. Alaska Native people were not just “patients,” a product or a thing. Alaska Native people were customers and owners of the business. The core product needed to become relationships—human, longitudinal, personal, trusting, informing, respecting, and accountable relationships.
SCF wanted to establish a health care model that would effectively address the majority of health care problems and concerns—chronic illnesses, long-term conditions, prevention, and wellness—rather than the traditional model that focused only on short-term, high-acuity problems. SCF realized that with the majority of health care issues, the customer-owners– not the provider or health system – has the most control over the outcome. (For example, the customer-owner decides whether to pick up the medicine providers prescribe, whether to take it as prescribed, whether to share it with their neighbors, whether to split it in half so it lasts longer, whether to stop taking it in a few days.)
In recognition of this, The Alaska Native leadership realized that the core product needed to become relationships—human, longitudinal, personal, trusting, informing, respecting, and accountable relationships. SCF decided it would dismantle anything not supporting these relationships, re-orient every piece of the health care system to optimize these relationships, assure whole system intentional and integrated design, and try to remove all barriers to these relationships being formed.
Southcentral Foundation receives between 35 and 40 percent of its funding from Indian Health Service, 47 to 48 percent from Medicare/Medicaid, and 10 percent from grants, contracts, and research.