Southcentral Foundation (SCF) is a tribal organization that compacts with the Secretary of Health and Human Services under Title V of the Indian Self-Determination Act. Under SCF’s compact we carry out various Indian Health Service programs across our region for more than thirty years. SCF acts pursuant to tribal authority granted by Cook Inlet Region, Inc., an Alaska Native regional corporation designated by Congress as an Indian Tribe for purposes of Indian Self-Determination Act activities.
In accordance with its self-governance compact with the Department of Health and Human Services, SCF currently provides medical, dental, optometric, behavioral health and substance abuse treatment services to over 60,000 Alaska Native and American Indian beneficiaries. They live within the Municipality of Anchorage, the Matanuska-Susitna Borough, and the residents of 55 rural Alaska villages covering an area exceeding 100,000 square miles and larger than the State of Oregon. SCF employs over 1,600 people.
Today I will focus my remarks on two issues, services available to Alaska’s Veterans and their families, and my perspective on how the Nuka System of Care can inform the Department of Veterans Affairs’ efforts to care for Veterans and their families.
1. Services Available to Alaska’s Veterans and their families
Southcentral Foundation is very pleased to have the opportunity to discuss our evolving relationship with the Veteran’s Administration. VHA has a tremendous history of transformation and success in launching programs and trainings to develop concrete, operational skills critical for change in care. VHA is now moving to build a relationship-based health care culture that embodies mutual trust, empathy, and respect as a springboard for achieving personalized proactive patient driven care. This requires a new approach to culture change that involves leadership commitment, experiential training and systems alignment.
The collaboration in delivering services in Alaska has been going well. The discussions about expanded relationships in healthcare services and discussions around the future are exciting. The support of our elected officials, particularly Senator Begich, in these discussions, has been quite helpful.
It is now possible for all Veteran’s to receive clinical services from tribal clinics in rural and remote locations. The signed agreements, and the efforts by the VA to support this effort with local tribal representatives, have been very welcome and is successful. In the clinics that SCF directly manages, and the many other clinics scattered across Alaska, it is now possible for local Veterans, both Alaska Native and non-Native, to receive the full range of primary care services. This program is a big success with many hundreds of geographically isolated Veterans now receiving healthcare while expanding the financial stability of these remote clinics.
We have also had ongoing friendly and supportive conversations with Alaska VA leadership related to partnering more extensively in the Matanuska-Susitna Valley. We have offered to collaborate around pharmacy and radiology services, and to provide direct clinical services during times of low staffing in the VA clinic located there. As our clinic in the Valley is currently not at capacity, we are willing to find ways to avoid duplication of efforts and become more closely collaborative.
In Alaska, the only statewide healthcare infrastructure capable of delivering services in every location in the state is the tribal system. Our system at SCF is a nationally and internationally recognized best practice in the delivery of care. We encourage the continued exploration by the VA of the possibilities of using the tribal health system to deliver a wider and wider array of services to our valued Veterans in Alaska.
2. The Nuka System of Care informing the VA system of care
We are excited also that at a national level the VA has expressed a lot of interest in the SCF Nuka System of Care as a model to further inform the ongoing work within the VA around the Patient Centered Medical Home. The VA has a long history of supporting and partnering Veterans in ways that have been innovative and creative and providing our valued Veterans with high quality services. The VA has expressed interest in exploring with us the application of our Baldrige award winning Relationship-Based Nuka System of Care within VA primary care clinics.
Southcentral Foundation has created an aligned healthcare system with a clear mission, vision, values and goals, an investment in a culture where relationships are at the core and organizational systems support and sustain putting values into action.
In June, 2012, a group of VHA program office representatives and operational leaders began studying Southcentral Foundation’s (SCF’s) Nuka System of Care. A workgroup was formed to identify lessons learned and opportunities moving forward in support of VHA’s strategic goal of providing Veterans with proactive and personalized healthcare.
The purpose of the workgroup is to apply lessons learned from the SCF Nuka System of Care to facilitate transformational initiatives and alignment of VHA organizational systems to support relationship-based, Veteran centered care. The goal is to provide personalized, proactive Veteran centered health care in an environment focused on community and “communal reliance,” facilitating collaboration, communication and partnership within the health care team led by the Veteran. The workgroup outlined the requirements of achieving that goal as follows:
• Committed local leadership endorsing the principles of relationship-based, Veteran centered care and actively engaged in programming, including a VHA-adapted SCF Nuka Core Concepts training co-led by local leaders.
• Strategic integration with other existing transformational initiatives.
• Co-located, horizontally organized health care teams trained, coached and mentored in relationship-based, Veteran centered care delivery.
• Human, process improvement, technical and organizational systems that are aligned to support these health care teams as they deliver personalized, proactive health care.
• Transparent, readily available data focused on important aspects of care to inform treatment, develop improvements, and observe changes. Systems to routinely solicit feedback on the Veteran experience.
• Workforce practices that favor and support personalized, proactive health care delivery. These practices might include: adding relationship-building qualities to performance based interviewing, staffing models to provide continuity of care and support within teams in anticipation of leave, CME training and turnover, and engagement and endorsement from bargaining unions.
During FY 13, a relationship was established with the VHA and SCF in order to understand lessons learned from the Nuka System’s transformation so that the VHA can consider applying these lessons to their own journey. The VHA is developing content, based on their vision, values, goals, and key characteristics; establishing initial pilot sites to partner with the workgroup to develop and test the training approach and content; and, is identifying a larger pool of sites to participate in a more robust pilot process in FY14 that will include training, as well as key areas of alignment.
To date VHA employees including many senior leaders have attended SCF Nuka System of Care trainings and have held interactive conversations with SCF leaders. SCF and VHA are eager to further our work and relationship together but have been limited. It has been difficult to move through the contracting process that will formalize further work and relationship. Any assistance in formalizing this relationship is appreciated.
Thank you for the opportunity to testify today on behalf of Southcentral Foundation’s 60,000 Alaska Native/American Indian customer-owners.
Table of Contents