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Transforming Health Care Delivery

May 2017

Debates about the best way to deliver U.S. health care are not new—some of the earliest date back more than a century—but there’s no question that they have intensified in recent years. Today, major changes to the landscape of American health care are taking shape before our eyes. Health funders do not always agree about the optimal form these changes should take, but there is a shared commitment to improved population health outcomes, increased access, and reduced costs—and consensus that much work is needed to achieve these goals.

A new GIH report describes an innovative and transformative approach to health care delivery called the Nuka System of Care. Developed by Alaska’s Southcentral Foundation, the Nuka System of Care has achieved dramatic improvements in access to, and quality of, care for rural, low-income Alaska Native communities. Members of these communities face major disadvantages at every stage of the lifespan. They experience high rates of child abuse and neglect, domestic violence, sexual assault, alcoholism and substance abuse, and suicide, along with higher than average mortality from a variety of conditions including cancer, heart disease, diabetes, and lung disease.

Despite the complexity of these social and medical challenges, the Nuka System has, among other accomplishments, significantly decreased emergency department use rates, increased access to primary care services from two weeks to same day, and achieved satisfaction rates above 90 percent for both customer-owners and employees.

The key to Nuka’s approach is viewing patients as customer-owners who have both an ownership stake in the organization and a meaningful role in decisionmaking. From this perspective flows a system that supports long-term, trusting relationships between customer-owners and their primary care providers; that treats customer-owners with respect and dignity; and that makes services accessible at any time. Integration of providers from other disciplines—e.g., behavioral health—and a team-based approach to service delivery complete the picture of redesigned service delivery.

Most of the Southcentral Foundation’s funding is from the federal Indian Health Service and third-party payors, but philanthropic investments have played an important role in Nuka’s evolution, particularly in the establishment of a Learning Institute for sharing innovative practices with other health systems. Philanthropic dollars can also be an avenue for replicating Nuka in other communities. Full replication would be difficult, because of many elements that would have to be in place, but primary care providers can still replicate discrete aspects of the Nuka system, such as its model of team-based health care delivery.

The traditional health care system struggles to provide high-quality care to patients like Nuka’s customer-owners and often falls far short. The Nuka System’s successes are encouraging evidence that imagination, resourcefulness, and a commitment to population health can lead the way to transformational improvements in health care delivery.