Southcentral Foundation is a non-profit health care organisation serving a population of around 60,000 Alaska Native and American Indian people in Southcentral Alaska, supporting the community through what is known as the Nuka System of Care (Nuka being an Alaska Native word meaning strong, giant structures and living things).
Nuka was developed in the late 1990s after legislation allowed Alaska Native people to take greater control over their health services, transforming the community’s role from ‘recipients of services’ to ‘owners’ of their health system, and giving them a role in designing and implementing services. Nuka is therefore built on partnership between Southcentral Foundation and the Alaska Native community, with the mission of ‘working together to achieve wellness through health and related services’. Southcentral Foundation provides the majority of the population’s health services on a prepaid basis.
The Nuka System of Care incorporates key elements of the patient-centred medical home model, with multidisciplinary teams providing integrated health and care services in primary care centres and the community, co-ordinating with a range of other services. This is combined with a broader approach to improving family and community wellbeing that extends well beyond the co-ordination of care services – for example, through initiatives like Nuka’s Family Wellness Warriors programme, which aims to tackle domestic violence, abuse and neglect across the population through education, training and community engagement.
Traditional Alaska Native healing is offered alongside other health and care services, and all of Nuka’s services aim to build on the culture of the Alaska Native community.
Community participation and collaboration
Alaska Native people are actively involved in the management of the Nuka System of Care in a number of ways. These include community participation in locality based advisory groups, the active involvement of Alaska Native ‘customer owners’ in Southcentral Foundation’s management and governance structure, and the use of surveys, focus groups and telephone hotlines to ensure that people can give feedback that is heard and acted on.
As well as building strong relationships with the population it serves, the Nuka System of Care depends on collaboration between Southcentral Foundation and a range of local, regional and national partners. New collaborations are being established each year as gaps in services are identified and filled.
Since it was established, the Nuka model of population-based care has achieved a number of positive results, including:
- significantly improved access to primary care services
- performance at the 75th percentile or better in 75 per cent of HEDIS measures
- customer satisfaction, with respect for cultures and traditions at 94 per cent.
There have also been reductions in hospital activity, including:
- 36 per cent reduction in hospital days
- 42 per cent reduction in urgent and emergency care services
- 58 per cent reduction in visits to specialist clinics.