The Southcentral Foundation (SCF) provides primary outpatient healthcare to 45,000 Alaskan Native and Native American people in the Anchorage area and another 10,000 people in remote villages, some of them accessible only by air. It began as a single dental clinic in 1982, and has grown to an award winning healthcare organization that operates a small hospital and manages more than 60 health programs, clinics and other services. But growth alone is not the stated goal. The website asserts, "It's all about relationships."
SCF developed the Nuka System of Care, which is described as "a collaboration of organizational strategies and a processes, medical, behavioral, dental and traditional practices and supporting infrastructure that work together-in relationship-to support wellness.” Nuka is an Alaskan Native word that means strong, and that also signifies giant structures and living things. SCF is funded by the Indian Health Service (IHS), Medicare, Medicaid, private insurance, grants, and philanthropy. The system won a Malcolm Baldrige award for quality in 2011.
Mark Trahant, a member of the Shoshone-Bannock Tribes and a former Kaiser Family Foundation media fellow, calls the organization a model for excellent, community-managed, low cost care. Writing in the Seattle Times, Trahant notes the entire Indian Health Service was federally operated until 1976, when some tribes, community groups and nonprofits began local management of organizations such as SCF. Trahant quotes Donald Berwick, MD, the former head of the Centers for Medicare and Medicaid, as saying the Indian Health Service’s ability to execute is "stunning." Berwick has said the IHS is trying to deliver the same or better care with half the funds available to other U.S. health systems.
Under the Nuka care system, hospital admissions, emergency room use and specialty visits have all been dramatically reduced while patient outcomes have improved. Ninety percent of children get needed immunizations by age two, the percent of diabetic adults with blood sugar under control ranks in the top 10 percent of a national benchmark, and employee and customer satisfaction rates are more than 90 percent.
A New York Times editorial "A Formula for Cutting Health Costs" lauds the work of the SCF and notes that many of its techniques could be adopted by any healthcare organization willing to transform its culture.
These include: patient care teams consisting of a physician, nurse, and assorted medical and behavioral specialists; data that allows teams to evaluate their clinical and financial performance and compare it with colleagues and national benchmarks; focus on the needs and convenience of patient rather than providers; and building trust and long term relationships between patients and providers.