Southcentral Delivers ‘Nuka System of Care’ & Empowers Patients as Customer-Owners

In the beginning, it was a radical idea whose time had come. For decades, health outcomes for Alaska Natives were steadily declining under the old, linear medical model run by the federal government. Struggling under slow, inefficient services, long wait times, indifferent communication, a lack of cultural sensitivity, a revolving door of practitioners and – worst of all – poor results, Alaska Natives had one of the highest mortality rates in the country.

In 1982, determined to find a better way, the Cook Inlet Region Inc. (CIRI) threw out the old model and established the Southcentral Foundation (SCF), a non-profit, patient-driven healthcare system designed by and for Alaska Natives, who are no longer identified as patients, but as “customer-owners.”

Named for an Alaska Native word that means “strong, giant structures and living things,” the “Nuka System of Care” is a “whole health” approach to healthcare that is patient-driven, using traditional holistic healing methods practiced for thousands of years.

“Alaska Native people have assumed the entire role of healthcare delivery from the federal government, Indian Health Service under the Self Determination Act of 1975,” says Dr. Katherine Gottlieb, president and CEO of Southcentral Foundation. “The vision of CIRI was to assume this role… with final assumption of services in 1998. Delivery of healthcare for the population within the area has always been a goal for purposes of enhancing and improving services to the Alaska Native and American Indian people.”

Gottlieb, who is a tribal member of the village of Old Harbor, a tribal member and elected tribal council member for Seldovia Village Tribe, and an honorary member of the Native Village of Eklutna, says that the overhaul in healthcare services for Alaska Natives was based on simple questions that no one had ever bothered to ask: What do the people want? What would improve their lives? What would tribally-based healthcare look like?

“Southcentral Foundation redesigned the healthcare services based on the feedback of the people,” says Dr. Gottlieb. “Changes included same day access to their own primary care provider, being treated with cultural appropriate respect, facilities that reflected Alaska Native culture, healthcare improvements resulting in better care.”

Under this system, according to the SCF website, the primary focus is relationship building and shared decision-making between the patient and his or her primary care team—with the goal of attaining good health, as opposed to treating illness. The Nuka system provides access to over 80 programs, including medical, dental, behavioral, traditional and healthcare support services.

Today, Nuka serves nearly 65,000 Alaska Native and American Indian people living in Anchorage, Matanuska-Susitna Valley and 55 rural villages in the Anchorage Service Unit, covering almost 110,000 square miles in Southcentral Alaska.

Two decades after CIRI assumed total control of its healthcare system, the results are in: Nuka System of Care has not only survived, but has become a model and global leader in the management and provision of health services. From 2000-2017, SCF reported a 40 percent drop in emergency room visits; a 36 percent drop in hospital stays; 97 percent customer-owner satisfaction; and 95 percent employee satisfaction.

In recognition of its excellence and innovation in healthcare, the Southcentral Foundation received the 2017 Malcolm Baldrige National Quality Award, the only presidential award given to U.S. companies for performance excellence.

The success of the Nuka System of Care can be attributed to several aspects, says Gottlieb, including engaging the community, shared responsibility and building a strong infrastructure.

“Renaming patients to be called ‘customer-owners’ reflects the idea that Alaska Native people should be treated with respect and servitude, as well as the notion of shared responsibility in managing their health resources, programs and activities,” says Gottlieb. “It also incorporates living out the vision and mission of what we do, beyond just doing our day to day jobs, with the goal of achieving a Native community that enjoys physical, mental, emotional and spiritual wellness.”

Gottlieb says the Nuka System of Care has been duplicated in other areas of the United States by tribes and healthcare organizations, and has become a model for healthcare practitioners around the world.

Looking toward the future, Gottlieb says the main goals are to ensure the sustainability of the Southcentral Foundation for future generations to come while continuing to address the needs of the community today. But for the time being, delivering improved health outcomes for Alaska Native people is what drives her passion for her work.

“The joy of serving a community that is engaged and has a voice in their health system is powerful when implementation takes place through the strength of a dedicated, strong, intelligent workforce who are also a living, breathing part of our community,” says Gottlieb. “It’s the flourishing of lives being changed toward better health outcomes, the hope for our future generations due to what is being accomplished through the generation today.”