‘Customer Ownership’ at the Forefront in Alaska

SCF recognizes that individuals have more control over their health outcomes than their providers and works to foster a system in which providers and customer-owners form trusting, long-term relationships. This trust enables providers to understand the influences in a person’s life and identify core issues impacting that person’s health. When customer-owners begin receiving services at SCF, they choose their provider and primary care team from a list that includes provider biographies and photos, in a process called empanelment.

SCF supports relationship building for employees and offers training to develop skills that nurture relationships. One example is SCF’s Core Concepts Workshop, a three-day interactive training program that teaches employees how they impact others, how to share and receive stories, how to understand their personal and professional ambitions, and how to engage in good dialogue and productive conversations. The tools taught in Core Concepts are designed to help employees form healthy relationships with customer-owners and with each other.

From the beginning, SCF recognized innovation comes from the ground up and sought customer-owner guidance on how to improve the healthcare system. Using the feedback it received, SCF established a set of relationship-based and culturally appropriate operational principles. These principles became the standard by which all improvements, innovations, and proposed changes are judged.

Overall redesign of a healthcare system allows for fundamental rethinking, a feat seldom possible with incremental change. SCF’s Nuka System of Care includes a number of approaches and best practices that previously had not been implemented to serve the Alaska Native and American Indian population on a scale as large and comprehensive as SCF’s approach. All improvements were modified as needed to ensure alignment with the operational principles.

Behavioral health integration

Furthermore, SCF redesigned its behavioral health service and integrated it into primary care based on customer-owner input. Now, customer-owners have same-day access to a master’s-level clinician stationed in the primary care clinic. Understanding customer-owners’ stories and the issues they face enables clinicians to connect—even in a brief encounter—and recommend the right level of services. Customer-owner needs are often addressed with a brief intervention by the clinician; if further services are needed, the customer-owner can be referred to an intake with a psychiatrist or therapist, given community case management, or referred to one of SCF’s learning circles.

Learning circles are a form of group therapy where customer-owners work through similar problems and share their experiences with one another. They represent a shift in the way care is offered: For the circles to be effective, behavioral health providers must take part in the sessions, rather than just lead them, and must develop good relationships with participants.

Wellness care plans

Wellness care plans are another example of how SCF delivers relationship-based care. These plans are individualized and co-created by the customer-owner and the integrated care team. A customer-owner may choose to have a wellness care plan, or have a more in-depth plan created if there are issues or concerns that cannot be solved through testing, medications, or consults.

When customer-owners have numerous healthcare encounters such as hospital admissions,  ER visits, or other specialty visits, SCF does not criticize, restrict visits, or impose a change in provider. Instead, it looks for ways to partner with customer-owners to help them reach their wellness goals. Primary care teams work with customer-owners to create a wellness care plan that addresses the root issues as defined by the customer-owner. Customer-owners can be referred to specific services that they and their provider think would be beneficial, including behaviorists, dietitians, learning circles, physical therapy, traditional healing, and chiropractic care. SCF has a robust data-tracking system that allows for the impact of those services to be evaluated in real time. The relationship between provider and customer-owner is key to creating and implementing the wellness care plan.