Photo by Amanda Gragert Mark Gorman, interim president and CEO of SouthEast Alaska Regional Health Consortium, stands in front of Mt. Edgecumbe Hospital.
SEARHC is first and foremost a Native health care organization, with a mission "to provide the highest quality health services in partnership with Native people." In some communities, such as Haines and Prince of Wales Island, SEARHC has been asked to step in and provide services to non-Natives by establishing what's known as a Section 330 Community Health Center. HRSA (pronounced HER-suh, the federal Health Resources and Services Administration) funds these clinics as part of its mission to provide services to medically underserved areas/populations. We also operate the Front Street Clinic in Juneau, which serves the homeless. SEARHC provides basic health care services to Natives as guaranteed under Article I, Section 8 of the Constitution and numerous treaties. Non-Natives using SEARHC services are billed the same way they would if they used any other provider unless they are eligible for sliding fee care in one of our community health center clinics.
What are the health concerns Nativesface today?
The most pressing health status issues facing Alaska Natives and American Indians are similar to the American population as a whole.
We are seeing alarming increases in obesity, heart disease, diabetes, tobacco use, cancer, injuries and behavioral health problems. All of these have a significant lifestyle component to them. Pursuing positive changes in diet, physical activity levels and tobacco use are required to improve these health status trends.
Additionally, we face skyrocketing health care costs and the ability to attract enough qualified medical providers to our remote region. Our costs are growing at a rate of 12-15 percent a year, and our Indian Health Service funding hasn't kept up with costs, going up maybe a half to 1 percent a year. That means we've had to look for other sources of revenue, such as patient revenue or state and federal grants, to provide our services. Complicating matters is Alaska's doctor shortage, where the state is 500 providers short of its needs.
Tribal health organizations such as SEARHC have had to come up with innovative ways, such as hiring more mid-level providers and training Community Health Aide Practitioners and Dental Health Aide Therapists, to fill the gaps. SEARHC also developed the Community Wellness Advocate program (training local residents who promote healthy activities within their communities) to promote healthy activities and prevent people from developing chronic illnesses such as diabetes and heart disease. We manage training centers in Sitka for the CHAP and CWA programs, serving students from all over Alaska.
How does prevention play a partin healthcare?
Over the last few decades our country has seen a shift where many of our biggest ailments today result from lifestyle choices rather than infectious diseases.
By promoting healthier lifestyle choices and regular screenings for Native adults and children, SEARHC is helping reduce the risk of diabetes, heart disease and other chronic illness in its patients.
SEARHC is taking a pro-active approach by focusing more resources than ever on preventing disease before it occurs, rather than waiting for patients to come to our facilities already suffering from a serious illness. But there's a lot more that needs to be done.
Alaska Natives and American Indians have the highest rate of tobacco use of any major ethnic group in the country, and tobacco use (and secondhand smoke) has been proven time and again to cause cancer, heart attacks, strokes and lung disease.
A growing problem is diabetes, and the rate of Native adults 35 and older with diabetes has more than doubled over the past decade. Most major health problems can be delayed or prevented by teaching people how to live healthy lifestyles.
What are the challenges to providing health care for people across such a large and rural region as Southeast Alaska?
One of the biggest challenges to providing health care across a large region is making sure people in the most remote communities have access. With the diminishing reliability of ferry service and the ever increasing cost of air transportation, moving patients around the region has become prohibitively expensive. As recently as a decade ago, most SEARHC patients had to travel to Mt. Edgecumbe Hospital in Sitka to receive care.
Over the past several years, SEARHC has opened or refurbished clinics in Juneau, Haines, on Prince of Wales Island, and in many of our smaller communities (we broke ground on a new clinic in Kake on Aug. 22). We staff these clinics with doctors and mid-level providers (physician assistants or nurse practitioners), and we have medical staff from our Sitka and Juneau facilities who travel to the villages to provide additional services. We added physical therapy in Haines (and soon for Klawock), and we've been the lead agency for a national demonstration project with our Frontier Extended Stay Clinics in Klawock and Haines.
We also have been one of the leaders in telemedicine, and SEARHC now has programs in telebehavioral health, telenutrition and telepharmacy.
From where does SEARHC receive its funds?
In 1995, when SEARHC entered into its first compact with the Indian Health Service, 78 percent of our $31.9 million budget came Indian Health Service funds. As SEARHC expanded, we had to find additional ways to fund our programs. In FY 2004, only 52 percent of our $80.7 million budget came from Indian Health Service funds.
In the five years from FY 1999 to FY 2004, we more than tripled the amount of patient service revenue, which now makes up 30 percent of our operating budget. We also tripled the amount of money we receive in grants, which is 16 percent of our budget. We also have two percent of our budget that comes from other revenue sources.
Editor's note: Capital City Weekly will each week feature a business or organizational leader to answer five questions. To send suggestions for interviewees, send e-mail to Amanda Gragertat firstname.lastname@example.org.