The Nuka Way

Steven Peskin, MD

One of the four 2011 Malcolm Baldridge National Quality Award winners in health care is Southcentral Foundation, a nonprofit organization established in 1982 to serve Alaska Natives who live in and around Anchorage. The Southcentral Foundation (SCF) describes itself as a Nuka system of care — Nuka being an Alaska native name given to strong, honorable structures or living things. The four guiding principles of the Southcentral Foundation are that it be customer-driven, that customers (patients) should know and trust the health care team, that customers should face no barriers to access care, and that employees are vital to system success. SCF has achieved the highest level of recognition of Patient-Centered Medical Home from NCQA.

The system has achieved remarkable results that include clinical improvement in patients with chronic conditions, notably diabetes, which is experienced in the native population at twice national rates; wellness and preventive services; emotional and social health; and dental care. These remarkable quality results have occurred with concurrent reductions in services: Emergency room and urgent care visits are 50% lower, hospital admissions decreased 53%, specialty care declined 65% and even primary care visits decreased 36%.

I believe clinical, operational, and service performance are central to SCF’s outstanding performance. One characteristic is the attainment of trust. The erosion of trust in our health care system and the profound negative consequences that erode quality and drive up costs are well described in David Shore’s book, The Trust Crisis in Healthcare.

Another characteristic is team-based care. Southcentral Foundation very effectively uses a wide range of clinicians and other staff to meet the needs of customers (patients). And finally, it is a learning organization undergirded by an information system that allows for real-time assessment of clinical, operational, and service performance

Though Alaska is geographically, culturally, and demographically distinct from the lower 48, the performance achieved by Southcentral Foundation there should translate to other communities.

Steven R. Peskin, MD, MBA, FACP, is medical director of Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield of New Jersey, and associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey — Robert Wood Johnson Medical School.