Interdisciplinary primary care provider teams develop working relationships with entire family units/support systems to constantly improve health, access to care, appropriate utilization of services and improved clinical outcomes. The key component is the relationship that is formed between provider and customer-owners.
Primary care teams include a physician or physician extender, RN case manager, a medical assistant and a behaviorist (one for every 3 teams).
In order to create effective relationships with their customer owners, Southcentral Foundation (SCF) tries to keep families together with the same primary care team, if the customer-owner chooses. This helps the providers identify and understand the larger contextual issues in a family (e.g. if the mom has diabetes, they know to educate the younger generation about risk factors). This policy also helps promote communication between the family members too, as they compare their health status and share information.
Customers have access to both alternative and traditional medicines. The providers educate the customer-owner about her/his treatment options, risks, and likely outcomes and then support the decision of the customer-owner.
The entire team shares one office so they are in continual contact and communication, which helps facilitate the coordination of care.
When seeing a customer-owner, the primary care provider works in partnership with a behaviorist who sees the customer-owner right away and typically with the primary care provider. The session is not a therapy session but an opportunity to assess customer-owners for the presence of any behavioral issues or problems and to address concerns or issues that the customer-owners have. The behaviorist supports the relationship between the provider and the customer-owner. The behaviorist may see the customer-owner several more times for a brief appointment in the Primary Care setting.
If the customer-owner chooses to be referred to long-term therapy or other behavioral health services, the behaviorist facilitates this process. By changing to this model, SCF has been able to reduce a long waiting list for therapy appointments down to no wait list and has been able to more appropriately address issues in a manner that works for the customer-owner.
The Values Driven System also provides a wide-range of behavioral health services and programs to address specific issues in the Alaska Native population, some of which are described below.
- Fetal alcohol syndrome (FAS) prevention and substance abuse programs. These are both significant problems for Alaska Natives, and the system provides both inpatient and outpatient services
- Safe home for women and children. Recently expanded to 18 beds from 12.
- 30-bed group home for youth with severe emotional problems. SCF is working together with the state of Alaska to bring a Residential Treatment Facility, a lock-down facility, to Alaska, as they now have to send youth out-of-state for that type of service. 400 youth are currently out of state, and success rates are low for these individuals who have limited access to their family, friends and culture.
- Transitional living for runaways.
- Therapeutic adolescent group homes.
- Substance abuse programs
- Long term and group therapy
- Acute and chronically mentally ill care
The Values Driven System guarantees customer-owners an appointment at a time that works for them, which includes same-day appointments. More importantly, the customer-owner chooses a provider that they will develop a relationship with, and the system works to ensure that the customer-owner is able to connect with that provider for their health needs.
One of the challenges faced the Values Driven System is the remoteness of many of their patients. One-third of the customers-owners live in 55 remote villages, which are located up to 1,500 miles away from Anchorage; some of the villages are not accessible by roads. In order to reach these customer-owners, SCF has deployed telemedicine technology.
In remote villages, SCF has placed telepharmacy-dispensing machines, which provide prescription medications through a vending machine of sorts. Pharmacists in Anchorage control the dispensing machines remotely, and the pharmacists can consult with patients directly using Internet-based conferencing technology.