Formula for Cutting Health Care

Imagine calling to see your doctor and being able to see them the same day.  Imagine a health care system where there is no co-pay, no deductible, and if you were prescribed medicine you would not pay for it. Imagine a health care system that had the availability of family physicians to the point where there were fewer admissions to the hospital because children were treated by their family physician for asthma because it would be so easy to get in to see them. Today with the whooping cough becoming worse, imagine a system where the percentage of infants receiving needed immunizations by age 2 has risen above 90 percent. As our nation becomes obese and diabetes more prevalent imagine a system where the percentage of diabetics with blood sugar under control ranks in the top 10 percentile of a standard national benchmark, and customer and employee satisfaction rates top 90 percent.

Now imagine that such a system costs less per person than private insurance, or Medicare.

That system is available to Alaska natives in Anchorage, Alaska and is the primary care center run by SouthCentral Foundation (SCF) – of which I am proud to be a member of their board of directors.

Southcentral Foundation (SCF) is a nonprofit health care organization established in 1982 to improve the health and social conditions of Alaska Native and American Indian people, enhance culture, and empower individuals and families to take charge of their lives. SCF provides a wide range of programs to address physical, mental, and emotional wellness for about 55,000 Alaska Native and American Indian people. Of these, 45,000 reside in the Anchorage area and 10,000 live in 55 remote villages accessible only by plane. SCF’s total coverage area, known as the Anchorage Service Unit (ASU), spans some 100,000 square miles. The ASU is served by a network of 24 health care facilities, including SCF’s two primary care centers (Anchorage and Wasilla) and two clinics (Iliamna and McGrath), and 16 subregional centers that SCF partners with to provide regional support. SCF employs 1,487 people—of which 53 percent are Alaska Natives or American Indians—and reported $201.3 million in revenues in 2010.

The Commerce Department awarded Southcentral Foundation a national quality award in 2011, the Malcolm Baldrige award, because Southcentral Foundation not only had amazing efficiencies: emergency room use has been reduced by 50 percent, hospital admissions by 53 percent, specialty care visits by 65 percent and visits to primary care doctors by 36 percent. These efficiencies were not at the expense of patient care, and the cost was less than health inflation for the rest of the United States.

Overall, SCF has achieved significant improvements in a number of key areas, including same-day access to care, which has led to a 50 percent decrease in costly emergency room and urgent care visits; a decrease in specialty care by about 65 percent; a decrease in primary care visits by 36 percent; and a decrease in hospital admissions by 53 percent.

Same-day access is achieved through a system that allows customer-owners to arrange to see their primary care provider on the same day as long they call by 4 p.m. and arrive by 4:30 p.m. This ensures that 70 to 80 percent of appointment slots are open at the start of each day.

Among the family wellness objectives set forth by SCF is a strong effort to reduce the incidence and improve the management of diabetes, a condition experienced by Alaska Native and American Indian people at twice the national rate. Since 2009, performance levels for diabetes care exceed the 90th percentile of the Healthcare Effectiveness Data and Information Set (HEDIS), a tool used by the majority of America’s health plans to measure performance on important dimensions of care and service. HEDIS measures different areas of diabetes prevention, diagnosis, and treatment such as ensuring that diabetic patients receive their annual HBA1c screening (a test that measures blood sugar levels over a period of three months), and treating diabetic nephropathy (kidney disease and damage).

But we also attribute our success to the change in culture from the IHS type, to where patients are no longer called patients, but called “customer-owners.”  Our board of directors are all Alaska Natives, and have direct input into this vision. The center is directed by a mission statement, ” Working together with the Native Community to achieve wellness through health and related services.”

This even goes to the architecture of the facility.  There are no private offices for physicians, nurses, no nursing stations- all health care providers, which include support staff,  sit in a common area.  This allows free and open communication between the providers. The waiting areas are large, and allow family members to sit comfortably. There are examination rooms, but also family rooms where all can discuss issues.

When some say the government cannot do anything right- this system proves they can.  While it is run locally, the system is funded by a block grant from the Indian Health Service, and accepts insurance payments, including Medicare.


Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit

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Latest Comments

  1. KAREN JONES says:

    This is a wonderful thing and I applaud your organization. I wish others would come to realize that this kind of thing can be universal in the United States.

  2. Lynn says:

    With 55% of funding from the block grant, how would other communities copy this model? It sounds great and it looks like it motivates people to see a doctor before things get serious but where would other communities get funding?

  3. Lynn says:

    Is there any universal health care in place in the US currently outside of military bases and prisons? I see pros and cons of universal health care and I have recently read of under the table deals in Canada when people wanted health care that would otherwise have to wait. Of course it would be a dream to know that a doctor had more than 7 to 10 minutes for each patient or that someone on the staff would spend that time if it was necessary.
    I have recently discovered a new medical specialty called preventive oncology that probably only exists in academic medicine. Real people don’t usually get much of a risk analysis and lifestyle makeover. If this specialty is really on to something, medical expenses for cancers could be reduced but then again, there is no proof of that yet.
    Singapore has people on short leashes and somehow has managed to be the country with the lowest infant mortality rate (due in part to the low birth rate). They make people pay a sizable portion of any medical bill which makes it disadvantageous to behave in ways that might make people sick.

  4. Lynn says:

    How much can the government regulate healthy behavior?
    I had nothing against Mayor Bloomberg’s anti-soda campaign but the infant formula lock down has me a bit perplexed. I am all for breast feeding and cared for my own children that way but my own mother bottle fed as did all moms in the mid-50’s, and we all grew reasonably well. Some mothers work and there are large ghettos in NY where some infants are raised by grandmothers who are not really old enough to be mothers until they are grandmothers.
    I can see having a government campaign to increase breast feeding and that is what health departments are doing in some communities but those free samples of formula really come in handy if for some reason the mother must miss a feeding. Apparently in NY, hospitals will only be able to give it with a doctor’s order if Mayor Bloomberg’s policy becomes law.
    On the one hand, society pays the price for unhealthy behavior, but on the other hand, is infant formula unhealthy? Should the government get that involved with personal choice? I do believe that the government has a right to tax junk food and make it disallowed on SNAP programs but WIC covers formula, even for babies who need it as a supplement for breast feeding and many indeed do. Nursing a baby requires a huge commitment from the mother and not mothers can commit to that.
    I am concerned that too much government involvement in personal decisions will result in rebellion and backlash.

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