Through a partnership of 12 federal healthcare facilities, Alaska has taken its first big step toward integrating its separate delivery systems.
The Alaska Federal Health Care Partnership, created in January 1995, already is boasting savings of $1 million, as well as better, more convenient care for thousands of Alaskans.
The partnership has linked delivery systems covering nearly 40%, or 240,000, of the state's 600,000 residents. In doing so, it has surmounted barriers among complex systems once considered near-impossible to integrate because of their separate funding and legal structures (Nov. 21, 1994, p. 59).
The state's population is served by four distinct delivery systems: community hospitals, federally funded Indian Health Service hospitals and clinics that serve Alaska natives and American Indians, Department of Veterans Affairs hospitals, and military hospitals.
The separate delivery systems mean duplication of facilities in some regions, while in others each patient group lacks some needed services and must travel long distances to receive them. The fragmented system is one reason managed care has not taken root in Alaska.
The new federal partnership includes all the government-run facilities: 12 hospitals and clinics run by the Alaska Native Medical Center, the Department of Veterans Affairs, the Coast Guard and the Department of Defense, and 300 medical providers at those facilities.
They are 74-bed Bassett Army Community Hospital, Fort Wainwright, Fairbanks; 70-bed 3rd Medical Group hospital, Elmendorf Air Force Base, Anchorage; Adak Naval Clinic, Adak; Troop Medical and Gemini Clinics, Anchorage; 354th Medical Group clinic, Eielson AFB, North Pole; Fort Greely U.S. Army Health Clinic, Delta Junction; Juneau Medical Clinic, 17th Coast Guard District, Juneau; Sitka Medical Clinic, Sitka Coast Guard Air Station, Sitka; Ketchikan Clinic, Coast Guard Base, Ketchikan; Rockmore/King Memorial Clinic, Coast Guard Support Center, Kodiak; Department of Veterans Affairs Medical and Regional Office Center, Anchorage; and 150-bed Alaska Native Medical Clinic, Anchorage.
In its first year, the partnership has reduced costs by more than $1 million through joint purchase of civilian services and supplies; sharing specialty medical staff previously unavailable to other partnership members; joint use of expensive, high-tech medical equipment; use of telemedicine technology; and sharing support staff such as administrative specialists and medical equipment repair technicians.
The partnership has brought together all but the community providers-and those can't be far behind, said Harlan Knudson, president of the Alaska State Hospital and Nursing Home Association. Integration of the federal facilities, which together spend $700 million a year on healthcare, presents a challenge to community providers.
"The door is open if we're smart enough. We have an excellent working relationship with the federal system," Knudson said. "But you're asking for a lot of changes, both from the federal and the community side."
If community providers don't integrate with the other players this year, it will be a huge lost opportunity to serve the state's different populations, Knudson said.
If community providers join, that is sure to change the nature of the partnership. "Our long-term goal is to integrate and do the best we can for all the state's population," said Air Force Chief Master Sergeant Glenn Corn, planner for the partnership. "So far we've been able to get along amongst ourselves, but when we start getting out there and competing for other than our beneficiaries, that gets real touchy."
Alaska's private physicians have begun to show interest in the federal initiative. For one thing, the partnership's "Alaska First" policy has given priority to qualified and affordable Alaska physicians before flying beneficiaries to the continental United States to receive care.
An executive committee made up of the chief of each agency heads the partnership. It is run informally by a seven-member strategic planning committee that meets via telemedicine channels. Depending on their various skills-such as contracting-each member leads different projects, according to Air Force Captain Jim Clapsaddle, chief of planning and marketing for the partnership.
The group intends to contract with vendors and other providers and offer managed-care programs directly to employers.
Before the federal partnership, providers in Alaska had been used to "billing whatever they wanted," Corn said. That is one reason the cost of care in Alaska can be three times as expensive as the same care provided in the "lower 48."
Now providers are coming around. "We're trying to work something out with a cardiology group here. Before, they weren't interested. I think (the partnership) is changing provider interest in managed care. They know they're going to have to start playing ball or you're going to have a big managed-care operation come in*.*.*.*and take over," Corn said.
Other organizations are inquiring about purchasing care from the partnership. "Recently, the U.S. Marshals (Service) expressed interest in participating in some of the partnership's cost-saving agreements," Clapsaddle said. The state of Alaska also has inquired about joint federal and state healthcare opportunities, he said.
Though they aren't certain how their program will evolve, the federal partners are determined to work together. "It's a team thing-to do the best we can for Alaska," Corn said.