Upon rating the U.S. the worst healthcare system among 11 developed nations, the Commonwealth Fund suggested the U.S. “may need to pursue different approaches” to delivering and financing care.¹ And while there's no shortage of new financial arrangements and technologies aimed at fixing healthcare, the solution may rest first and foremost in a traditional concept of primary care: human connection, i.e., relationships.
Evidence suggests that if we refocus on the relationship between individuals and their caregivers, we can improve the state of U.S. healthcare significantly.
Indeed, the story of Southcentral Foundation (SCF), an Alaska Native-owned nonprofit health system in Anchorage, demonstrates the power of human connection to fix healthcare and deliver extraordinary outcomes. Between 1999 and 2014, SCF achieved:
- a 75% reduction in hospital readmissions,
- a 71% reduction in hospital days per 1,000 people,
- a 36% reduction outpatient visits per 1,000 people, and
- 93% customer satisfaction.²
The key to their success? A fundamental shift in thinking to optimize relationships between providers and their patients.
A first step toward elevating this relationship was the decision to refer to patients as "customer-owners" rather than “patients."
"Alaska Native leadership recognized that the core product is something bigger than just tests, diagnoses, pills and procedures,” explained SCF CEO Katherine Gottlieb in Transforming Your Practice: What Matters Most. “It is about human beings and relationships - messy, human, longitudinal, personal, trusting, informing, respecting and accountable relationships."³
SCF also recognized that up to 85% of healthcare is comprised of chronic conditions and other low acuity cases in which the customer-owner, not the provider, has control over the outcome. As such, the opportunity for clinicians to influence patient decisions depends on the strength of their relationship over time.4
Four principles guide SCF's innovative approach to healthcare, called the Nuka system of care (Nuka meaning “strength”).
Described in Tranforming Your Practice: What Matters Most, the Nuka system of care principles are:
- Customer-driven: The customer drives everything. The customer-owner (patient) is in control and makes decisions, while the clinical team uses their expertise to explain options and make recommendations. “It turns out that when given this kind of control and partnership over time, customers make knowledgeable, informed decisions about their healthcare treatment and generally choose less aggressive treatments than medical professionals would choose for them,” states Gottlieb.
- Trust: Every customer deserves a care team they can trust. At SCF, the clinical team is responsible for working with each customer to establish “a trusting, accountable, long-term relationship” as they provide services and coordinate care. Each customer must feel that their clinical team knows them and respects their values, which drive care plans. As part of this commitment, SCF strives to have customers and families see the same caregivers each time. Additionally, recognizing the importance of behavioral health, SCF brings behavioral health specialists into the fold.
- No Barriers to Care. SCF believes all barriers to care must be removed for customers seeking care. For example, to optimize efficiency and access to care, SCF clinicians handle what they can by phone, email or text. When a customer must be seen, the nature of their problem dictates the type of caregiver they see, e.g., case manager, behavioral clinician, nurse, medical assistant or doctor. Office visits with a doctor are not the first line of support.
- Staff and infrastructure are vital to success. Through rigorous hiring, orientation and training, SCF ensures that each staff member is steeped in the philosophy of Alaska Native peoples and cultures, as well as the quality improvement method pivotal to SCF transformation.5
Without customer-owners, it may be challenging for health systems to emulate the Nuka system of care. But Personalized Advocacy, a new approach to healthcare, can.
Working outside of health systems but in close coordination with them, Personalized Advocacy supports the same principles that underlie the Nuka system of care. Personalized Advocacy:
- Puts the person at the center of care. Personalized advocacy delivers a connected and seamless health and benefits experience that “meets each person where they are,” making it much easier for people to get the support they need as they navigate healthcare. Personalized Advocacy also focuses on the unique needs of every individual in the population, not just the sick or the sickest, helping each person stay healthy or get on the best path to health and well-being.
- Builds trusted relationships with individuals and families. Dedicated Health Assistants and Nurses, supported by a multidisciplinary clinical team and intelligent technology, form long-term, trusted relationships with individuals and families. These relationships enable a much deeper understanding of each person and their full life context, improving the effectiveness of support and healthcare treatment.
- Removes barriers to care. Health Assistants and Nurses are trained not just to uncover barriers to care but to resolve them. Whether an individual is having difficulty affording a medication, securing transportation to a provider, or finding time to get to their support group meeting, Health Assistants and Nurses use compassion and resourcefulness to find a solution.
- Empowers people to make better healthcare decisions. By creating long-term, trusted relationships; educating people about their healthcare options, and delivering highly personalized recommendations based on data and insight, Health Assistants and Nurses empower individuals and families to make better healthcare decisions over time.
And like SCF's Nuka system of care, Personalized Advocacy delivers extraordinary results, including an annual 18% reduction in readmissions, up to 15% cost savings and 98% customer satisfaction.
Want to learn more about Personalized Advocacy? Read the paper today.
¹ Schneider, E., Sarnak, D., Squires, D., Shah, A., Doty, M. (July 2017), The Commonwealth Fund, Mirror Mirror, 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care, retrieved from http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/
² Hussey, R., MD and Gottleib, K. (2014, 1000 Lives Improvement), Redesigning Healthcare. Learning from the Nuka System of Care to Inform the Development of Healthcare in NHS Wales, retrieved from http://www.1000livesplus.wales.nhs.uk/sitesplus/documents/1011/Redesigning_Healthcare_Nuka_System_of_Care.pdf
3 - 5 Gottlieb, K., MBA; Sylvester, I., MBA; and Eby, D., MD, MPH, (January 2008), Transforming Your Practice; What Matters Most, retrieved from https://www.southcentralfoundation.com/wp-content/uploads/2017/01/NEWS-Transforming-Your-Practice_press-packet.pdf