I Alaska har man lyckats minska antalet akutbesök med 40% och antalet sjukhusvistelser med 36%. Samtidigt har man goda kliniska resultat och mycket nöjda patienter såväl som personal. Bakom de fina resultaten står den icke-vinstdrivande, lokalsamhälles-drivna organisationen Southcentral Foundation (SCF). De 65 000 urinvånare som ingår i SCFs upptagningsområde är själva ägare av systemet och tjänsterna har utvecklats i nära samverkan med dem. En stark och relationsbaserad primärvård, aktivt ägandeskap och mod att förändra alla nödvändiga delar av systemet, är några av framgångsfaktorerna enligt Dr Doug Eby från SCF, som idag skriver ett exklusivt blogginlägg för Forum för Health Policy. 

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Community driven health care builds trust and reduces costs

Doug Eby

Approaches to healthcare used in the past and present are simply not able to meet the challenges posed by aging populations, mental/behavioral/addiction issues, increased complexity, and inequities. Southcentral Foundation (SCF), an Alaska Native owned, and community driven, healthcare organization has built the Nuka System of Care, improving health outcomes, controlling total cost, and dramatically improving service and happiness.

SCF spent 6 months (and continues to spend huge amounts of time) listening deeply and asking for input/guidance from the community in order to find out what they want/need. The Nuka System of Care is built on several core realities:

  • Customer-Ownership. The people we serve are “customer-owners,” reflecting the fact that they are the owners of both the health care system and their own personal and family health journey—and deserve to be treated like powerful customers making choices at every level.
  • Relationship-Based Care. Integrated teams of clinical staff form strong, trusting, and personal long-term relationships with customer-owners with wide open access aimed at wellness, rather than just treating illness. It is only when clinical staff understand the unique story, in historical and current context, of each customer-owner and family, that real partnering and change occur.
  • Super Powerful Primary Care.  Expertise in medical, behavioral, addictions, complex adults and children, chronic pain, HIV, aging well, pregnancy, pharmacy, disability, movement, social context, are all pulled INTO primary care with highly capable care coordination and the ability to go into homes while providing 70-80% of interactions  virtually, asynchronous and synchronous, on demand. These are all necessary elements of highly effective, full primary care that is truly capable of increasing wellness, great chronic condition optimization, and huge reductions in hospital, emergency department (ED), specialty, lab, radiology, and pharmaceutical use/cost.
  • Whole System Transformation. We were willing to change everything about the health care system. Every facet of the experience was overhauled, based on what Alaska Native people told us would work. Effective efforts at breaking cycles of trauma, abuse, and personal habits are critical. We also created world class capability in data, improvement, quality, IT, finance, and workforce support and training capabilities.

Following the principles set out by Alaska Native people enabled SCF to do what no other system has, including winning the U.S. National Baldrige award twice. ED use has decreased by 40 percent, and hospital stays by 36 percent.  Most clinical outcomes are in the top 25thpercentile nationally, and several are in the top 10th.  Almost all customer-owners and staff say they are happy.  As SCF’s story shows, when the community really takes the lead, and we are unafraid to make bold, sweeping changes in response, everything people want to believe is possible has actually occurred – at scale!


Dr. Doug Eby är vice ordförande för medicinska tjänster vid Southcentral Foundation (SCF). Han har tjänstgjort i ledningsgrupperna i  SCF och Alaska Native Medical Center sedan 1995. Han har spelat en nyckelroll i utvecklingen av SCFs innovativa primärvårdssystem och föreläser nationellt och internationellt om utformning av hälso- och sjukvårdssystem och kvalitetsförbättring. Utöver sin medicinska examen har han en master i folkhälsa.


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