South central foundation Alaska If you are in a mechanical manufacturing environment then hitting a target is a matter much like the throwing of a rock – figuring out speed trajectory If you are in a messy, human, complex, adaptive environment it is like throwing a bird at a target – it is all about the ‘attractor’ Healthcare mostly throws birds at targets and only thinks about the throwing part than wonders why the Human fails to hit the target

1. Southcentral Foundation
The SCF Nuka Model of Care
Th SCF N k M d l f C
Customer-Owners Driving Healthcare
Charles Clement, Vice President Operations, Chief
Operating Offi
O
ti
Officer
April Kyle, Human Resources Administrator
Steve Tierney, Medical Director Quality Improvement
Michelle Tierney, Vice President Organizational
Tierney
Development and Innovation

2. Today…
y
Share the SCF Story
Transformation of our system –
resulting SCF Nuka Model of Care
Describe how a customer-owner
customer owner
system shapes and improves health
performance in outcomes,
satisfaction, experience of care, and
ti f ti
i
f
d
overall cost.
Describe some of our key
improvements to our systems
transformation

4. Southcentral Foundation
25+ years of history
Innovative, relationship based, customer
owned systems
d
t
1,400 staff
140,000 statewide customers
55,000 ‘local’ customer-owners including
10,000 i
10 000 in over 50 remote villages
t
ill
Expanding local population

5. Southcentral Foundation
Medical Services – Primary Care, Women’s
Health, Pediatrics, Optometry, Urgent
Care
Dental
Behavioral Health – clinics residential
clinics,
treatments, after-care, youth, elders
Family Wellness Warriors – abuse and
neglect treatment and prevention
Tribal and Traditional Services
Chiropractic, massage, acupuncture
Southcentral
Foundation

6. Alaska Native Medical
Center
150 Bed Hospital
Over 400,000 outpatient visits last year
Local primary care, regional community
hospital, and tertiary care statewide hub
Level II Trauma Center, Magnet Status
Combined project of SCF and ANTHC
Full system – includes medications, etc.
Southcentral
Foundation

8. Our Choice
The Alaska Native people were given
this choice and we chose to assume
the responsibility for our own health
care
Change everything
Total redesign
g
With our choices, values and ……

9. Where we were in Jan. 1993
100 % increase in Native population in 10 yrs
Long waits for scheduled appointments,
4 to 6 hour waits in ER/Urgent Care
common
Long waits on phone, pharmacy
phone pharmacy,
everywhere
Poor continuity, little coordination across
depts,
Increase age, illness burden, space issues
Little
Littl customer i
t
input, not used in planning
t
t
di
l
i
System not designed around the customer

10. Everyone was frustrated…
y
Customers frustrated – waiting
waiting,
impersonal, paternalistic, crowded,
unfriendly
y
Clinical staff frustrated – too many
p p ,
people, not enough time, no personal
g
,
p
relationship, too many demands
Management frustrated – lots of
unhappy people, hard to motivate staff,
poor financial performance, poor
facilities
f iliti

11. What If
If….
What would a healthcare system based on
Alaska Native community values look like?
What if you actually threw out EVERYTHING in
the
th medical system and started with Alaska
di l
t
d t t d ith Al k
Native community structures and strengths as
the base?
Asset based philosophy, structures, systems
So…..
We declared nothing would remain the way it
was unless we decided to do it that way.

12. So
We wanted Alaska Native people to own
d l k
i
l
their own healthcare
We wanted to have a system where the
values, goals, and strengths of the
customer drove the system design
We wanted to get to whole person care –
physical, mental, emotional, spiritual
We wanted family and community to
y
y
matter & to be known personally
And – we wanted the best that modern
medicine has to offer

13. Why is Customer Owned Important
y
p
Efforts of “experts” who know
o ts o e pe ts
o
o
what is best for Alaska Native
people (healthcare professionals,
missionaries, government officials)
Result has been loss of self esteem
and confidence leading to
d
fid
l di
t
dependency
Healing and progress on the journey
towards health only is possible when
the customer/owner takes control
and l d the change.
d leads h h

14. Scotland
Caring and compassionate
C i
d
i
staff and services
Clear communication and
explanation of conditions and
l
f
d
d
treatment
Effective collaboration
Continuity of care
Good access
Clinical excellence
Alaska
Services and systems built on
S
i
d
b il
strengths of Alaska Native
cultures
Not complicated but simple
and easy to use
Together with the customer
as an active partner
Relationships between
customer owner, family and
provider must be fostered
and supported
Access is optimized and wait
A
i
ti i d
d
it
times are limited
Outcome and process
measures to continuously
evaluate and improve

15. Scotland
Alaska
Person
Centeredness
Shared
Responsibility
Safety of Patients
Commitment to
Quality
l
Clinical
Effectiveness
Family Wellness

16. Why Listen to our story
Complete system redesign on Alaska
Native values
Decrease
Decrease
Decrease
Decrease
in ER/Urgent Care over 40%
specialty care by over 50%
in primary care visits by 20%
in admissions and days by over 35%
Improved health outcomes
Improved satisfaction indicators –
customer and employee

17. Question Assumptions
Medical Model not questioned in 100
years, but optimally effective for
population health
‘Healthcare’ tries to build on one
p
philosophy – why? Span is so huge
p y
y
p
g
Knowledge – clinical, system design,
change management, operational
management – h
t have evolved hugely – b t
l dh
l
but
not the basic healthcare paradigm – why?

18. Analogy - Hitting the target
target…
If you are in a mechanical, manufacturing
mechanical
environment then hitting a target is a matter
much like the throwing of a rock – figuring out
speed, t j t
d trajectory, etc.
t
If you are in a messy, human, complex,
adaptive environment – it is like throwing a
bird at a target – it is all about the ‘attractor’
Healthcare mostly throws birds at targets and
only thi k about th throwing part…
l thinks b t the th
i
t

19. Reality – various ‘platforms’
platforms
Healthcare has several ‘platforms’
ICU/ER/OR – high tech, linear, mechanical
Procedures – linear, mechanical
Consultative – time limited, specific issue
limited
focused, additive expert support
Longitudinal relationship over time –
chronic conditions, outpatient, residential,
h
i
diti
t ti t
id ti l
behavioral health, primary care
One size does not fit all – first two are
product, manufacturing efforts – second two
are service and knowledge efforts primarily

20. Control: Who really makes the decisions
100
Patient/Family
“Control”
The “System”
y
0
Low
Acuity
High
1. Control – who makes the final decision influencing outcome?
2. Influences – family, friends, co-workers, religion, values, money
3. Real opportunity to influence health costs/outcomes – influence
on the choices made – behavioral change
4. Current model – t t diagnosis, treatment (meds or procedures)
4 C
t
d l tests, di
i t
t
t( d
d
)

21. Reality
y
Health is a longitudinal journey
g
j
y
Across decades
In a social, religious, family context
Highly i fl
Hi hl influenced b values, beliefs, habits,
d by
l
b li f h bit
and many ‘outside’ voices.
Office visits are brief, reactive stop-gaps
Hospitalizations are brief, intense interruptions
MUST fix basic, underlying primary care
platform first or nothing else will work well

22. Purpose of Primary Care
p
y
Is a Service Industry – NOT a product industry
– coaching, teaching, partnering are central –
pills and procedures supportive
Changes what we think we do, who we hire,
how we train, how we structure, how we
reward, and how entire system is constructed
as a system.
We must optimize relationship – personal,
trusting, accountable – minimize b i
t
ti
t bl
i i i barriers

23. The General Framework
Vision, Mission, Key Points
Leads to Operational Principles –
these are specific enough to be used
to evaluate and even score new
ideas for whether to implement
them into SCF or not

24. Mission, Vision, Key Points
Vision: A Native Community that
enjoys physical, mental, emotional
and spiritual wellness
Mission: Working toget e with the
ss o
o
g together t t e
Native Community to achieve
oug
a
a d
a d
wellness through health and related
services.

25. Key Points
Shared Responsibility
We value working together with the individual, the family, and
g g
,
y,
the community. We strive to honor the dignity of every
individual. We see the journey to wellness being traveled in
shared responsibility and partnership with those for whom we
p
provide services.
Commitment to Quality
We strive to provide the best services for the Native
Community. We employ fully qualified staff in all positions
and we commit ourselves to recruiting and training Native
staff to meet this need. We structure our organization to
optimize the skills and contributions of our staff.
Family Wellness
We value the f
l
h family as the heart of the Native Community.
l
h h
f h
C
We work to promote wellness that goes beyond absence of
illness and prevention of disease. We encourage physical,
mental, social, spiritual and economic wellness in the
individual, h f
i di id l the family, the community, and the world in which
il
h
i
d h
ld i
hi h
we live.

26. SCF Operating Principles
Relationships between the customer-owner, the
family, and provider must be fostered and
supported
Emphasis on wellness of the whole person,
family, and community including; physical
y,
y
g; p y
mental, emotional, and spiritual wellness
Locations that are convenient for the customerp
owner and create minimal stops for the
customer-owner.
Access is optimized and waiting times are
limited
Together with the customer-owner as an active
partner
Intentional whole system design to maximize
y
g
coordination and minimize duplication

27. Operating Principles
Outcome and process measures to continuously
evaluate
e al ate and improve
imp o e
Not complicated, but simple and easy to use
Services are financially sustainable and viable
y
Hub of the system is the family
Interests of the customer-owner drive the
system to determine what we do and how we do
it
Population-based systems and services
Services and systems build on the strengths of
Alaska Native cultures.

28. Customer-owner Changes for
Effective Relationships
Be active not passive
Take responsibility for your health
Get information about your health
Ask questions about advice
Ask for options
s o opt o s

29. Healthcare Provider Changes
for Effective Relationships
No longer a hero but a partner
Control does not equal compliance
Replace blaming with
understanding
Give customer options not orders
Provide customer with resources
Make it simple
p

30. Some of our improvements
Leadership
Mission, vision, key points, principles –making
part of f b i of day to day work
t f fabric f d
t d
k
Functional structure
Training and development – succession
planning
Standardize Improvement Processes and
Tools
Facility Design

33. Some of our improvements
Strategic Planning
Continuous planning cycle
p
g y
Linkage from 20 years to today
Automated planning tool and reports
p
g
p
Measurement of how we are doing at
macro and micro levels

34. Some of our improvements
Customer focus
Listening p
g posts continuously updated
y p
and evaluated
Benchmarked feedback tool for
satisfaction
Gatherings, listening conferences,
customer service reps, and family

35. Some of our Improvements
p
Measurement and Analysis
y
Development of Balanced Scorecards
and Dashboards for every
department coordinated and
connected throughout the
organization
i ti
Data Mall for segmentation,
understanding performance and
registry type information

36. Tab Based Functionality

37. Segmentation of Data

38. Comparison Charts to Identify
Best Practices

39. Condition Centered
Action List
Fictitious Patient Info

40. Some of our Improvements
p
Workforce improvements
Recruitment Processes: group interviewing,
behavioral based interviewing, change how
we recruit, online tool for applications,
same d
day offers
ff
On-boarding including orientation
Core Concepts training on building effective
p
g
g
relationships
Job progressions and career ladders
Development Center
p
• Upfront training for administrative support and
Certified Medical Assistants
• Learning centers tied to workforce competencies

41. Some of our Improvements
Process and clinical improvements
Microsystem Optimization -teams
• Primary Care: MD, RN, Certified Medical
y
,
,
Assistant, Admin Support
• Human Resources, HR Generalist and Assistants
Redefine work
• Move from episodic, reactive care to long-term
relationship
•M
Move from only one-to-one visits t use of
f
l
t
i it to
f
groups, phone, email, fax
• Move from doctor-centric to team based approach
in l ti
i relationship
hi

43. Some of our Improvements
Process and clinical improvements
ocess a d c ca
p o e e ts
Customer-owner choice of healthcare
provider
Behavioral Health Consultants
Case management and chronic
illness management
•Depression, asthma, chronic pain,
diabetes, HIV etc.
di b t
HIV, t
Advanced Access – appointments
when the customer wants

44. Parallel Work Flow Redesign

45. Some of our Improvements
Process and clinical improvements
Integration of Complementary Medicine
Telehealth, telepharmacy and
telemedicine
t l
di i
Family Wellness Warriors Initiative
Service A
S
i Agreements
t
Hospitalists

46. Southcentral Foundation
VISION
A Native community that enjoys
emotional, physical, mental, and
spiritual wellness.
MISSION
Working together with the Native
community to achieve wellness through
health and related services.

47. Specifics on improvements

48. Relationship-Based System
R l ti
hi B
dS t
Tribal Governance Relationships
Employee Relationships
Community Relationships
Provider Relationships

49. Customer/Owner Listening
Not just one method of listening
Personal
P
l
interaction with
staff
Group visits
Comment cards
Customer
C t
Satisfaction
surveys
y
SCF internet
Annual
Gathering
24-hour hotline
24 h
h tli
Listening
Conference
Governing board
Advisory
committees
Focus groups
g
p
Service
agreements

50. Using the Voice of the
Customer/Owner
54% of SCF employees are Alaska Native
and American Indian people, we bring the
voice of the customer interactions
throughout the organization
Alaska Native and American Indian people
recognize our families will utilize these
services for generations to come
g

51. Core Concepts
W ork together in relationship to learn and
grow
E ncourage understanding
L isten with an open mind
L augh and enjoy humor throughout the day
N otice th di it and value of ourselves and
ti the dignity
d
l
f
l
d
others
E ngage others with compassion
S hare our stories and our hearts
S trive to honor and respect ourselves and
others

52. Listening Conference
Yearly Since 2003
Panel of Board Members,
President/CEO and Vice Presidents
Open microphone
All customer/owners, community
invited
No agenda

53. Listening Conference
continued
Starts with a small presentation
SCF History
Listening
Setting Priorities
Looking to the future
Driving change
We re
We’re owning the system
Your voice matters
Thank you /explain the process
y
p
p

54. Listening Conference
Microphone is passed around the
room to customer/owners
Ask questions
Opportunities for improvement
Compliments
C
li
t
Suggestions
Notes are taken during the whole
conference

55. Listening Conference
Transcripts are reviewed
Entered into our customer comment
database
Forwarded to appropriate
department/committee/employee
Every customer comment is followed
up on
Tracking and trending

57. The Gathering
Yearly since 1997
l i
99
Convention center
161 Booths of all kinds
Education
Healthy life styles
SCF departments
Community (Education, Regional Native
Corporations, etc.)
p
)
Activities
Entertainment

58. The Gathering
g
Interactions with employees
Feedback from customer/owners
Examples
•
•
•
•
More help for elders
Parking
More cancer support
Better customer service when checking in for an
appointment
• Helping the homeless/emergency financial situation
Information f ll
I f
ti
follow through on survey results by
th
h
lt b
committee/managers
Tracked through electronic feedback system
ensure appropriate action is taken
k

60. Website

61. Strategic Planning Cycle
W hat are w e trying to accom plish?
H ow w ill w e know that a
change is an im provem ent?
W hat changes can w e m ake
that w ill result in im provem ent?
AC T
- W ha t cha ng e s
are to be m a d e?
- N e xt C ycle?
ST U D Y
- C o m p lete th e
a na lysis of the d ata
- C o m p are d a ta to
p re di ti n s
dictio
- Su m m arize w h a t
w a s le a rn ed
PL A N
- O b je ctive
- Q u estio n s a nd
P re dictio n s (w hy)
- Pla n to carry o ut
th e cycle (w h o,
w h a t, w h ere , w h en )
DO
- C a rry ou t th e p la n
- D o cu m en t p rob le m s
an d un exp e cte d
ob servatio n s
b
ti
- Be g in a na lysis
o f the da ta

62. Planning and Improvement Linkages
August 2006
Planning and Improvement Linkages
Green = Core foundation
Pink = Initiatives
Orange = Work Plans/Action Items
Rose = Employee Evaluation
Blue = Improvement Tools
Grey = Other Useful Tools
Double Line Box = Part of Annual Planning Tool
Mission, Vision, Key Points, Operational Principles
Established by Vice President Leadership Committee and approved by Board of Directors
Annual Planning Process
and Cycle, Baldrige
Process, Improvement
Cycle, and Committee
Structure
Str ct re are the
approaches and systems
in which these tools are
deployed.
Corporate Goals
ESTABLISHED AT CORPORATE LEVEL
Established by Vice President Leadership Committee and approved by Board of Directors
and are derived from the Mission Vision, Key Points and Operational Principles
Balanced Scorecard (BSC)
Linked to Corporate Objectives and
p
j
measure progress on achieving Corporate
Objectives
Corporate Objectives
ESTABLISHED AT CORPORATE LEVEL
Reviewed and updated annually by Vice President Leadership Team as part of Planning
Cycle with input from employees/customers
Because initiatives tie to Objectives
and they are longer term, they
should be linked to BSC.
4 Oval Structure
Functional Structure
Committee Initiative
Functional Structure
Committee Work Plan/
Action Item
Division
Work Plan/Action
Item
Department Work
Plan/Action Item
OTHER USEFUL TOOLS
Project Team Charter
Assessment
Conference Lessons
Learned
BSC/DB Definitions
Medelearn
Intranet Tools
including forms
Policy & Procedure
Templates
Committee Reporting
Form
Employee
Performance Action
Plan
Functional Structure
Committee
Work Plan/Action Item
Division Initiative
Department
Initiative
Department
Work Plan/Action
Item
Department
Work Plan/Action
Item
Work Plan
W k Pl or Action Item
A ti It
Details the short term action items (tests of change
or less than quarter in duration) that will be
completed and/tested to achieve an initiative. Work
plans may be developed at all levels of the
organization
Department
Work Plan/Action
Item
Link to
Improvement
Tools
Initiatives
Strategic activities identified that are
longer term (occur in 1-2-3 years) to
achieve the corporate objectives.
Initiatives may be developed at all
levels of the organization.
Corporate
Initiative
Employee Performance Action Plan
Employee
Employee
Performance Action Details for each employee their action Performance Action
items for the year linked to initiatives
Plan
Plan
and work plans.
ADLI
Change Concepts:
Survey Monkey:
Baldrige Assessment and
Developed for most
initiatives to outline the
details of the initiative.
PDSA
Developed for work
plans that involve
improvement activities to
outline the details of the
work plan. Changes are
tested in Rapid Cycle,
with one cycle building
on another.
Employee
Performance Action
Plan
Improvement Tools
Operational Principles:
Measurement Rules Template:
Committee Manager:
Project or Project
Team Charter
Used to test ideas or concepts to ensure consistency with MVKP&Corporate Goals
Developed to assist with defining BSC / Dashboards measures. Part of the intranet tool
Used to develop Project Team in order to communicate changes, meeting minutes etc
corporate wide
Approach, Deploy, Learning, Integration: From Baldrige used to evaluate PDSA cycles.
Change concepts are used in improvement to assist in generating new ideas when
making changes
Used to measure success for process changes
Feedback: Survey that can be used to assess where the organization/department/committee is based
on Baldrige Criteria
Dashboards (DB)
Operational Measures that monitor
the day to day operations. These
measures inform where
improvement may be targeted. If the
annual plan is used as an
operational work plan in addition to a
strategic plan, DB items may be
linked to these operational initiatives/
work plan items.
Measurement Rules
Template
Data and Information drives all aspects of the Improvement Process and is part of all tools. Data are reviewed from the 4 perspectives: Finance/Workload, Organizational
Effectiveness, Customer, & Workforce including National Research Corporation-Customer Satisfaction; Morehead Associates-Employee Satisfaction; BSC/DB, Hedis etc.

63. Measurement Linkages

65. Improvement Model:
From The Improvement Guide. A Practical Approach to Enhancing Organizational Performance by
Langly, Nolan K., Nolan T., Norman, and Provost

66. Continuous Improvement
A P
A
A
P
P
S
S D
D
S D
S D
Situation as it is
From The Improvement Guide. A Practical Approach to Enhancing Organizational Performance by
Langly, Nolan K., Nolan T., Norman, and Provost
Impr
rovement
n
A
P
Situation
as it
Should
Be

68. SCF Facilities Supporting
Health
The key determinant of health (and
success in education and finances) is
Self Confidence
Se Co de ce d a s o p de,
Self Confidence draws from pride,
honor, dignity, respect
Outstandingly beautiful facilities are
a key piece of improving Alaska
Native pride honor dignity - self
pride, honor,
confidence

69. Customer-Owner Design
Easy to find, welcoming spaces
Beauty, light, comfort, colors and
textures that are familiar
Native feel but not any specific one
feel,
culture
Dignity, pride respect, honor,
Dignity pride, respect honor
relationship
Privacy, ti
P i
time, li t i
listening
Family and friends welcome

72. Facility design
Smaller, quieter, more personal feeling
Not on top of each other spreading
infection and being disruptive
Accommodates family and privacy both
Comfortable exam spaces and on the
same level as the clinical people – respect
Self management, customer-owner
customer owner
control
Visual, sharing, listening, professional

73. Facility Design
Group sociology – Family dynamics - max
15 people, Team dynamics up to 65, over
65 – bureaucracy
Back to smaller ‘team’ practices – 6
‘primary care’.
Decentralized Health Information C t
D
t li d H lth I f
ti
Centers
into every waiting area
Shared specialty rooms and equipment central spine
Extensive use of glass, natural light, semig
,
g ,
privacy

74. Facility Design
Emphasis shifted towards more team
space and more importance of
g
p
integrated team space
More and more team care, ‘virtual’ care
(email and phone and home visitors),
less visits.
l
i it
No ‘nurses station’
CMS and CMA s with teams – phone
CMA’s
traffic direct to teams
Shared resources – behaviorists,
dieticians, pharmacists, coverage staff visible/accessible

75. Facility Design
Structural alignment with shift in
power to be more balanced – spaces
de-medicalized
d
di li d
Family rooms
Group rooms
G
Co-located Mental Health therapists
Experiments with merged
h
d
pharmacist, pregnancy and pediatric
care

76. Data Slides

77. Diabetes: Annual HbA1C
%
100
88.1
88.2
87.3
86.7
88.8
91.0
90.5
91.9
Mar
Jun
Sep
Dec
Mar
Jun
Sep
Dec
50
0
2008
SCF
2009
2008 HEDIS 90th Percentile (88.81)

78. Diabetes: HbA1C Poor Control
40
%
23.0
24.2
26.9
26.5
23.7
22.5
22.5
22.8
Mar
Jun
Sep
Dec
Mar
Jun
Sep
Dec
20
0
2008
SCF
2009
2008 HEDIS 10th Percentile (32.60)

79. Diabetes: LDL < 100mg/dl
%
100
50.3
49.8
48.5
49.1
48.3
52.1
54.0
52.9
Mar
Jun
Sep
Dec
Mar
Jun
Sep
Dec
50
0
2008
SCF
2009
2008 HEDIS 90th Percentile (42.31)

80. Diabetes: B/P < 130/80
%
100
34.0
50
39.4
39.8
Jun
Sep
Dec
0
Mar
Jun
Sep
2008
SCF
Dec
Mar
2009
2008 HEDIS 90th Percentile (41.30)

81. Cardiovascular: LDL < 100mg/dl
g
%
100
50
49.2
49 2
51.0
51 0
50.3
50 3
49.1
49 1
Mar
40.3
Jun
Sep
Dec
0
Dec
2008
SCF
2009
2008 HEDIS 90th Percentile (52.87)

82. 50
SCF Overall
5 to 9 yrs
10 to 17 yrs
Dec
Nov
Oct
Dec
Nov
Oct
Dec
Nov
Oct
Dec
Nov
0
Oct
%
100
Asthma: Appropriate Meds
97 95 96 95
87 86 87 96 96
84 82 83
18 to 56 yrs
2009
SCF
2008 HEDIS 90th Percentile (Overall 91.94)

83. Cancer Screening: Colorectal
(Flex sig and Colonoscopy)
%
100
50
48.9
48 9
50.3
50 3
52.2
52 2
55.6
55 6
57.0
57.8
58.2
58.6
Mar
Jun
Sep
Dec
Mar
Jun
Sep
Dec
0
2008
SCF
2009
2008 HEDIS 90th Percentile (65.72)

84. Cancer Screening: Cervical
%
100
73.4
73.6
73.8
73.6
74.1
75.3
75.5
75.2
Mar
Jun
Sep
Dec
Mar
Jun
Sep
Dec
50
0
2008
SCF
2009
2008 HEDIS 90th Percentile (77.46)

85. Cancer Screening: Breast
100
%
59.0
58.2
57.5
56.5
56.5
56.1
56.6
57.4
Mar
Jun
Sep
Dec
Mar
Jun
Sep
Dec
50
0
2008
SCF
2009
2008 HEDIS 90th Percentile (61.17)

86. Complex Utilizer: Annual Behavorial Visit
100
%
52.3
53.2
55.6
58.4
58 4
59.0
59 0
Dec
Mar
Jun
Sep
Dec
50
0
2008
2009
SCF
SCF Target (75%)

87. Controlled Medications: Annual Behavorial Visit
%
100
50
30.3
28.8
30.4
32.8
32 8
35.4
35 4
Dec
Mar
Jun
Sep
Dec
0
2008
2009
SCF
SCF T
Target (50%)

88. Access to Recovery: 6 Month Follow-Up of Intakes
94.0
%
100
80.7
50
0
2008 (N=151)
SCF
2009 (N=657)
Avg
A All G
Grantees (2008 64 % 2009 63 %)
(2008:64.7% 2009: 63.7%)

89. Access to Recovery: Alcohol & Drug Abstinence
100
%
72.7
50
46.1
66.4
76.8
65.5
62.8
70.9
50.0
50 0
0
Intake 6 mo Intake 6 mo Intake 6 mo Intake 6 mo
FY09-Q1
FY09 Q1
n=128
FY09-Q2
FY09 Q2
n=122
FY09-Q3
FY09 Q3
n=142
FY09-Q4
FY09 Q4
n=86

90. Access to Recovery: Employment & Education
%
100
39.1
39 1
50
18.8
23.8
33.6
28.2
37.3
37 3
29.1
34.9
0
Intake 6 mo Intake 6 mo Intake 6 mo Intake 6 mo
FY09-Q1
n=128
FY09-Q2
n=122
FY09-Q3
n=142
FY09-Q4
n=86

91. Su
uicides pe 100,00
er
00
Crude Rate: AN Suicides
Anchorage & MatSu Residents
100
50
46.70
24.60
0
2004
#Suicides=16
2006
#Suicides=9
2008
#Suicides=3

92. Emergency Dept Visits per 1000 Member Months
Visit per 100
ts
00
100
50
42.76
43.97
2008
2009
0
SCF
HEDIS 10th Percentile (40.59)

93. Monthly
M thl ED Visits Per 1000 Customers
Vi it P
C t
(Historical)
19% Decrease Since 2000
48
40
39
2007
2006
2005
2004
2003
2002
2001
0
2000
Visits per 1000
80

94. Visit per 1000
ts
0
Total Outpatient Visits per 1000 Member Months
400
299.35
322.25
2008
2009
200
0
SCF
HEDIS 25th Pctile (274.04)
HEDIS 50th Pctile (324.01)

95. 800
693
400
200
07
200
06
200
05
200
04
200
03
200
02
200
01
200
00
0
199
99
Visits per 100
00
1200
Qrtly Outpatient Visits Per 1000 Customers
(Historical)
1077
36 % Decrease Since 1999

96. Total Inpt Days per 1000 Member Months
Da per 100
ays
00
50
27.00
26.82
2008
2009
25
0
SCF
2008 HEDIS 10th Percentile (16.84)

97. 81.5
71 % D
Decrease Si
Since 1999
50
23.3
23 3
200
07
200
06
200
05
200
04
200
03
200
02
200
01
200
00
0
199
99
Da per 10
ays
000
100
Qrtly Hospital Days per 1000 Customers
(Historical)

98. Discharges per 1000
Total Inpt Discharges per 1000 Member Months
10
5.72
5.98
2008
2009
5
0
SCF
2008 HEDIS 10th Percentile (5.26)

99. 20
19.03
75% Decrease Since 1999
10
4.72
2007
2006
2005
2004
2003
2002
2001
2000
0
1999
missions per 1000
p
Adm
Qrtly Hosp. Admissions Per 1000 Customers
(Historical)

100. Customer Satisfaction (Top Box % )
100
%
68.2
71.2
2008
2009
50
0
SCF
**Mayo 69%
y
**Clev. 66%
**JH 75%

101. Customer Satisfaction (Top Box % )
%
100
70
74
08
09
73
73
83
91
53
56
66
66
08
09
08
09
50
0
Clinics
08
09
Dental
08
09
Home Hlth
SCF
Emerg.
g
Serv.
Outpt BH
p

102. %
BSC Customer Satisfaction (Positive Response)
91.7
88.5
100
50
0
2008
SCF
2009
BSC 2009 Target (85%)

103. Ability to Give "Input" (Top Box % )
100
%
65.3
65.0
08
09
50
0
SCF
CAHPS (Top Box) 2009 (53.5%)

104. FY Operating Margin
15.0 12.5
11.0
11.1
8.6
8.8
8.4
2.4
2.3
2009
5.0
2008
%
10.0
10 0
0.0
2007
2006
SATO
2005
2004
SCF
2003
2002
-5.0
MGMA 90th %tile 2009 (1.3)

105. FY Total Revenue ($Millions)
200
150.3 149.0
128.5 143.2 146.3
102.5 120.2
174.6
100
0
2009
9
2008
8
2007
7
2006
6
SATO
2005
5
2004
4
2003
3
2002
2
SCF
MGMA 90th %tile 2009 (77.4)

106. SCF Customer Growth (# Empanelled)
80,000
59,992
#
60,000
40,000
40 000
20,000
18,216
0
FY 1999
FY 2009

107. Relat
tive % chan from baseline
nge
b
Cumulative Per Capita Expenditures
Relative % Change with 2004 as Baseline
30
27
26
26
25
20
15
15
10
5
5
0
-5
2004
2005
2006
2007
2008
-10
SCF Cumulative Primary Care
SCF Cumulative Hospital Services
National Health Spending
National Hospital Care Expenditures
National Physician and Clinic Services Expenditures

108. Workforce Commitment Indicator
5
S
Score
4
3.83
3 83
3.91
3 91
3.92
3 92
4.07
4 07
2003
2005
2007
2009
3
2
1
0
SCF
Morehead Nat HC Ave 2009 (4.10)

109. Courses per 100 FTE
s
F
Development Center Courses per 100 FTE
10
8.59
8 59
3.94
5
0
SCF
Local Hospital
2010

110. % of Workforce Promoted
20
%
13.50
10
11.80
12.60
2007
2008
8.70
8 70
0
2005
2006
SCF
2008 Saratoga 90%tile (11.50)

111. % of AN/AI Workforce Promoted
20
%
14.1
10
9.5
9.2
9.5
2006
2007
2008
0
SCF
2009
2008 Saratoga 90%tile (11.50)

112. "I understand mission & core values"
5
4.31
4.32
2003
2005
Sco
ore
4
4.43
4 43
3.87
3
2
1
0
SCF
2007
2009
Morehead Nat HC Ave 2009 (4.34)

113. 90 Day Turnover Rate
%
20
10
7.1
5.9
59
3.4
0
2007
SCF
2008
2009
2008 Saratoga 90%tile (7.30)

114. "This org. cares about employee safety"
5
S
Score
4
3.88
3 88
4.05
4.17
4.30
2003
2005
2007
2009
3
2
1
0
SCF
Morehead Nat HC Ave 2009 (4.16)

115. Score
Benefit Satisfaction & Organizational Support
5
4
3
2
1
0
3.69 3.66
3 69 3 66 3.89 3 67 3 73 3.87 3 68 3.93 4.02
3.67 3.73
3.68
05
07
09
I am Satisfied
w/ Benefits
SCF
05
07
09
Org Support
Work vs Pers.
05
07
09
Org Interested in
HealthWellness
2009 Morehead Natl HC Ave (Sat 3.66 Sup 3.82)
3 66
3 82)

116. 62
55
59
41
42
43
35
VAL
58
PEDS
50
47
48
Overall
Overall
Overall
Overall
Overall
Overall
0
Overall
%
100
FMC
% Appointments Available at 0800
for Whole Day (FMC/PEDS/VAL)
03
04
05
06
07
08
09
SCF
09
SCF Innovative Target (50%)

117. 4000
Behavioral Health Urgent Response Capacity
g
p
p
y
3984 3867
2915
3000
#
2005
2000
1000
1176
1114
2004
2005
333
0
2003
2006
SCF
2007
2008
2009

118. Continuity of Care with Primary Provider
100
83
73
%
71
76
6764
50 35
0
99 00 01 02 03 04 05 06 07 08
PEDS
FMC
VAL
*
09
MHS (44.85%)