Flash Player 9 (or above) is needed to view presentations.
We have detected that you do not have it on your computer. To install it, go here.

Like this presentation? Why not share!

Primary Care on the Last Frontier: The Challenges of Alaska’s Primary Health Care System



Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Mark Millard

Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Mark Millard



Total Views
Views on SlideShare
Embed Views



2 Embeds 11

http://www.nashp.org 9
http://www.slideshare.net 2


Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
  • http://www.fioricetsupply.com is the place to resolve the price problem. Buy now and make a deal for you.
    Are you sure you want to
    Your message goes here
Post Comment
Edit your comment

Primary Care on the Last Frontier: The Challenges of Alaska’s Primary Health Care System Primary Care on the Last Frontier: The Challenges of Alaska’s Primary Health Care System Presentation Transcript

  • Primary Care on the Last Frontier The Challenges of Alaska’s Primary Health Care System
  • Alaska’s Primary Care System: Issues, Trends, and Strategies Overview of Alaska Health Care System  State Health Care Reform Effort  Health Workforce Capacity Issues  Workforce Capacity Improvement Strategies  2
  • Context and History Demographics and Geography are vital to  understanding our health care delivery system. 3
  • Alaska’s Roads Roads are in red. Rivers also make up major transportation corridors. 4
  • Geography and Demographics Alaska is largely inaccessible by road.  Over half of the 670,000 residents live in  Anchorage and the Mat/Su Borough. Rural Alaska is largely isolated, Native, and  sparsely populated. 5
  • History of Health Care in Alaska 1940-50’s the US Public Health Service  (USPHS) established hospitals in response to a Tuberculosis (TB) epidemic. Community Health Aides originated from the  early USPHS TB effort. IHS has played a major role in the provision and  evolution of health care in rural Alaska. 6
  • History of Health Care in Alaska WWII invasion of Attu and Kiska Islands  (Aleutians) sparked a military presence. Military infrastructure has played a significant  role in the development of telemedicine efforts. 7
  • Capacity/Programs and Facilities 118 Community Health Center (CHC) sites  administered by 26 grantees. 13 tribally administered.  2 public entity grantees.  First grantee in 1974.  Major expansion of CHCs from 1998 onward.  10 Tribal health corporations have 6 rural  hospitals, and 220 clinics in regional centers and rural village communities. 8
  • Alaska’s Federally Funded Community Health Centers 1974-2007 Agencies Sites 140 118 120 Cumulative Count 100 80 60 40 26 24 20 5 12 12 0 1970s 1980s 1900s 2000s Year Funding Began 9
  • Capacity/Programs and Facilities The Denali Commission  Leveraging of federal dollars  Upgrading Alaska’s rural primary care facilities  Private primary care clinics/providers  Larger communities have them  Smaller communities generally do not  16 General Acute Care hospitals, and 6  PHS/Tribal Hospitals. (2,417 beds). 11 of the 16 hospitals are Critical Access hospitals. 10
  • Capacity/Providers 1,434 physicians (53% in primary care).  284 PAs (PAs practice under physician  supervision). 450 Advanced Nurse Practitioners (may  practice independently). 251 Community Health Aide Practitioners.  160 Community Health Aides (100 are III and  IV). 11
  • State Primary Care Office Role High degree of collaborative work with the APCA to  support our CHC’s and Primary Care “Safety net” providers. Advocacy within state & with federal partners.  Bill analysis and commentary.  Conduct, participate, and support studies regarding  primary care & primary care workforce (SORRAS, PSTF, planning grant). NHSC Support.  SEARCH program support and J1 visa program  administration. 12
  • State Primary Care Office Role Research and advocacy regarding state  workforce strategies. Designations HPSA/MUA(P).  TA and data support to CHC applicants and  existing programs. TA regarding Medicaid reimbursement,  service integration, professional and facility licensing and capital funding. 13
  • Health Care Reform Efforts State just completed planning grant (we’re a  late-comer to this effort). Conducted a task force to examine physician  supply within Alaska. Conducted an update of Status of  Recruitment Resources and Strategies report. 14
  • Findings from Reform Efforts Alaska has the highest rate of seasonal  variation (22%) in private sector employment. Alaska has some of the lowest rates of  private sector firms offering insurance. Alaska has some of the longest waiting times  for insurance enrollment. 15
  • Findings from Reform Efforts Alaska has unique workforce and employer  characteristics. This makes reliance upon employment-based  coverage strategies problematic. Planning grant exposed problems of  Medicare participation by providers, exacerbating shortages. 16
  • Alaska's private sector employment is far more seasonal than other states 25% 20% 15% 10% 5% 0% J an F eb M a rc h A p ril M ay J une J uly A ug S ep t Oc t No v De c J an 07 p -5% A K 2 1.8 % WY 10 .2 % M E 8 .8 % B a la nc e US 2 .4 % 17
  • Coverage Initiatives Proposed and Initiated Denali KidCare (SCHIP) increased to 175%  FPL from below 150% (2007 session). Governor appointed Health Care Strategies  Planning Council, report due January 1. Coverage bills introduced in legislature  propose supplementing employer-based insurance with State subsidies to individuals for purchase. 18
  • Health Workforce Capacity Issues Alaska has a shortage of 218 physicians or  14% of the expected physician workforce. Frequent barriers to recruitment  Dearth of qualified candidates  Geographic isolation/harsh living conditions.  Alaska invests on average $34,413 for each  successful primary care hire. 19
  • Health Workforce Capacity Issues Costs of temporary traveling providers  (locums expenses) contributed to recruitment costs. Sparse populations add to productivity and  coverage challenges. It is difficult to maintain HPSAs and high  scores in frontier areas. 20
  • Workforce Capacity Improvement Strategies Increase educational/residency slots  University of Alaska  Alaska Family Practice Residency Program  University of Washington  WWAMI program.  Support midlevel practitioner education and  placement. MEDEX program.  21
  • Workforce Capacity Improvement Strategies Expansion of the scope of the Community  Health Aide (CHA)/Practitioner program to include Dental Health Aides and Practitioners and Behavioral Health Aides. Research and leadership support for State  Loan Repayment program efforts. Developed strategies to prioritize service  need. 22
  • Workforce Training and Incentive Efforts Number of WWAMI medical training slots for  Alaskans increased from 10 to at least 20. Bill added legislative intent to include a post  training service requirement. Mental Health Trust Authority with the University  of Alaska make $200,000 available for loan repayment to behavioral health professionals. 23
  • Community Health Aide/Practitioner Program Unique to Alaska.  Origins in the 1950’s. Local village residents  trained to assist with TB epidemic. Expanded to include basic first aid training.  1960’s formal CHA training program  established by IHS and recognized in Federal Statutes. 24
  • Community Health Aide/Practitioner Program Higher level CHAs and CHAPs are Medicaid  reimbursable. Program model expanded to include Dental  Health Aides and Dental Health Aide Therapists. 2004 first graduates. Now 20 DHA’s/12 DHAT’s.  Chronic dental workforce shortages  Poor oral health in Native Villages Behavioral Health Aide program also initiated.  25
  • Prioritizing Services POPULATION >5001 EMS CATEGORY 20-100 101-500 Access Space Guidelines Communi ty Small = 1,535 GSF Level Medium = 1,990 GSF Large = 2460 GSF Designatio n Description Limited air / water access Small Medium Large and/or Road access > 60 miles; Daily air/water access Isolated I & II Considered a subregional Medium Large center and < 60 minutes travel time to next care level Highway II EMS Only Designated Medium < 60 minutes travel time to Itinerant Space2 next care level Highway I 1.Some communities in this population range may be candidates for multi-community or sub-regional centers. While services, staffing & square footage will be unique for each individual subregional center, a general guideline of 10,000 GSF is recommended. 2.500 GSF or designated space in community building, school, etc. 26
  • Prioritizing Services Dedicated Small Medium Large STAFFING Itinerant Clinic Clinic Clinic Space EMT EMT EMT EMT CHA/P Resident Providers CHA/P CHA/P MLP Itinerant Itinerant Itinerant Itinerant PHN Itinerant Itinerant Itinerant Itinerant Dental Dedicated PROGRAMS AND Small Medium Large Itinerant SERVICES Clinic Clinic Clinic Space Basic EMS X X X X Preventive Health Screenings X X X X Other Preventive Health Services X X X Basic Primary Care X X X Limited Laboratory and X X X Pharmacy X X Patient Case Management X X Outreach, Transportation & X X Interpreter X X Community Health X Advanced EMS X Limited Radiological On-site Administration & Support 27