Southcentral Foundation’s Path to Self-Governance

Interest among American Indian Tribes in taking ownership of their own health care is high, and there is good reason for this. Research has shown that when the people receiving health services are involved in the decision-making process, or better yet, if they own their own health care, programs and services have a potential for enhancement and the people’s health statistics will improve. At Southcentral Foundation, Alaska Native people have been running their own health care system for over two decades. The following provides some brief information about SCF’s path to self-governance.

SCF was established in 1982 under the Tribal authority of Cook Inlet Region, Inc. SCF’s first self-determination contract was in 1984 for the provision of dentistry, optometry, community health representatives, and injury control services. A funding request to provide substance abuse treatment services was added in 1987.

Throughout the late 1980s and the early 1990s, SCF increased its contracting capacity and by late 1994, it was administering nearly half the primary care services for Alaska Native people in the Cook Inlet region. Self-governance, a Tribally-driven initiative made possible through congressional appropriations, opened the door for Alaska Native people to completely redesign the health care system based on the Alaska Native community’s needs and values.

In 1998, SCF took ownership and management of primary care and other programs located in the Anchorage Native Primary Care Center. And in 1999, SCF and the Alaska Native Tribal Health Consortium signed an agreement to take ownership and management of the entire Alaska Native Medical Center. SCF spent a year collecting feedback from the Alaska Native Community and finding out what they wanted from the health care system, and using this feedback, launched the Nuka System of Care in partnership with the Alaska Native community. This involved a complete overhaul of the entire system; not only was direct care changed, but also every other area of SCF including human resources, data services, finance, etc.

Today, SCF serves over 65,000 customer-owners living in Anchorage, the Matanuska-Susitna Valley, and 55 rural villages in the Anchorage Service Unit. Health outcomes for customer-owners have improved significantly, with emergency room visits decreasing by 40% from 2000 to 2017, and hospital stays decreasing by 36% during that same time period. SCF is in the 90th percentile nationwide for the Healthcare Effectiveness Data and Information Set benchmarks in measures such as cervical cancer screening, diabetes poor control, and CVD control < 100 mg/dL. 97% of customer-owners are satisfied with the care provided by SCF, and SCF has also achieved 95%employee satisfaction. SCF continually works with the Alaska Native Community to improve the system and offer programs suited to the community’s needs. For more information about SCF’s journey to self-governance, contact the SCF Learning Institute today!