Nuka approach to customer-owned care: how integrated care team dynamics impact outcomes

Steve Tierney lodden@scf.cc

Abstract

  In partnership with the Alaska Native people, Southcentral Foundation (SCF) developed the customer-owned and -managed, relationship-based Nuka System of Care and transformed its health care delivery system into an integrated customer-centric model. The success of this approach is largely due to the co-located, multidisciplinary integrated care teams, which consist of the primary care provider, the case manager, the certified medical assistant, and the case management support. This efficient, collaborative unit functions in approximately 3 feet of modular space, elbow-to-elbow, in constant communication around the electronic health record. Other disciplines, shared across several pediatric/primary care teams, are seamlessly woven into the teams such as behavioral health consultants, dieticians, the pharmacists, and, midwives. The dynamics of this unique arrangement fosters relationships and focuses on what the customer wants and needs. This transformation from a discipline-centric model to an innovative, integrated customer-centric model, where customers receive same-day access to all of their services in one place with co-located integrated care teams, resulted in a 50 percent drop in urgent care and ER utilization, 53 percent drop in hospital admission, 65 percent drop in specialist utilization, 20 percent drop in primary care utilization, an employee turnover rate of less than 12 percent, and a customer and staff overall satisfaction rate of over 90 percent. In data comparisons with HEDIS benchmarks, SCF scores in the 90th percentile for many of its services. The Nuka System of Care is not just something that works in Alaska.  Other health care systems around the world are replicating the system. A few examples of this replication include the Veterans Health Administration who is working to transform health care into a VHA model based on the Nuka System of Care; the Cerner Corporation has chosen SCF as its development partner for customer-owner driven population health solution design; and the Harvard Medical School Center for Primary Care, through a data-sharing agreement, will use the Nuka System of Care to create an academic case study centered on SCF’s Nuka System of Care for teaching medical students. In 2011, SCF became the recipient of the Malcolm Baldrige National Quality Award for performance excellence for its innovative, relationship-based, and customer-driven Nuka System of Care.

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