Leadership

Serving Remote Communities: The Challenges and Rewards of Tribal Healthcare in Alaska

By Pauline Tise, CPCS, CPMSM

Working in Tribal healthcare in Alaska provides an opportunity to make a difference every day. As director of the medical staff office at the Alaska Native Tribal Health Consortium (ANTHC), I have the privilege of collaborating with many great mission-driven providers and people working to increase access to care for a population spread across one of the most remote and vast regions in the United States.

The Alaska Tribal Healthcare System serves Alaska Natives from all regions of the state, including remote villages that are often only accessible by air or boat. This geographic isolation presents many logistical challenges and brings much complexity to the delivery of care. It also provides an opportunity to make a meaningful impact on the health of a population that has traditionally faced significant healthcare disparities.

Tribal healthcare falls under the governance of the Indian Health Service (IHS). The Indian Self Determination and Education Assistance Act of 1975 empowered federally recognized tribes to enter contracts and compacts with the Department of Health and Human Services to manage and deliver healthcare to their own communities. In Alaska, the ANTHC manages this compact to provide care for much of the state.

The ANTHC Medical Staff Office handles the credentialing and privileging for all the providers at the Alaska Native Medical Center (ANMC), the Magnet Specialty Services, and Level II Trauma Center in Anchorage, as well as a couple of the smaller regional hospitals and many of the smaller clinics in the remote locations. Recruiting staff and retaining staff for these remote locations is a significant challenge, which those working in rural areas are familiar with.

In Tribal healthcare, we have an additional element in that our providers need to meet more stringent background and character checks because of the Indian Child Welfare Act, which is intended to help prevent a reoccurrence of past harm. We regularly encounter challenges with providers who apply to work at our facilities but must meet the qualifications, which include high standards for character and professionalism. There is an ongoing impression that Alaska is still the “Wild West” and that people can run to escape their past here.

Thanks to the information available in the National Practitioner Data Bank (NPDB) and our credentialing team's efforts, we can keep our patients safe and ensure our providers have quality colleagues. The history of inadequate care and cultural disconnect have led to a historical mistrust of the healthcare system within many Alaska Native communities, which is something we as an organization are working hard to overcome, as ANTHC aims to change this narrative.

Our vision, "Alaska Natives are the healthiest people in the world", is an ambitious statement that guides our strategy and actions. This vision drives our mission, "Optimizing health and well-being through collaborative partnerships and services." We are committed to reversing the trends of poor health outcomes for Alaska Natives and increasing access to care, using tools such as telemedicine to help bring care closer to home. Providers from ANMC are privileged and credentialed to travel to the regional hospitals to bring specialty care to the patients rather than requiring patients to leave their communities for specialty services.

Additionally, we are making improvements to gain the community's trust; small actions can have a substantial impact, such as educating new providers about Alaska Native nonverbal communication traditions. ANTHC is committed to including Alaska Natives in staffing, with the goal of achieving 50% native staffing. The medical staff office is 80% Native Alaskan staff, and we are working closely with our graduate medical education (GME) team to increase recruitment and promotion of Alaska Natives into the healthcare system. The Division of Environmental Health and Engineering (DEHE) runs STEM programs for Alaska Native schoolchildren.

In addition to providing access to healthcare, ANTHC is working to make structural improvements to improve the overall health of Alaska Natives. Many of our patients live a subsistence lifestyle, with limited access to basic utilities such as running water, which is common in some villages. One of the primary roles of DEHE is making structural improvements, such as bringing water purification plants and sewage plants to villages.

Working in the Alaska Native Tribal healthcare system has allowed me to take on unique challenges and opportunities to bring quality care to Alaska Native communities. The future of Tribal healthcare is rooted in the cultural values of Alaska Native people. Recruitment and retention of staff, development, and infrastructure maintenance are ongoing challenges that our staff and providers face. I am fortunate to work with a mission-driven workforce devoted to improving care for our people.

Sources:

Overview | Alaska Native Tribal Health Consortium

https://www.anthc.org/who-we-are/overview/

IHS Disparities https://www.ihs.gov/sites/newsroom/themes/responsive2017/display_objects/documents/factsheets/Disparities.pdf

Rural Tribal Health Overview — Rural Health Information Hub, https://www.ruralhealthinfo.org/topics/rural-Tribal-health#self-governance-program