The Alaska Federal Health Care Partnership An Overview

The Alaska Federal Health Care Partnership “ An Overview of Multi. Agency Collaboration” Chris Mandregan, MPH, Director, Alaska Area Indian Health Service, AFHCP Executive Committee Member

What is the ‘Partnership? ’ A formal, voluntary, inter-agency relationship between the IHS, VA, Do. D and DHS, working together by the sharing of each other’s resources, talents, and experience to improve patient care throughout the state of Alaska Federal Health Care Partnership

Mission We, the Alaska Federal Health Care Partnership, are dedicated to providing our beneficiaries ready access to quality, customer oriented, compassionate, comprehensive, and cost-effective health care Alaska Federal Health Care Partnership

Vision A Partnership of multicultural intra-agencies working in concert, achieving the highest level of health status for beneficiaries. Alaska Federal Health Care Partnership

Overall Goals… • Facilitate patient access to the right care at the right time • Optimize technology • Promote patient wellness • Create a better business environment • Maintain medical preparedness Alaska Federal Health Care Partnership

Underlying Philosophy • • Learning Organization Patient centered Health care as close to home as possible Long term relationships Respectful of individual cultures Evolving process Inclusive not exclusive Alaska Federal Health Care Partnership

Challenges • Alaska is large - 20% of the entire United States • Air evacuation is the only practical means of patient transportation • The travel budget for some health corporations is comparable to their staffing budget • Limited competition in medical services market - ‘fee-for-service’ Alaska Federal Health Care Partnership

Medical Environment… • Alaska ranks 48 th in Provider-to-Patient ratio (~1: 5000) for sub-specialists • Medical resources limited: – One cardiology group – One neonatology group – One neurosurgery group Alaska Federal Health Care Partnership

Medical Environment… • Alaska has no HMO or Managed Care structure - “fee-for-service” • Cost for medical services can routinely exceed 200% of CONUS costs • One civilian hospital in interior Alaska (Fairbanks Memorial) Alaska Federal Health Care Partnership

Who are the ‘Partners? ’ • Department of Defense (USA & USAF) • Department of Homeland Security (USCG) • Department of Veterans Affairs • Indian Health Service – Alaska Native Tribal Health Consortium (ANTHC) – Alaska Native Medical Center (ANMC) Alaska Federal Health Care Partnership

The ‘Partners…’ Department of Defense - (Do. D) U. S. Army: • Bassett Army Community Hospital (BACH) • TMC, Fort Richardson U. S. Air Force: • 3 rd Medical Group (3 MDG) • 354 th Medical Group (354 MDG) Alaska Federal Health Care Partnership

The ‘Partners…’ Department of Homeland Security U. S. Coast Guard: • USCG Clinics - Kodiak, Juneau, Sitka Alaska Federal Health Care Partnership

The ‘Partners…’ Indian Health Service - (IHS) Alaska Native Tribal Health Consortium (ANTHC): • Regional Tribal Health Consortia/Corporations • Alaska Native Medical Center Alaska Federal Health Care Partnership

The ‘Partners…’ Veterans Affairs - (VA) Alaska Veterans Affairs Healthcare System and Regional & Office – (AVAHSRO) Alaska Federal Health Care Partnership

Population* Alaska State Population: 626, 932 * 2000 Census Figures Alaska Federal Health Care Partnership Do. D/Do. T VA IHS/Tribal 75, 000 120, 000 Total Federal/ Tribal Population 275, 000 Note: Total Federal/Tribal Population includes both “dual” and “triple” beneficiaries

History… • 1940 -1970 Informal cooperation to serve a geographically isolated community • 1980 s VA/Elmendorf AFB joint venture to build a new hospital • 1993 -1994 Alaskan military medical treatment facilities (MTF’s) form a partnership to pursue TRICARE objectives Alaska Federal Health Care Partnership

History… • Oct 1994 Implementation of the Do. D Alaska Region Health Care Plan (ARHCP) • 1994 -1995 Do. D, VA and Indian Health Service (IHS) in Anchorage & Fairbanks join to form Federal “alliance” • Aug 1995 Creation of the Alaska Federal Health Care Partnership (AFHCP) • Jan 1999 Alaska Native Tribal Health Consortium (ANTHC) joins Partnership Alaska Federal Health Care Partnership

Organizational Relationships AFHCP Executive Board Partnership Office AFHCAN Office (Managing Partner ANTHC) AFHCP Planning Committee Health Service Acquisition Committee (HSAC) Logistics Committee Federal Education Sharing Group (FESG) AFHCAN Integration Committee (AIC) Teleradiology Etc. Alaska Federal Health Care Partnership

Organization and Functions • Cooperative leadership: – Joint Executive Committee – Joint sub-committee’s – Partnership Office (PO) • Efficient use of federal resources within Alaska: – Five primary agencies – ~235 medical facilities Alaska Federal Health Care Partnership

Partnership Office Staff Linda Lekness Director, AFHCP (AVAHSRO) Feb 03 CPT Kirk Webb Deputy Director, AFHCP (BACH) Aug 03 Brenda Jack Office Manager, AFHCP (ANTHC) Mar 00 Raquel Valle Health Systems Specialist (BACH) Feb 02 Alaska Federal Health Care Partnership Alnetta Effenbeck Health Systems Specialist (3 MDG) June 03 CWO 2 Jay Brudzinski AK Managed Care Officer (USCG) Aug 00

Roles and Responsibilities… • Clearing-house for Partnership information • Support for Partnership work-plan priorities – Coordination – Analysis – Recommendations • Monitor goals and achievements • Report on activities • Ensure coordination and consistency in efforts Alaska Federal Health Care Partnership

Legal Authority • AFHCP “Interagency Umbrella Agreement”: – VA, Do. D, DHA, IHS, and Tribal Sharing and Interagency Agreements (PL 97 -174, Economy Act 1932) – Indian Health Care Improvement Act (25 U. S. C. ) – Indian Self Determination Act (PL 638) • Other joint competitive contracts: – Federal Acquisition Regulation (FAR) Alaska Federal Health Care Partnership

Partnership Agreements 33 Agreements

Resource Sharing • Staff: – Medical Specialty Services • Urology • Ophthalmology -3 MDG provides services to VA & ANMC (IHS/tribal) • Hepatology - ANMC (IHS/tribal) provides services to DOD & VA • Oncology – VA provides Certified Tumor Registrar to IHS/tribal oncology program • Audiology • Dermatology Alaska Federal Health Care Partnership

Resource Sharing • Staff (continued): – Nursing – Telemedicine, Teleradiology, and Teleconferencing – Education, training, and logistics, etc. – Partnership Office Staff

Resource Sharing – Joint Venture • Alaska is one of two states without a VA hospital (Hawaii is the other) – VA sends patients to 3 rd Med Group at Elmendorf Air Force Base and – Alaska Native Medical Center – VA awards multi-agency contract with local hospital for inpatient care for all Partnership members at reduced rates Alaska Federal Health Care Partnership

Contract Services • Emergency Air Ambulance services IHS/Tribal contract for all Partners (AEROMED) • Preferred-Provider hospitals - VA contract for Inpatient & Outpatient • Prime Vendor Pharmacy – VA (Amerisource) • Urology services • Transcription services Alaska Federal Health Care Partnership

Partnership Agreements Perinatology Agreement ANMC/3 MDG • 81 Flights Avoided • Timely Access to Genetic Counseling • 3 MDG OB/GYN Clinicians better manage patients • Care No Longer Refused • Estimated FY-03 1 st Quarter Cost-Savings: $51, 390. 00 Alaska Federal Health Care Partnership

Partnership Agreements Medical Training Services Agreement ANTHC/1984 th Battalion • • • 4 - RN’s 1 -LPN 2 -OR Techs 1 -EMT Over 368 hrs Alaska Federal Health Care Partnership

Partnership Agreements Dermatology Peer Review ANMC and 3 MDG • Only 2 “Federal-Partner” Dermatologists in AK • Specialized Dermatology Peer Review • Non-payable Agreement • Teledermatology • Future AFHCP initiatives within Dermatology field Alaska Federal Health Care Partnership

Alaska Federal Health Care Access Network (AFCHAN) • Partnership-driven proposal for state-wide telemedicine system – AFCHAN • 4 -year, multi-million dollar endeavor • Connected 235 IHS, Do. D, VA and DHS sites throughout Alaska by a statewide telehealth network • Continued integration with teleradiology system (digital computed radiography) • Improved access to specialty care for patients in extremely rural locations – audiology, radiology, cardiology, dermatology

FY-2003 Financial Outcomes FY 03 (1 st – 3 rd Qtr) Cost Savings: $3, 540, 532. 80 Alaska Federal Health Care Partnership

Strategic Goals… 2003 and Beyond Strategic Goal: access to health care for federal beneficiaries • Complete AFHCAN sustainability plan and enhance telehealth capabilities • Evaluate and implement new agreements which support the mission of AFHCP • Implement initiative to evaluate clinical outcomes in common areas, using common measures • Provide educational sessions for members Alaska Federal Health Care Partnership

2002 – 2003 Accomplishments • Completed over 40 clinical and administrative initiatives (contracts, MOU’s etc. ) • Successfully completed initial 4 -year plan for telemedicine/telehealth – system installation • Financial outcomes exceeded $3 million for partner organizations • Hosted professional educational offerings to over 330 partner clinicians • Received national awards and recognition Alaska Federal Health Care Partnership

AFHCP Recognition • Published in Modern Healthcare (1996) • VA US-Health, Strategic Alliance Award (1997) • AK FEA Federal Employee Team of the Year Award (1997) • VP Gore’s Hammer Award - Reinventing Government (1997) • Published twice in US Medicine (1997) • DHHS Secretary’s Award (1998) • Published in Veterans Health System Journal (1999) • Astra. Zenca Partnerships In Government Award presented by NMHCC (2002) • Government Executive Magazine Grace Hopper Award – Innovations in Government Technology Alaska Federal Health Care Partnership