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Yukon should adopt Alaska’s Nuka healthcare model, review panel recommends

The independent panel that spent more than a year reviewing the Yukon’s health and social programs and services is urging the territory to look across the border and adopt a healthcare model created in Alaska.
Whitehorse General Hospital in Whitehorse on Feb. 14, 2019. A report by an independent panel that reviewed the Yukon’s health and social system says that by adopting the Nuka System of Care, the territory could reduce hospital visits and stays and save nearly $19 million per year in costs by 2035. (Crystal Schick/Yukon News file)

The independent panel that spent more than a year reviewing the Yukon’s health and social programs and services is urging the territory to look across the border and adopt a healthcare model created in Alaska.

The award-winning Nuka System of Care, created and administered by the non-profit, Alaska-Native-owned Southcentral Foundation in Anchorage, is lauded throughout the five-person panel’s 200-plus-page final report, Putting People First.

The report, released to the public last week, contains 76 recommendations on how to improve the territory’s health and social system, with a focus on improving experiences for both patients and providers as well as making operations and delivery more efficient.

“The panel looked at a number of different models of organization and delivery and we were very much impressed with the Nuka Model of Care that’s operated by the Southcentral Foundation in Alaska,” panel member Gregory Marchildon told media during a press conference on May 13.

“And we took some of the lessons from that model of care and adapted them into the Yukon context.”

The Nuka model currently provides “medical, dental, behavioural, traditional and health care support services” to more than 65,000 Alaska Natives in Anchorage and the Anchorage area, according to the Southcentral Foundation’s website.

One of its key components is providing what it calls its “customer-owners” with primary care — for example, access to a family doctor or nurse — in order to mitigate the possibility of more serious health issues arising later.

The model also emphasizes, among other things, the importance of ensuring services are culturally appropriate, centring patients’ wants and needs when creating care plans, building long-term relationships between patients and care providers, building a team of care providers around patients and short wait times for appointments.

According to Putting People First, between 2000 and 2017, the number of hospital stays by Southcentral Foundation customer-owners dropped by 36 per cent. Visits to the emergency department also dropped by 40 per cent during the same timeframe; according to the report, the Yukon could save nearly $11 million per year in hospital costs if it were to see similar reductions.

That would amount to a decrease of more than 10 per cent, or $267, for every Yukoner.

“With hospital use expected to grow over the coming years as the population grows and ages, the potential savings grow as well,” the report continues, projecting that by 2035, a 10 per cent reduction in spending would work out to nearly $19 million saved.

“Yukon will be able to use these funds to offset increased costs in other areas associated with the implementation of the Nuka model of care, especially in the area of primary health care,” the report says.

Part of the costs of adapting the Nuka model to the Yukon include a complete restructuring of how healthcare is administered in the territory.

Instead of the Department of Health and Social Services funding, regulating, administering and delivering programs and services, the panel is recommending the government create an arm’s length public organization, Wellness Yukon, to handle administration and delivery.

“These would be services across the health continuum starting with primary care … (as well as) hospital care, long-term care, home and community care, medical evacuation and medical transportation, chronic disease management and so on,” Marchildon told reporters.

“It would also be responsible for measuring, monitoring and evaluating performance in terms of outcomes, satisfaction, quality and cost.”

Yukoners would also see primary care become “the centre of the health care universe,” with each Yukoner assigned to a primary care team that would help coordinate their care throughout the “health care continuum,” including specialized or Outside hospital care.

“What this means is that Yukoners can expect that they will have contact with a group of providers not just the first time they get sick, but continually,” Marchildon said.

“… This marks a pretty big change from the traditional referral model and it’s one of the reasons in Alaska, they’ve been able to achieve so much in terms of improving satisfaction, improving the quality of care, improving the outcomes and actually over time, in reducing costs.”

Primary care teams, which would operate through both community health centres and hubs, would be responsible for anywhere between 1,200 to 1,400 Yukoners. The teams would be led by either a doctor or nurse practitioner and also include medical assistants — a new component to Yukon health care — that come from the communities themselves.

The idea is that the assistants, with additional training and education, would eventually become nurses, nurse practitioners or doctors themselves, Marchildon explained, joining the system while having “a much closer connection to the communities and a much more enduring connection to the communities than what is currently the situation.”

“So this is very much looking to the long-term to change the basic dynamic,” he said.

The primary care teams would then be linked to “polyclinics,” based in larger hubs, that offer more specialized care like midwifery and dietician services or respiratory therapy. The polyclinics would “flow” any patient information back to that patient’s primary care team to ensure a continuity in care.

“So this marks a pretty big departure from the system,” Marchildon said. “It means a system (that) is … much more directed both by Yukoners and by the members of the primary care teams than right now, in which, basically, you don’t have that kind of continuity and coordination that you could have through this new system.”

Contact Jackie Hong at