The Alaska Federal Health Care Partnership

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The Alaska Federal Health Care Partnership

• An Overview of Multi-Agency Collaboration

Chris Mandregan, MPH, Director, Alaska Area Indi
an Health Service, AFHCP Executive Committee
Member
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What is the Partnership?

• A formal, voluntary, inter-agency relationship
  between the IHS, VA, DoD and DHS, working
  together by the sharing of each others
  resources, talents, and experience to improve
  patient care throughout the state of Alaska

Alaska Federal Health Care Partnership
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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
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Vision

• A Partnership of multi-cultural intra-agencies
  working in concert, achieving the highest level
  of health status for beneficiaries.

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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

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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

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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

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Medical Environment

• Alaska ranks 48th in Provider-to-Patient ratio
  (15000) for sub-specialists
  
• Medical resources limited
• One cardiology group
• One neonatology group
• One neurosurgery group

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Medical Environment
Alaska has no HMO or Managed Care structure -
fee-for-service Cost for medical services can r
outinely exceed 200 of CONUS costs
One civilian hospital in interior Alaska
(Fairbanks Memorial)
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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)

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The Partners

• Department of Defense - (DoD)

U.S. Army Bassett Army Community Hospital (BACH
)
TMC, Fort Richardson
U.S. Air Force 3rd Medical Group (3MDG) 354th
Medical Group (354MDG)
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The Partners
Department of Homeland Security
U.S. Coast Guard USCG Clinics - Kodiak, Juneau,
Sitka
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The Partners
Indian Health Service - (IHS)
Alaska Native Tribal Health Consortium (ANTHC)
Regional Tribal Health Consortia/Corporations
Alaska Native Medical Center
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The Partners
Veterans Affairs - (VA)
Alaska Veterans Affairs Healthcare System and
Regional Office (AVAHSRO)
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Population
Alaska State Population 626,932
DoD/DoT 75,000
VA 75,000
IHS/Tribal 120,000
Total Federal/ 275,000 Tribal Population
Note Total Federal/Tribal Population includes
both dual and triple beneficiaries
2000 Census Figures
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History

• 1940-1970 Informal cooperation to serve a
  geographically isolated community
  
• 1980s VA/Elmendorf AFB joint venture
  to build a new hospital
  
• 1993-1994 Alaskan military medical
  treatment facilities (MTFs) form
  a partnership to pursue TRICARE
  objectives

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History

• Oct 1994 Implementation of the DoD Alaska
  Region Health Care Plan (ARHCP)
  
• 1994-1995 DoD, 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

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Organizational Relationships
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Organization and Functions

• Cooperative leadership
• Joint Executive Committee
• Joint sub-committees
• Partnership Office (PO)
• Efficient use of federal resources within
  Alaska
  
• Five primary agencies
• 235 medical facilities

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Partnership Office Staff

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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

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Legal Authority

• AFHCP Interagency Umbrella Agreement
• VA, DoD, DHA, IHS, and Tribal Sharing and
  Interagency Agreements (PL97-174, Economy Act
  1932)
  
• Indian Health Care Improvement Act (25 U.S.C.)
• Indian Self Determination Act (PL638)
• Other joint competitive contracts
• Federal Acquisition Regulation (FAR)

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Partnership Agreements
33 Agreements
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Resource Sharing

• Staff
• Medical Specialty Services
• Urology
• Ophthalmology -3MDG 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

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Resource Sharing

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

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Resource Sharing Joint Venture

• Alaska is one of two states without a VA hospital
  (Hawaii is the other)
  
• VA sends patients to 3rd 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
  

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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

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Partnership Agreements

• Perinatology Agreement
• ANMC/3MDG
• 81 Flights Avoided
• Timely Access to Genetic Counseling
• 3MDG OB/GYN Clinicians better manage patients
• Care No Longer Refused
• Estimated FY-03 1st Quarter Cost-Savings
  51,390.00

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Partnership Agreements

• Medical Training Services Agreement
• ANTHC/1984th Battalion
• 4- RNs
• 1-LPN
• 2-OR Techs
• 1-EMT
• Over 368 hrs

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Partnership Agreements
Dermatology Peer Review ANMC and 3MDG Only 2
Federal-Partner Dermatologists in AK
Specialized Dermatology Peer Review
Non-payable Agreement Teledermatology Future AFH
CP initiatives within Dermatology field
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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, DoD, 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

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FY-2003 Financial Outcomes

• FY03 (1st 3rd Qtr) Cost Savings
• 3,540,532.80

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Strategic Goals2003 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

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2002 2003 Accomplishments

• Completed over 40 clinical and administrative
  initiatives (contracts, MOUs 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

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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 Gores Hammer Award - Reinventing Government
  (1997)
  
• Published twice in US Medicine (1997)
• DHHS Secretarys Award (1998)
• Published in Veterans Health System Journal
  (1999)
  
• AstraZenca Partnerships In Government Award
  presented by NMHCC (2002)
  
• Government Executive Magazine Grace Hopper Award
  Innovations in Government Technology

Alaska Federal Health Care Partnership