# Presentation: 722737

## 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

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

- What is the ‘*Partnership*?’

**Alaska Federal Health Care Partnership**

## 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

- Mission

**Alaska Federal Health Care Partnership**

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

- Vision

**Alaska Federal Health Care Partnership**

## Facilitate patient access to the right care at the right time
Optimize technology 
Promote patient wellness
Create a better business environment
Maintain medical preparedness

- Optimize technology
- Promote patient wellness
- Create a better business environment
- Maintain medical preparedness

- Overall Goals...

**Alaska Federal Health Care Partnership**

## Learning Organization 
Patient centered
Health care as close to home as possible
Long term relationships
Respectful of individual cultures
Evolving process
Inclusive not exclusive

- Patient centered
- Health care as close to home as possible
- Long term relationships
- Respectful of individual cultures
- Evolving process
- Inclusive not exclusive

- Underlying Philosophy

**Alaska Federal Health Care Partnership**

## 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’

- 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’

- Challenges

**Alaska Federal Health Care Partnership**

## Medical Environment...

- Alaska ranks 48th 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_ - (DoD)

- 	_U.S. Air Force_:
- 3rd Medical Group (3MDG)
- 354th Medical Group (354MDG)

- 	_U.S. Army_:
- Bassett Army Community Hospital (BACH)
- TMC, Fort Richardson

**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

- 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

**Alaska Federal Health Care Partnership**

## 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 (MTF’s) form a partnership to 			      pursue TRICARE objectives

**Alaska Federal Health Care Partnership**

## 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

**Alaska Federal Health Care Partnership**

## Organizational Relationships

**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

**Alaska Federal Health Care Partnership**

## 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, 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)

**Alaska Federal Health Care Partnership**

## Partnership Agreements

- 33 Agreements

## 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

**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 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

**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 

- 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

**Alaska Federal Health Care Partnership**

## Partnership Agreements 

- 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 3MDG**_
- 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, 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

## FY-2003 Financial Outcomes 

- FY-2003 Financial Outcomes

**FY03 (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**

## 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)
AstraZenca Partnerships In Government Award presented by NMHCC (2002)
Government Executive Magazine Grace Hopper Award – Innovations in Government Technology

- 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)
- AstraZenca Partnerships In Government Award presented by NMHCC (2002)
- Government Executive Magazine Grace Hopper Award – Innovations in Government Technology

- AFHCP Recognition

**Alaska Federal Health Care Partnership**