Relationship-Based Health Care: Achieving Improved Outcomes Through Shared Responsibility
Authors: Kyle April 
Published: January 2024

Pressures are mounting on health care organizations today to provide better care while also controlling costs. Engaging people in their own health care can both result in better health outcomes for patients, and ease the burden on the medical system. Southcentral Foundation (SCF), an Alaska Native-owned health care system, transformed its system in the late 1990s to focus on customer-ownership and relationships. Today, SCF serves as an example of what can be achieved through a system focused on these core elements.
SCF does not refer to the people it serves as “patients.” This term sounds passive and does not reflect the level of engagement that SCF’s providers and customers have with each other and the customer’s health care. Rather, since the Alaska Native and American Indian people SCF serves are both customers and the owners of the health care system, they are referred to as “customer-owners.” This is not just a change in terminology, it signifies a change in the relationship between customer-owners and their care providers. Unlike a traditional system in which the patient often has a minimal role in their diagnosis and treatment, our customer-owners work together—in relationship—with their care providers to achieve overall wellness.
These relationships are another central element of SCF’s whole system transformation. SCF recognizes that each individual has more control over his or her own health outcomes than providers, and that when providers build strong, long-term relationships with customer-owners, they can more effectively help customer-owners achieve wellness. Customer-owners choose their own providers and form strong, long-term relationships so providers can support them in their journeys toward wellness.
SCF’s focus on customer-ownership and relationships has resulted in improved health outcomes for customer-owners while also managing costs. Emergency Department visits for customer-owners decreased by 44%in the five years after SCF transformed its system, and inpatient discharges decreased by 63% over that same time period. SCF ranks above the 75th percentile for many health measures such as diabetes and cancer screenings. 97% of customer-owners are satisfied with the care provided by SCF, and SCF has also achieved 95% employee satisfaction.
This workshop is for health care leaders, medical directors, improvement personnel, and anyone else looking for ideas for systemic reform. The session will be delivered in an interactive lecture format, with time allocated throughout for participants to discuss the material presented in small groups. After the discussions, the groups will report out to the larger group so that a variety of perspectives can be shared. Presenters will also regularly ask questions to engage the audience and encourage participants to share their own experiences and ideas relating to the material presented.
At the end of the session, the key elements of SCF’s system of care will be summarized, along with points raised by participants during the session. Suggestions will also be offered for participants looking to reform their own systems according to principles of relationship-based care and customer-ownership.