Sunday, April 13, 2008

Alaska's Healthcare Efforts

Governor Sarah Palin is leading Alaska’s efforts to have affordable healthcare and to make certain that the Alaskan healthcare system is responsive to changing demographics and market conditions. In January 2008, with recommendations from the Health Care Strategies Planning Council and the Health and Social Services Certificate of Need Negotiated Rule Making Committee, the Governor introduced the “Alaska Health Care Transparency Act.”

The Act would establish the Alaska Health Care Commission to do further healthcare planning from a statewide perspective. A healthcare information office would be established to give consumers factual information on quality, costs, and other matters to help them make better informed decisions about healthcare.

The recommendations made to the Governor were recently released in the “Health Care Action Plan: “Making Alaskans the Healthiest people in the Nation.” The plan details long term goals and strategic directions for the years 2008-2014. The final report complete with summaries and recommendations was released in December 2007.

Several goals are listed in the plan but one goal would make quality healthcare accessible to all Alaskans by:

  • Expanding telehealth and electronic health record systems and taking the lead in pursuing matching FCC grant funds in the short term
  • Increasing the presence of the public health system particularly public health nurses in rural communities
  • Enabling Alaskans to have access to a primary care provider and behavioral health provider when needed
  • Helping Alaskans to not use emergency rooms for primary care
    Exploring private enterprise incentives
  • Improving primary and long term healthcare options for elders, particularly with regard to Medicaid and Medicare

The Governor is also proposing a repeal of the “Certificate of Need Program”. CON is a regulatory process requiring certain healthcare providers to obtain state approval before offering certain new or expanded services. According to Health and Social Services Commissioner Karleen Jackson, the CON program does not benefit the citizens of Alaska because of the litigious environment surrounding it.

According to the Mukluk Telegraph newsletter published by the Alaska Native Tribal Health Consortium (ANTHC), as many know, residents in remote Alaska areas are faced with difficulties getting healthcare. Transportation to providers can mean driving long distances, taking boat rides, or even flying to the doctor. Today, some patients in Adak, Akutan, Nelson Lagoon, King Cove, St. George, and Cold Bay have been able to monitor their care at home using technology.
However, as with many groups, ANTHC is facing several challenges all directly or indirectly related to funding. IHS annual funding increases from 1 to 2 percent are not keeping up with medical care costs and population growth. Added to this, there are substantial cost increases for utilities employee benefits, construction, pharmaceuticals, surgical implants, and travel.

To further help deliver home healthcare, the Alaska Federal Health Care Partnership (AFHCP) is partnering with the Eastern Aleutian Tribes to provide VitelNet Home Telehealth Monitors also known as “Turtles” to deliver care in some of the most remote homes. Already success has been seen in treating diabetics and also the population that needs to be on the prescription medication coumadin. “In a state where access to care is a major issue, home telehealth monitoring profoundly impacts healthcare delivery in Alaska,” said Mark Anaruk, project manager for AFHCP.

The Alaska Federal Health Care Access Network (AFHCAN) provides access to healthcare using telehealth technologies, and helps beneficiaries of IHS and tribal organizations, the Department of Defense, U.S. Coast Guard, the VA, and provides benefits to state Public Health Nursing offices.

AFHCAN is promoting telehealth by sending traveling specialists to remote healthcare facilities to educate end users on how to use VTC technology. This technology is used for dermatology, otolaryngology, and podiatry to provide continuing education. AFHCAN is evaluating the data from these VTC sessions to see if it helps increase the use of telemedicine in distant sites. In addition, AFHCAN provides the Traveling Audiology Program to provide audiology services in remote areas.

AFHCAN in recent years has been using telemedicine carts, but now the carts have been improved and come equipped with additional monitoring and diagnostic equipment. The use of telemedicine is expanding and ANTHC is now forming a subsidiary company that will distribute the telehealth carts nationally and internationally.

According to the newletter “Alaska Rural Health Notes” published by the Alaska Center for Rural Health, besides the actual hardships in delivering good healthcare, another problem has to do with the enormity of the health workforce crisis. However, Alaska is not alone in the struggle to recruit and retain a competent health workforce.

The University of Alaska, Fairbanks will receive a grant to help train healthcare workers in rural Alaska through the Rural Alaska Health Education and Training Project. The Alaska Congressional Delegation announced that the university would receive a $1,858,528 grant through the Department of Labor’s Community-Based Job Training Grant Competition. According to Senator Ted Stevens, “the lack of healthcare workers in Alaska, particularly in our most remote areas is alarming.”

For example, Alaska faces a staggering shortage of behavioral health professionals at every level of training. Also, Tribal Alaska’s vacancy rate is over 40% for dentists and over 50% for pharmacists. In addition, shortages for physical therapists, occupational therapists, and speech pathologists are also dire.

Addressing mental illness is an enormous undertaking in the state. In an effort to improve suicide prevention outcomes, the goal is to better utilize the state’s telemedicine capabilities. Many Alaskan Native Health Corporations have signed telemedicine agreements to help increase early intervention, screening, and treatment capacity in rural areas. There are also plans to link with developing rural health clinics to improve service delivery, provide gatekeeper training, and analyze recommendations from the Alaska Follow-Back Study to be able to identify new strategies to use for earlier intervention with identified high-risk individuals.

The TeleBehavioral Health Project has been piloted in Alaska with AMHTA, DHSS, and Federal grant funds. This program provides access to services via technology to remote hub villages so that Alaskans with psychiatric issues do not have to leave their home community to obtain services or deteriorate to an emergency status as this could mean that they would have to be transferred to the Alaska Psychiatric Institute.

The Alaska Psychiatric Institute has been working on an automation project that could enhance their electronic medical record system and at the same time help expand the TeleBehavioral Health Project. As with many projects, additional funding is needed to help continue the automation work.

None of the above issues can be addressed and work if broadband isn’t established throughout the state. Through the FCC Rural Health Pilot Program, a grant for $10.5 million is going to help develop an Alaska e-health network for telehealth and health information exchange and provide for the design and development of a statewide broadband network.

To help with the project, ANTHC has been designated to act as interim project manager to design and develop the network. ANTHC envisions the eventual creation of a public private partnership to manage the Alaska e-health network for the long term.

The specific objectives for the network are to unify the separate electronic healthcare networks that are being developed throughout the state, and supply rural health providers with connectivity to providers both in Alaska and the lower 48 states. The network will provide for the exchange of health information, support telemedicine services, transfer high resolution images, provide for videoconferencing, and for voice-over-internet applications.