Hundreds of health care workers and government officials descended on Anchorage this week for the kickoff of a five-year, $1.3 billion program aimed at reimagining medical care across Alaska.
The money comes from the Rural Health Transformation Program created by President Trump’s signature tax- and spending-cut legislation passed last summer — the same legislation that pares back Medicaid.
The problem the funding seeks to solve is no secret, the state’s former chief medical officer, Dr. Anne Zink, said on a call with reporters and state officials. Zink is working with the state Department of Health on the program, she said.
“We consistently see that people who live in rural areas — Alaska and beyond — have worse health outcomes with increased cost,” she said. “This is an opportunity to rethink the way that care is delivered to make sure, no matter where you live, you have access to quality, timely, effective care.”
States across the country are racing to develop plans to spend the influx of cash. They have until October to obligate the first tranche of cash and another year to spend it.
Alaska is building its version of the program around six goals, from improving maternal health, preventive care and access to healthcare to strengthening the workforce and rethinking how doctors and hospitals charge for care.
That last point — what the state is calling “pay for value” — is a big one. Most medical care is what’s known as “fee for service,” for example, when a patient goes to a doctor and pays the doctor for their time, whether they get healthy or not.
With pay for value, the idea is to pay for results.
But given the fragmented nature of health care in Alaska, where many patients have to travel hundreds of miles from home for care, “the realities of making that transition take time,” said Deputy Health Commissioner Emily Ricci.
“It's very challenging, and it will look different for every community and every provider and the provider types,” Ricci said.
Another example: Say you have a rash. You go to the doctor. The doctor sends you to the dermatologist, who sends you to the pharmacy for a medicated lotion.
Does your primary care provider know what your dermatologist prescribed? Does your dermatologist know your regular doctor tried that same medication with the hard-to-pronounce name six months ago?
And does anyone know if you eventually get better?
Maybe not. And that’s an issue standing in the way of a transition to value-based care that the state would like to address, Ricci said.
“How can we use this funding to begin now, over the next five years, building out the infrastructure, the concepts, the protocols, the data that providers need in order to kind of make that transition?” Ricci said.
So technology is one focus for the first of what the Department of Health said will be a series of workshops in Anchorage.
The meetings — known as “convenings” — are an effort to get as many stakeholders involved as possible, from cities and tribes to hospitals, medical providers and vendors, Health Commissioner Heidi Hedberg said.
“This funding is really to support what the community and region need,” Hedberg said. “Every community, and every region, needs something different.”
Alaska will receive roughly $273 million per year for five years as part of the $50 billion nationwide program. Hedberg calls it “generational.”
But the elephant in the room, of course, is that the same tax cut legislation that created the program could also push many Alaskans away from the health care system, said Alaska Hospital and Healthcare Association head Jared Kosin.
“I see the bright side and the good things looking ahead,” Kosin said. “I talk about coverage disruptions with these enhanced premium tax credits expiring. We talk about coverage disruptions with the tightening of Medicaid eligibility right around the corner.”
State officials have downplayed the spending law's impact on Alaskans on Medicaid. But Kosin is worried the changes will push health care costs up, he said, because when people can’t pay, hospitals have no choice but to shift those costs onto those who can.
Kosin said he’s also concerned that the transition to a new administration after Gov. Mike Dunleavy’s term ends in December could throw a wrench in the state’s plans.
State officials, though, say they’re building sustainability into their plans. Ricci, the deputy health commissioner, said that the state Health Department was “acutely aware” of the challenges involved in standing up a program that will span at least two governors’ administrations over half a decade.
“The key to that, I think, is bringing in the communities and the partners and the healthcare entities into the discussion from the beginning and into that structure,” Ricci said.
Put more simply, “this is a project for Alaskans by Alaskans,” said Zink, the state’s former chief medical officer.
“The sustainability will be dependent on Alaskans,” she said.
Alaska Public Media’s Rachel Cassandra contributed reporting.
