Southeast Alaska Regional Health Consortium: Roald Helgesen, CEO

by HCE Exchange on August 19, 2010

The Southeast Alaska Regional Health Consortium (SEARHC: pronounced search) is a non-profit corporation made up of 18 different tribal governments throughout the region. Southeast Alaska consists of the continental US area known as The Alaska Panhandle, the area below the state’s peninsula. Home to many of Alaska’s larger towns including the state capital Juneau, the region is a poplar tourist and fishing destination, as well as relying on forestry and state government to support the economy.

About the size of the Florida panhandle in length, the region is a vast, rural area. Within this area there are 18 tribal governments who came together to form SEARHC. We’ve continued a tribal government-to-U.S. government relationship with the Indian Health Service to provide this care to this region. CEO Roald Helgesen explains why the foundations of this organization are important to a greater understanding of its mission. “It’s important to understand when you talk about what our mission is, that in the context of what we do and why we do it, it’s really about the tribes making decision for themselves about their health priorities.”

Unique Needs Means New Forms of Healthcare

“We provide services based on what initially was done by the Indian Health Service in our region, but we’ve been able to expand that care dramatically to include medical services, behavior health services and dental services,” explains Helgesen. SEARHC is also able to provide several prevention services integrated into the primary care services, hospital services on a region-wide basis and a unique community health partnering program. “This program is unlike anything else in the US and is used in the smallest communities,” says Helgesen. “Alaska, is the only state that uses someone called a community health aide , a para-professional staff member whose trained for several years and works as an extension of a physician providing primary care in a typically small community.”

With clinics that have physician assistants, nurse practitioners and sub-regional clinics (one in Klawock and another in Haines) SEARHC has created a network of community healthcare. A regional clinic in  Juneau (poulation of 30,000) serves the capitol’s Native residents. The organization’s largest clinic in Sitka provides a 27-bed hospital, full imaging unit, complex laboratory and several ancillary services. Specialty care such as surgical, OB/GYN, pediatrics and ear, nose and throat are also offered there. The non-profit also runs two behavioral health programs specifically for substance abuse treatment. The Ravens  Way program works with adolescents providing an intensive residential substance abuse program and the Bill Brady Healing Center is an adult residential substance abuse program. Additionally, there is Safe Harbor House designed specially for female patients.

High Tech for the Last Frontier

“As we look into the future, SEARHC is right in the middle of what we call a Systems Transformation,” explains Helgesen.  “We are aligning our services and the catalyst for aligning the services is our work toward an electronic record. The electronic record includes an ancillary package that a laboratory package, a radiology package, a pharmacy package and a financial reimbursement package. We’re not just electronifying our system, we are looking at our systems so they are the same across the region.  A patient who accesses a clinic from one location  will have the same processes and procedures as someone who accesses the clinic somewhere else in the region.  This information is real-time and up-to-date.” Helgesen describes this process as a dramatic step for the organization and a high priority for its administration. “We are truly changing our systems and processes. Associated with that we are using information from the Institute for Health Care Improvement to increase access to care for our patients across the region.”

Bringing Healthcare to a Rugged Terrain

Some of the greatest challenges for the organization have also inspired the implementation of some of the SEARHC’s most defining attributes. The first challenge is dealing with the rough terrain and widespread population. Routine Access to a centrally located hospital is just not easy with a population spread out over vast area of rough terrain. So SEARHC has had to create a plan to allow everyone in the region appropriate access to health care. “If you look at the map,” explains Helgesen, “you see the incredible distances we have to travel. But what makes it all the more complicated is there are no roads to travel on, our travel is by ferry or mostly by aircraft, a small plane from community to community. Our largest issue in access to care is about transportation. We’ve overcome some of these issues with transportation by seeking alternative forms of care, by pushing care out as far as possible to the patient with mid-level providers.”

By using a dental health aide, many routine dental procedures can be completed close to patient homes. Telebehavioral health has also been used successfully by SEARHC. Here video conferencing systems connect patients in one community with a psychologist, masters-level clinician or even a psychiatrist so care providers don’t have to be in multiple places at the same time.

And most importantly, the organization has created a new innovative program, which directly addresses the immediate care needs of patients. Since there are not hospitals in every of community, many patients who become ill and need advanced level care need to be Medivaced to a hospital for higher level care.  “In reality, many of those patients don’t necessarily require Medivac,” explains Helgesen. “ Take  for instance a person who has been sick for several days and is dehydrated. Several hours of I-V therapy under observation, may allow the patient to stay in their own community.

“We have advanced and become a demonstration site for something we call a Frontier Extended State Clinic, which is now used by four sites across the US, three of which are in Alaska with one in Washington. We provide hospital-like beds on a temporary basis for what is usually two to three hours. It supplies that temporary care needed and patients are able to stay home and avoid the high expense of the Medivac and the danger from inclement weather to crew and patient.” The temporary care also provides a higher level of care in the community until a medivac team is able to arrive when the patient does need higher level care. “This is an exciting project we are involved in,” says Helgesen. “It really underscores the issues of transportation in SE Alaska. Weather can be a significant challenge at times, with frequent storms off the coast, so this type of care is essential.”

Encouraging the Next Generation of Alaskan Healthcare Providers

As with many rural area, recruitment and employee retention is a critical challenge facing SEARHC. “We have one of the most beautiful places in the world but many are challenged by the isolation of the area and it’s rural state,” says Helgesen. “One of the attractive parts of working in a tribal health system is that we are tribal. This is a unique opportunity that you don’t get everyday. It gives us the chance to work with the tribal people of SE Alaska that have a rich cultural respect and providers enjoy that aspect of the care. It’s not something you find everywhere.”

Tribal recruitment has also become a high priority, especially in encouraging tribal youth to become the healthcare providers of the future. The program is called the Ethel Lund Village Health Occupations Program which brings youth in from across southeastern Alaska to the organization’s Sitka campus.They learn about careers in healthcare and about the different aspects and disciplines that are involved in running a facility, including gaining an awareness that there are more than doctors and nurses that make up a healthcare unit. Another program is the Youth First Responder program, which also works to encourage young people to look into a healthcare career at the time when they are considering job options. “Our hope is they are going to catch the healthcare bug. The excitement that goes along with providing direct care will have them providing that care in the future.”

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