A PCMH Model That Works

Reflections on the PBS Special

Bradley P. Fox, MD


March 31, 2015

Editor's Note: A PBS two-part documentary, Rx: The Quiet Revolution, will air on April 2. Reflecting on his physician father's practice and the move away from hands-on care in contemporary medicine, the documentary's award-winning director, David Grubin, highlights a range of innovative practice models from Maine to Alaska. Medscape asked a number of our experts to preview the film and offer us their reactions and opinions about how well the documentary depicts the healthcare system as they know it and live it.

In this commentary, Bradley Fox, a family physician, Medscape advisor, and clinical faculty member at Gannon University, offers us his perspective.

On April 2, a documentary titled Rx: The Quiet Revolution will air on PBS. I had the privilege of watching an early screening and have been asked to comment on one segment, "Alaska: The Nuka System of Care," which describes the operation of a primary healthcare system for Alaskan Natives that has now been in operation for over 20 years. The Nuka System of Care, established by the Southcentral Foundation, is a name given to the whole healthcare system created, managed, and owned by Alaska Native people to achieve physical, mental, emotional, and spiritual wellness. The relationship-based Nuka System of Care is composed of organizational strategies and processes; medical, behavioral, dental, and traditional practices; and supporting infrastructure that work together—in relationship—to support wellness.

For nearly a decade, I have been working to create a patient-centered medical home (PCMH) environment within my practice—and not just to satisfy requirements for National Committee for Quality Assurance certification. Rather, my goal is to provide better care for my patients and, hopefully, to allow for a more full and involved relationship with them as well. In Anchorage, the Nuka System, which serves nearly 65,000 native Alaskans, does this and more. With a multidisciplinary team approach that includes "Western medicine" as well as traditional healers, the Southcentral Foundation has established a practice that truly puts the patient at the center of everything. They have open access with minimal waiting. They enable health coaches called community health aids who take the role of physician extender to a new level. They incorporate telemedicine and remote pharmacy dispensing, and they robustly use their electronic health record. But most important, they incorporate the patient (which they do not refer to as "patient" but as another term that truly encapsulates the concept, and which I won't share because I don't want to take away the impact from the presentation or ruin the surprise) into every step of the process.

Perhaps it is the uniqueness of the population that this system serves, or perhaps it is the vision of those who established it in the late 1990s (yes, that long ago) that makes this system work as well as it does. Or maybe, just maybe, the PCMH that we in primary care have been striving to achieve, and have been singing the praises of for nearly a decade, has been successfully modeled in this comprehensive system and we could all learn from them.


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