The Interior’s Healthcare Hub

Serving the Interior since 1959, TVC is the largest and most comprehensive clinic in the state, with a main facility and an adjacent 1st Care center for walk-in family medical services. In 2020, the number of visits to TVC and the 1st Care center totaled 142,747. In addition to primary care, TVC also offers medical specialties that include asthma, allergy, behavioral health, endocrinology, and osteopathic manipulative medicine.

Completing the circle of care, Denali Center is a 90-bed facility providing short- and long-term care since 1994. Based on the Eden Alternative philosophy, staff provide care to an assigned elder and rooms are designed in a home-like fashion to prevent patients from suffering from what the Eden model’s co-founder Dr. Bill Thomas calls the “Three Plagues of Nursing Homes”—loneliness, helplessness, and boredom. In 2021, Denali Center provided services for seventy-three residents in need of long-term and dementia care and skilled nursing or rehabilitation.

Ebenal says Foundation Health creates services and makes decisions based on its overall mission: People First. Community Focused. Excellence Every Time. She says everybody from the board of directors to frontline staff live that mission.

The Safety Net

In addition to the roughly 100,000 residents in the Fairbanks area, Foundation Health is effectively responsible for providing healthcare services to the northern two-thirds of the state. Martin says staff do their best to be ready for anything at any time. That level of preparation comes at a cost, though. Supply chain issues can affect the level of patient care, so Foundation Health developed a storage system for items that are regularly used or harder to acquire.

“We are very deliberate in identifying things we have to keep on hand, tracking our periodic automatic replenishment levels, and even keeping older technology around,” says Martin. “We’re hoarders of the best kind.”

An additional challenge comes with providing care for patients from outlying areas. Foundation Health spokesperson Kari Burrell says patients who must drive long distances or fly in from remote communities would often like to get all their medical needs met during a single visit. However, scheduling multiple appointments is not always possible since steps in the process, such as obtaining lab results, are needed first.

“Our providers try to help patients navigate those situations as quickly as possible,” says Burrell. “Sometimes it doesn’t work out, and patients have to come back for a second trip.”

To better assist remote patients, Burrell says Foundation Health is upgrading its electronic medical record system. Currently, there are fourteen parts of the system, and the goal is to develop a way to connect all parts. Though it is several years out, Foundation Health would eventually like to find a way to extend access to providers outside of its system, to help with better care coordination.

Foundation Health has also done more with telehealth services to meet the changing needs of patients. Two telehealth services regularly employed are Telestroke, which works with patients when a local neurologist isn’t available, and TeleNephrology for dialysis patients.

“We can’t be everything to everyone, but we try,” says Martin.

See One, Do One, Teach One

From a medical staffing perspective, Ramirez says that the remoteness of the Interior often requires physicians and nurses to practice at a much broader scope than a dedicated specialist. She feels that Foundation Health tends to attract people who like to practice on this level and are driven more by a community mission.

Workforce development is a top priority, according to Nicole Welch, Foundation Health chief human resources officer. “We’ve been very focused on ‘grow your own’,” says Welch. “Meaning we realize that we could assist community members by offering entry-level job opportunities and work with them to further their education and career advancement.”

Welch adds that a health system is more than physicians and nurses. Career opportunities are available for nearly every field, including medical, information technology, education, business, finance, human resources, and more.

Welch says that Foundation Health will always rely on a pipeline of out-of-state applicants who come to Alaska, in part, for the adventure. However, Foundation Health has found that in-state hires tend to stay longer than out-of-state counterparts, who often move away after a few years. This finding spurred a renewed dedication to local workforce development, where staff are able to learn as they work. Welch says providing these types of learning and professional opportunities has enhanced employee engagement.

“This has been a huge financial investment,” says Welch . “It’s also been a huge investment by our staff who consistently work with new students, particularly staff who are already busy and maybe even burned out.”

Ramirez says the benefit of working with students is knowing that some will continue their careers, or return later to new positions, with Foundation Health. Established professionals often find many benefits from teaching students on a personal and community level, even if a student goes elsewhere to work or continue their education. “When you’re a better teacher, you’re better at what you’re doing,” says Ramirez.

Ebenal adds that working with educational staff is a great testing ground for students who are still trying to focus their careers. More than once, a student has started in one area of study but ended up in a completely different one. “You may come in as a phlebotomist and suddenly pass out when there’s blood,” says Ebenal. “At that point, Nicole’s team will reach out and figure out other career options that are available. They’re very good at finding careers. They don’t give up on people.”

There is also a financial benefit to the community, given that Foundation Health is the largest private employer in Fairbanks. Its annual operating budget is more than $300 million, with $180 million-plus in payroll. Furthermore, an expansive healthcare organization is a quality-of-life amenity as people consider moving to Fairbanks to support other industries.

Stuff, Staff, and Space

Foundation Health has received a number of awards at its facilities. FMH won the Organ Donation Referral Achievement Award, the Silver Level Beacon Award for Excellence (Intensive Care Unit), the Commission on Cancer Outstanding Achievement Award, and Mountain-Pacific Health Awards, among others. Honors for Denali Center include the Mountain Pacific Commitment to Quality Award, the American Health Care Association Bronze Baldridge Quality Award, and recognition by US World and News Report Best Nursing Homes.

Martin says these are all evidence-based awards that point to organizations, departments, and service lines that are exceeding standards, and they demonstrate that Foundation Health has the technology, the expertise, and the facilities to support the needs of the community. “We are who we are because of our employees,” says Martin. “The physicians and staff live the mission and are engaged in caring for friends, neighbors, and families in our community.”

For all its success, Foundation Health is also dedicated to continued improvement. Burrell says it is currently working on a community health needs assessment for the Interior that will lead to a community health improvement plan. She says a healthy community is more than just healthcare; it’s a long-term partnership with social services, education, and the borough government to find creative ways toward healthy living.

“We partner with a broad array of organizations to regularly discuss common goals,” says Burrell. “And together we do our best to invest in the community through improved services or better methods.”

Foundation Health is also collaborating with Virginia Mason Institute on workflow optimization that allows services and operations to run more efficiently. Even with a community-focused mission, Ramirez says processes are often designed from the provider or staff’s perspective, but they don’t have to be. “Sometimes we need outside help to hold that mirror up and ask whether something we’re doing is really in the best interest of the patient,” says Ramirez.

Collaboration distributes problem solving beyond established leadership to everyone involved in daily operations, Ramirez adds. Although staff spend most of their time completing assigned duties, they can also spend a small amount of time on continual process improvement as they develop new skill sets. She says this cultural shift will go a long way toward preparing Foundation Health for a future that could include disasters, more epidemics like COVID-19, or new technologies.

Ramirez says, “We want people to not just get care but the best care close to home.”