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Feature Healthcare systems

Lower costs and better outcomes: a system of care built on relationships

BMJ 2013; 347 doi: (Published 30 August 2013) Cite this as: BMJ 2013;347:f5301
  1. Bill Graves, freelance journalist
  1. 1Oregon, USA
  1. billgraves1{at}

The healthcare world constantly wants more care at less cost. In rural Alaska, the Southcentral Foundation’s “Nuka” system is leading the way. Bill Graves investigates.

Tamara Pickett prescribes drugs for a 65 year old Alaska Native woman with diabetes, but she also helps her find healthier ways of living through the dark winters in Anchorage.

Pickett is a primary care physician at Southcentral Foundation, a health organization based in Anchorage and run for and by Alaska Native and American Indians. She leads a team of health workers who have cultivated a long standing relationship with a woman here called Linda, as her real name is confidential. They know Linda goes away in the summer to a fish camp about 330 miles southwest of Anchorage near Dillingham, where she joins her family and tribe in processing and drying salmon, picking berries, and living the healthy traditional lifestyle of Native Americans. When Linda returns to Anchorage in the fall, “she’s stopped taking her medications, she’s lost weight and she’s happy and vibrant,” says Pickett. But then, isolated in Anchorage, Linda would slip back into inactivity and a poor diet, gain weight and again need drugs, including insulin.

Pickett and her team are now ready for Linda when she returns to Anchorage. They’ve helped guide her for exercise at the Wellness Center, to a diabetic education center, to an elder social circle, to the team’s behavioral therapist and even to traditional healers, all in facilities on Southcentral’s sprawling campus. Pickett’s team not only deals with its patients’ medical needs in its clinic, but also helps them find a lifetime path to health out in the world.

Southcentral calls its healthcare system Nuka—a native word for strong living things—and it is drawing attention of health leaders across the globe, including those in England and …

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