Community Health Aides: An old concept finding new life

By Steve Kipp
Wednesday, January 16, 2019

Video by Alexandra Gunnoe, Premera Blue Cross

Napaskiak is an unlikely place to witness health care innovation.

A small village of mostly native Alaskans, Napaskiak is located 400 miles west of Anchorage and is a 20-minute hop by bush plane from Bethel, the nearest city.

From the air, the town looks like it was shaken and tossed across the land. Homes that are little more than plywood shacks rest at all angles on pilings sunk into the frozen ground, while rusted snow machines, the occasional basketball hoop and beached fishing boats lie scattered among the long grasses.

There are no roads, just frost-covered boardwalks that cut across the tundra. ATVs are the preferred mode of transportation, their engines piercing the silent remoteness of the village.

I was in Napaskiak on a monochrome day last November with a Premera working group studying the problems facing the delivery of health care in rural and remote areas of Washington and Alaska.

Our work began last March, after Premera announced it would invest millions of dollars to improve access to health care in rural areas. The money comes from a tax refund Premera will receive as part of an overhaul of the corporate tax system last year.

In addition to rural health care, Premera is investing in stabilizing the individual health insurance markets in Washington and Alaska and in behavioral health programs, particularly as they relate to homelessness.

Since last March, our working group visited 83 organizations and met with more than 100 people in 45 communities across Washington and Alaska. Napaskiak was one of the last places we visited. For many of us, it made the biggest impression. I had never seen anything like it.

I grew up in New Jersey and have spent the last 25 years living in Seattle. Rural to me is red barns, cornfields and roadside produce stands.

Napaskiak, like dozens of Native Alaskan villages spread across the state, isn’t rural; it is remote. There is a big difference. In rural areas in states like Washington, getting to the hospital might mean driving for two or three hours.

When it comes to remote Alaska, driving to the hospital is not an option.

Reaching places like Napaskiak which are nothing more than small islands plunked into the wilderness entail flying in by small plane or arriving by boat or blasting across the frozen ground on a snow machine.

For people like me who have lived their entire lives in and around big cities, the sheer vastness of Alaska is almost incomprehensible. The state occupies an area two and half times the size of Texas. Nearly all of Alaska’s 720,000 residents live within a thin band from Fairbanks to Anchorage. The rest, about 50,000, reside in small towns and villages separated by miles of empty wilderness.

It is this remoteness, coupled with high costs and a scarcity of doctors, that forced Alaskans to think differently about how to deliver health care: enter the Community Health Aide Program.

The program is decades old, but it is commanding renewed attention from across the country as a solution to delivering high-quality care at a lower cost.

Community Health Aides are trained to do many of the things doctors can do. Think part nurse, part family doctor, part Army medic, and you get the idea. They serve as the first point of contact in a patient’s journey that begins in a remote village clinic, travels through sub-regional and regional clinics and may end in a large hospital in Anchorage.

Within the Alaska Native Tribal Health Consortium, the Community Health Aide Program has grown to include nearly 200 Community Health Aides, 125 behavioral health aides and 60 dental health aides.

In many cases, health aides are homegrown, entering the program because they want to give back to the villages where they grew up.

The job is not easy.

The hours are long. The pay is mediocre, especially when compared to doctors, and burnout is common. In places like Napaskiak, there is only budget for one health aide. Circumstances sometimes mean the health aide is on call 24 hours a day, seven days a week.

As if to underscore this point, when we landed on a small airstrip about 100 yards outside of town, I saw a man, his face bruised and misshapen, sitting on an ATV waiting to board our plane for the return trip to Bethel. I later learned Napaskiak’s health aide had stayed up all night with the man, treating his injuries as best he could before sending him to a clinic in Bethel.

Despite these challenges, it is easy to see how states in the Lower 48, even urban states like New Jersey, could utilize community health aides.

As our plane climbed into the sky for the return trip to Bethel, I thought about how many times a health aide could have treated me instead of a doctor. We often think we have to see the head mechanic, when all we really need is just someone to change the oil. Alaska’s Community Health Aide Program won’t solve all of the problems plaguing our health care system, but it could lower costs while allowing doctors to spend more time with patients who need their help the most.

Steve Kipp is the vice president of Corporate Communications at Premera Blue Cross. 

Steve-Kipp-Profile


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