$20M expansion aims to address Unalaska’s emergency care funding challenges

Unalaska’s community health center is preparing to start construction on an expansion that could help secure emergency care funding.

Iliuliuk Family Health Services (IFHS) handles everything from routine checkups to life-threatening emergencies. With roughly 20 staff members managing both primary and emergency care, the workload is intense.

“In the last year, we had just under 5600 patients,” said Dawn Johnson, interim CEO of IFHS.

The nonprofit health center recently received a $20 million federal grant to expand and renovate its facility. Johnson said these improvements could help the clinic qualify for urgent and emergency care grants — funding that’s crucial to keep these services on the island.

“That’s where the biggest challenge and the biggest need is — funding for the emergent care,” she said.

The clinic’s primary funding covers general care like checkups and vaccinations. It’s also the go-to facility for emergencies on an island of 4,000 residents — a number that swells during high fishing seasons. Johnson said they increase staffing during these busy periods.

“If 911 is called and a patient is in distress in any way, shape or form, they’re coming to us ... and at that point we have a provider, a nursing staff and an x-ray person that’s on call 24/7,” she said.

As a Federally Qualified Health Center (FQHC), IFHS faces unique funding challenges for emergency care because those services don’t get reimbursed.

“Regardless of what we’re doing, if we’re doing lifesaving measures using lifesaving equipment in the middle of the night at 2 a.m., we’re not getting reimbursed for that,” Johnson said. “We’re only able to charge for a clinic visit.”

This payment model isn’t sustainable, she said. The clinic can’t afford to keep staff ready for both primary care and emergency response.

“You’re not going to find another FQHC that provides urgent emergent care. And you’re not going to find any freestanding emergency room that’s going to offer primary care,” Johnson said. “It’s unique and it’s a good thing that we do that, it’s also a challenge.”

The City of Unalaska provided a $1 million grant earlier this year to keep emergency services running, but that funding is temporary.

Johnson said the new facility upgrade offers a more permanent solution by bringing the emergency department up to hospital-status code, which could help the clinic qualify for dedicated emergency funding.

“We’re not stopping at the word no,” she said. “We’re going to look under every rock and around every tree to figure out how we can continue to offer the urgent and emergent care that’s needed.”

The expansion project is expected to be completed by the end of 2025 — along with new clinic housing funded by a separate state grant.