BETHEL -- A planned expansion and renovation of the biggest health care facility in Western Alaska is moving ahead with needed state legislation, an act of Congress and a key loan all in hand. The changes may go far deeper than modern new space and a new look, even one rooted in indigenous cultures, says the health organization's top official.
The Yukon-Kuskokwim Health Corp. project includes a proposed new 130,000-square-foot, three-story outpatient clinic that would provide a place for a retooled, team approach to each patient's care, said Dan Winkelman, YKHC president and chief executive. It also includes a renovation and expansion of the old hospital, which opened in 1981 and used to be known as "The Yellow Submarine" before it was repainted in shades of blue. The redone hospital will be about 110,000 square feet, under the plan.
They call it the Dr. Paul John Calricaraq Project, after the late tribal leader from Toksook Bay, whose teachings are incorporated into the planning. A book on John sits on Winkelman's desk. Calricaraq is Yup'ik for "to live a healthy life." YKHC is a tribally managed health organization.
The expansion will cost upwards of $225 million but if it becomes reality, it will bring in tens of millions of additional operational dollars from the U.S. Indian Health Service to staff the new space, Winkelman said. That would mean 200 to 400 more YKHC health care jobs in the region, he said.
"We have this tremendous opportunity," he said. "I'm going to use this project to drive positive change through the company. It is going to touch everything that we do."
A giant flowchart is tacked up in Winkelman's office to help him track dozens of pieces. The design and some necessary agreements are still being worked out.
Last week, the U.S. Department of Agriculture announced $165 million in long-term financing for a project that it estimated would cost $287 million. Winkelman said he is working to bring the cost down to about $225 million.
Construction financing is being worked on through the Alaska Municipal Bond Bank Authority and the Alaska Industrial Development and Export Authority, with the USDA loan functioning like a mortgage to pay back that initial debt, according to YKHC. The big missing piece is a joint venture agreement with the Indian Health Service. YKHC would build the project, and IHS would seek funding to staff it, under the agreement.
"It's not a go yet," Winkelman stressed.
A new look
Still, elements are falling into place. State legislation sponsored by Sen. Lyman Hoffman and Rep. Bob Herron, both Democrats from Bethel, allows YKHC and other regional health organizations to tap into the municipal bond bank with its low-interest financing. U.S. Rep. Don Young and Sen. Lisa Murkowski pushed through a federal act to transfer 23 acres of federal land in Bethel to YKHC for the project. YKHC is one of three organizations in the country cleared to move ahead with IHS out of 37 that applied. It's a competitive ranking of tribal projects, but more planning is needed.
"This is a very large and complex project and we are unable to provide a timeline for when these planning activities and the joint venture agreement will be complete," IHS said in an email.
YKHC's annual budget is about $150 million, with $70 million of that from IHS, a figure that could grow to $100 million with the expansion.
On the construction side, YKHC is putting in about $30 million, in addition to committing to pay back loans, Winkleman said.
"We did give it a lot of scrutiny both at our level here in the state and at the national office," said Jim Nordlund, Alaska director for USDA rural development. This is the biggest rural development loan for a community facility in the agency's history, he said. YKHC, which was struggling financially just two years ago, has stabilized after cutting staff and other costs and boosting collections, Winkelman said. It ended its budget year Sept. 30 more than $10 million in the black. Employees have gotten their first raise in four years, he said.
"All the factors we look at to underwrite a loan were really met with flying colors on this particular project," Nordlund said.
YKHC has outgrown the hospital that serves about 25,000 people in a region the size of Kansas. Many outpatient visits -- for frostbite and sore throats, baby checkups and prenatal visits -- take place in exam rooms within the hospital proper, which is an outdated and inefficient model of care, hospital leaders say.
Now YKHC is reaching out to village residents and staff members to determine what they want out of the new facility. An architectural team led by Tracy Vanairsdale of Bettisworth North in Fairbanks includes Seattle's Johnpaul Jones, who has Cherokee and Choctaw ancestors and brings cultural and natural elements into his designs.
The animals of the delta, the colors of the tundra and mountains and sea, a sense of shifting seasons and the region's deep traditions may find their way into the facility, Jones has said in public meetings on the project.
"He keeps looking at the materials that we use in everyday life. It could be the berries, the baskets and the textures and colors of those. It could be the fish hanging. It could be the actual traditional buildings," Winkelman said.
Residents say they want to feel comfortable there. They've asked for waiting rooms that feel like living rooms. They want a community gathering area that could provide opportunity for dancing and drumming. One commenter told YKHC, "I would love to have my wedding there."
Winkelman said he wants to incorporate ideas that are affordable and connect to patient health.
Team approach to patients
YKHC intends to overhaul the way it provides patient care even if the construction doesn't happen, but the new space will help dramatically, Winkelman said.
Under the plan, patients will be connected to a team of professionals including a doctor, a pharmacist, nurses and mid-level practitioners, case managers and specialists in diabetes, tobacco control, behavioral health and women's health, among others.
The model has been around for decades, Winkelman said, and is similar to the approach of Southcentral Foundation, another Alaska Native health organization. But it is new to the Yukon-Kuskokwim Delta.
In the new clinic, patients will see their own family doctor rather than whoever is available. Preventive care such as help to stop smoking or chewing would tie in with medical care instead of being an add-on off to the side.
Case managers will coordinate visits so that someone coming in from a village for an annual checkup could see the dentist and also get a consultation about diabetes all in one afternoon. Patients no longer will have to navigate the YKHC maze, but will get one number to call for their team.
Patients now wait 12 to 17 days for an appointment. A boost in staffing will lessen those wait times, Winkelman said.
"This project is about increasing access," he said.
The hospital and new clinic must represent the Yup'ik, Cup'ik and Athabascan cultures, and it must be centered on the customer, he said.
Among the pieces, YKHC is looking to the hotel industry for guidance as it develops its first customer service standards. Almost half of the complaints at YKHC stem from poor customer service, Winkelman said.
If the IHS agreement is approved, construction would be begin next year, YKHC said. The new clinic would open in 2019 and the hospital makeover would be completed two years later.