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I wish I had a dollar for every management consultant report, book or journal that exhorted the value of out-of-the-box thinking. Talk about a cash windfall.

In one book, the author, decidedly tongue in cheek, posited that it would be one of history’s true spectacles to see the millions of MBAs in this country all join hands and jump out of the box together.

As healthcare reform with the inevitable cuts in reimbursement rumbles onward, and as our elected representatives seemingly stumble along for the ride to the next election cycle, it is ironic that what may really save us from financial disaster is some out-of-the-box thinking. Some of the smartest people in the healthcare reform room believe that redesign of the healthcare system as we know it today will be built around radical new (read: not so new) ideas: that we must emphasize wellness, not after-the-fact responses to correct America’s ongoing bad personal lifestyle choices like a three times weekly order of jumbo chicken fried steak, cream gravy and a double order of french fries, hold the salad and vegetables. To be honest, the sort of dramatic shift in lifestyle to a healthy diet with less chronic obesity will take generations to accomplish, the First Lady’s focus on healthy diets for kids notwithstanding. Just look at the people trodding through the average American airport; there are more people with varying stages of being overweight than not.

Then there are the under-the-surface issues that do not always show themselves unless you frequent places where you will find the victims of even more devastating choices or chronic mental illness: drug and alcohol addiction, schizophrenia, etc. There are states where this is more common than others. In Alaska, where I am working on a major search for the Alaska Native Tribal Health Consortium (ANTHC), alcoholism, drug addiction, and mental illness are serious health issues among the Native Alaskans. The statewide suicide rate is four times the national average. In some areas, it is eight times the national average. This is why rehab programs, that can be found at medical clinics such as West Coast Recovery Centers, are highly important and need to be one of the first port of calls for those who are struggling with addictions.

A local TV station recently featured a video from a Sobriety Celebration. Featured speakers included the Chief Executive Officer of ANTHC and several board members. ANTHC, which operates the tertiary care referral hospital for Alaska Natives, plays an important role in addressing this serious problem that impacts the health of so many Natives.

What makes ANTHC so remarkable is that they see improving the health status of their customers as a critical part of this mission. Yes, they have a beautiful tertiary care referral ANMC_exterior_photo_2 hospital and today it represents 80 percent of their revenue, but it is improving the health status of their stakeholders, not grabbing more market share of tertiary patients, that drives this organization.

Two of the Consortium’s other operating divisions, Environmental Health and Engineering and Community Health Services, focus their resources on keeping people well. The Environment Health and Engineering group builds sewers and waste water plants for remote tribal villages where contaminated drinking water contributes to significant health issues that frequently lead to hospitalization. Community Health Services targets education, dental hygiene and alcohol and drug abuse prevention, among other responsibilities. Because ANTHC operates under a modified capitated model doing the job that once fell to the federal government’s Indian Health Service, it is in their financial interest to keep people well and out of the hospital. Joining with regional tribal organizations that focus on delivering primary care, ANTHC understands that their role in life is NOT just to treat the critically ill or injured, but to reduce the number of people who must come to Anchorage for tertiary care — a difficult challenge for some Natives in far-flung parts of this vast state.

ANTHC is trying an out-of-the box approach that the vast majority of tertiary care hospitals in the lower 48 only talk about.

Aside from the “out-of-the-box” phrase, another term healthcare leaders are using with greater regularity is “alignment,” usually with the word with enormous financial implications: “incentives” as in aligning incentives. The beauty of ANTHC was created with a different set of incentives and they diligently work to keep them aligned with their mission — improving the health status of their Alaska Natives, and reducing the need to go the tertiary care hospital.

When I began the search for the new Administrator of ANTHC’s Alaska Native Medical Center, I ran into more than a few skeptics who theorized that it would be a tough assignment to find qualified executives who would be interested in relocating to Anchorage to run a “special interest” hospital. In fact, we were overrun with exceptional candidates. They saw an opportunity to work in an organization that is ultimately about keeping people well, not trying to expand market share.

The hospital is very busy — some days overcrowded — but ANTHC’s leadership will keep working, every day, every week, every year to make it less so, and be financially viable in making this sort of progress that is foreign to many healthcare leaders.

Now that is a solution that is not only out-of-the-box, but a mission worth exploring.

2011 John Gregory Self