Alaska, United States: Organisation of Services

In contrast to Turkey’s challenges with tracking patients during voluntary empanelment, the Southcentral Foundation (SCF) Nuka System of Care serving Alaska Native and American Indian people in Alaska, United States has achieved efficient voluntary empanelment through the support of an Empanelment Department. The population served by SCF is largely poor, rural, marginalized, and suffers from high rates of chronic disease. Catalyzed by a law passed by the United States Congress, SCF has been tribally owned and managed since 1997. As such, patients are called “customer-owners” and have significant oversight into the functioning of their health system. Customer-owners can join open enrollment panels at any time or join a panel to which his or her family already belongs, even if it is not accepting new patients otherwise.12 Each panel includes approximately 1500 customer-owners, and care teams comprise a primary care physician, nurse case managers, certified medical assistants, and administrative staff. The Empanelment Department and SCF staff assist in all aspects of panel placement and management, helping to improve relationships between primary care providers and customer-owners if conflicts arise or matching customer-owners with a new panel as needed. In addition to checking empanelment status at each visit, staff work to ensure continuity of information and communication between providers when patients switch panels. This constant monitoring and support requires significant human resources and efficient information systems.1


  1. Gottlieb K. The Nuka System of Care: improving health through ownership and relationships. Int J Circumpolar Health. 2013 Aug 5;72. 
  2. Johnston JM, Smith JJ, Hiratsuka VY, Dillard DA, Szafran QN, Driscoll DL. Tribal implementation of a patient-centred medical home model in Alaska accompanied by decreased hospital use. Int J Circumpolar Health. 2013 Aug 5;72.