Alaska CEO's legacy is a renowned model for tribal health services
Indian Country Today
Katherine Gottlieb, Sugpiaq, oversaw a period of massive growth and change in one of Alaska’s main Native health care providers.
During her 30 years with Southcentral Foundation, all but four at the helm, the organization grew more than a hundred-fold and transformed primary care services for Native Americans in the Anchorage area and other parts of Alaska. It has become an international model for patient-centered care.
Gottlieb, its president and CEO, resigned Monday.
She was not available for an interview but testified extensively at a New Zealand tribunal on health care for the Maori in 2018. There, Gottlieb said when she started working at the foundation in 1987, it had 24 employees and a budget of $3 million dollars.
It now has 2,700 employees, a budget of more than $400 million, and serves some 65,000 Native Americans.
Southcentral Foundation, among other Native organizations, took over management of Indian Health Service programs in the early 1980s, under the Indian Self Determination Act.
At the health service in Anchorage, appointments were weeks to months out. Even with an appointment, wait times could be an hour or more. Employee dissatisfaction was high. Facilities were old and ill-suited for acute care — the Anchorage hospital had been built in the mid-1900s with large dorms for tuberculosis patients. Anyone who had insurance or could afford to went elsewhere.
At the tribunal hearing, Gottlieb said, “Prolonged federal domination of Indian Health Service programs has served to retard rather than enhance progress of Indian people and their communities and denied an effective voice in the planning, implementation of programs that respond to the true needs of the people.”
She credits the “Nuka” system of care for the foundation’s transformation. Nuka is an Alaska Native word used for strong, giant structures.
The Nuka approach, Gottlieb said, has transformed health care, improved outcomes and reduced costs. The foundation created and bolstered extensive medical, behavioral and dental programs including services for elders, youth and veterans, along with a Family Wellness Warriors Initiative on domestic violence, abuse and neglect in the Alaska Native community. It made systemic changes for better data management, integrated care by teams of providers and workforce development.
The first step was taking control. When Native entities took over management of former Indian Health Service programs, they were able to bill Medicare, Medicaid and private insurance companies, which doubled revenues. Also key to their success: self determination.
“What happens if you assume the responsibility, that means your responsibility is for grandma, grandpa, auntie, uncles, cousins and your sisters and brothers and babies?” Gottlieb asked the New Zealand officials and audience, “Do you want that responsibility? Not everybody does, but in Alaska, we chose to do it. And we're driving health disparities down.”
The foundation conducted surveys and held focus groups. It has an all-Native board, and 55 percent of its employees are Native American.
“We listen, listen, listen, all kinds of ways — governing boards, interaction, hotlines, gatherings and employee engagement. We love it,” Gottlieb said.
Some of the changes customer-owners asked for: no long waits, consistent treatment, cleaner and better facilities, access to their own provider and culturally appropriate care.
She said another aspect of the Nuka system is it draws on strengths of Native cultures, including respecting, valuing and recognizing that “there’s good in every person.”
Gottlieb said the foundation made excellence a priority, which, after years of concerted effort, led to an award from the National Institute of Standards and Technology for best-in-class management practices and achievement.
“We have won a Malcolm Baldrige award. … It’s the highest award of best excellent practices and quality by the president of the United States of America,” Gottlieb said at the hearing.
“We're the only Indigenous population that has ever done that. And the only health entity, the only health entity in the United States of America, Native or non-Native that has ever won it twice, twice. It's huge,” Gottlieb said.
“I’m telling you that because Indigenous people can run healthcare systems. And when they do, look what can happen? We drove down the ER visits in our hospital by 40 percent, and a drop in our hospital stays by 36 percent.”
Gottlieb said the foundation gets questions from around the world — Scotland, Norway, Sweden, Singapore — about the Nuka system. “The requests are: ‘Why, what's happening in our primary care system? How did you do this?’
“It isn't just about Indigenous people. It's about people taking over their own healthcare. It's about people shaping their healthcare, turning it over to the people,” she said at the hearring.
The foundation also created complementary health programs: acupuncture, massage therapy and chiropractic care.
“You got traditional healers. Awesome,” Gottlieb said. “Let’s do a whole dental program. And then let's change all behavioral health stuff. We could do a lot of things. … We can go after things in a whole different way, because we know how to get at our people. We are living in the trenches. It's our culture.”
Evelyn Beeter, Athabascan, lives in Chistochina, in eastern Interior Alaska, which receives primary care services from Southcentral Foundation. She said providing care to communities almost 300 miles from the foundation’s hospitals in Anchorage and Wasilla presented some logistical challenges, especially in the beginning. But the primary care was good, she said. “It was kind of hard at first but it's like, as it evolved, it kind of got easier.”
Dr. Ted Mala, Inupiaq, was director of traditional healing for Southcentral Foundation at the Alaska Medical Center, which is co-managed by Southcentral Foundation and the statewide Alaska Native Tribal Health Consortium. He said in one capacity or another, he worked with the Gottliebs for decades.
“She's very strong, very moral, very understanding of the many, many people. And she has not only mentored many men and women and young people, but started a lot of their careers. … She needs to be revered as a great role model for everyone to emulate,” Mala said. "And I admire her for standing by her husband, and she has always taken the high road. She's always followed the most difficult decisions and never flinched from that. And I think it's a great personal loss for the Native community."
Gottlieb’s resignation came a few weeks after her husband and the chief of staff, Kevin Gottlieb, and two dental directors were fired. An investigation showed they “falsified health records by attributing one dentist as the provider of routine dental exams when that dentist did not actually perform the procedures,” the foundation stated. “All procedures were performed by qualified dentists, and there was no impact to customer-owner safety.” Mala said there was no personal gain involved. No charges have been filed.
The Southcentral Foundation, in a statement, noted some of the many honors Katherine Gottlieb has received over the years.
“At the national level, Gottlieb is known for her advocacy in Alaska Native and Native American health policy,” the organization said.
Since 2015, she has served on Harvard Medical School’s faculty as a visiting scientist in global health and social medicine. In 2018, she was appointed as the school’s community engagement clerkship faculty director.
Gottlieb received the Harry S. Hertz Leadership Award in 2015 and the Indian Health Service National Director Award in 2016, the foundation said. As a 2004 MacArthur fellow, she donated part of her genius award to initiate the foundation’s Health Education and Wellness Center. She also received an honorary doctoral degree in Humane Letters from the University of Alaska Anchorage in 2016 in recognition of her leadership in transforming health care services for Alaska Native people.
Katherine Gottlieb’s resignation is effective at the end of August.
Tax forms filed in 2018 show Katherine Gottlieb’s annual salary was $641,000. Kevin Gottlieb was paid $724,000 that year.
- Public health then and now: The history and politics of US health care policy for American Indians and Alaskan Natives
- Southcentral Foundation: SCF Home
- Traditional healing: Native Voices: Native Peoples' Concepts of Health and Illness
- Malcolm Baldrige National Quality Award
- Editorial: A formula for cutting health costs
- Katherine Gottlieb McArthur Award
Joaqlin Estus, Tlingit, is a national correspondent for Indian Country Today, and a longtime Alaska journalist.