When is the last time you opened a medical bill and smiled?
Our complex, expensive health care system is more likely to induce something else -- consumer anxiety, burdensome debt, uninsured citizens who end up in high-priced emergency rooms.
Now imagine you're teaching the next generation of doctors and nurses, health care technicians, social workers and policymakers. How would you help them think through, remake, adjust and improve this system -- before it does us all in?
That's Bill Hogan's job. He is dean of UAA's newly formed College of Health. The regents selected the university in Anchorage as "the health campus" for the entire UA system, charging it with raising an army of homegrown doctors, nurses and medical workers, as well as battling public health problems wherever they surface.
Alaska's long history of substance abuse, clashing cultures, geographic sprawl and challenging northern environment make that task daunting. Now, add newer complications like climate change and health care reform.
I visited Hogan and the associate dean, Susan Kaplan, to learn how the new college plans to tackle these persistent and developing problems, and why he was willing to take it all on.
New to UAA, Hogan is a social worker. Mental illness, substance abuse and developmental disabilities are troubles he was trained to tend.
The CEO job for a mental health center in Wasilla brought him to Alaska. By 2003 he was director of the Division of Behavioral Health for the state, then eventually deputy commissioner and commissioner for the Department of Health and Social Services.
He said his state jobs did well preparing him to deliver Alaska's next generation of health care workers.
"DHSS has the biggest budget in the state, $2.6 billion. Their scope is large -- public health, seniors, disabilities, behavioral health, children, juvenile justice. As commissioner, you have to have a systems perspective, but the way I made sense of it all was to keep the individual child or family in mind."
Associate Dean Kaplan brings occupational therapy, research and teaching skills from a long career in Florida. She said a key asset for UAA is Hogan's deep familiarity with this place, its problems and its players.
"He knows absolutely everybody in the state," she said. "That's invaluable."
The new college includes Allied Health, home to seven of the fastest growing job sectors in Alaska -- everything from medical billing and coding to radiology techs to paramedics.
The college's grow-your-own ambitions show up in WWAMI, a collaborative medical school among universities in five states -- Alaska, Washington, Wyoming, Montana and Idaho -- and the University of Washington School of Medicine. UAA plans to add 10 more medical students to the program, for an annual cohort of 30. By 2015, medical students will have the option of studying all four years in Alaska instead of moving around the Northwest.
"We think this will lead to more doctors staying here," Hogan said.
UAA also hosts 13 rural sites, from Nome to Valdez, where nursing students work in labs with on-site instructors but attend lectures by video-conference. Instead of relying on itinerant traveling nurses to meet the state's insatiable demand, this network aims to graduate them in the communities where they live.
The campus' home in Anchorage's U-Med District places it within a half-mile of most of the major health agencies and services in town -- Providence, Alaska Regional, the Alaska Native Medical Center, the Tribal Health Consortium, Southcentral Foundation, Centers for Disease Control, Alaska Psychiatric Institute, Anchorage Neighborhood Health, Anchorage Community Mental Health, Cook Inlet Tribal Council and Joint Base Elmendorf-Richardson.
That proximity is great for internships and fieldwork but it's also expected to open doors to jointly funded research. Already, a new UMED District Research Alliance, championed by WWAMI director Jane Shelby, has gathered area leaders to discuss the state's biggest health questions.
This comes on top of seed money the health college is offering local researchers, hoping to focus their work on top state priorities: interpersonal violence, childhood trauma, substance abuse, health care systems policy and environmental health.
Hogan has been monitoring the Affordable Care Act and what it will mean for Alaska. To date, Gov. Sean Parnell has declined to set up an exchange or partner with any northwest state that has one, so the federal government will set up ours by Oct. 1.
To help the public work with the new regime, United Way and the Alaska Native Tribal Health Consortium were awarded contracts to act as exchange "navigators."
Advocates like this are in demand. Research shows that patients who have help with "the system" get better quicker. Hogan and Kaplan are investigating a certification program for the new role.
"There's a much greater focus on health outcomes," Hogan said. "It's how primary care clinics and practitioners will get paid in the future -- did the patient actually get better?"
What a concept.
Kathleen McCoy is an electronic media specialist at UAA, where she highlights campus life through social and online media.