October 28, 2004 | Read Time: 13 minutes
Alaskan’s crusade to improve health care is rewarded
Like many an optimist, Katherine Gottlieb — a health-care leader here who last month received a MacArthur Foundation
“genius” prize — believes every person “has the ability to change their world right where they are.”
The Alaska Native mother of six put this credo to work 17 years ago when she went looking for “a way to bring home money to feed the kids” and took a receptionist job at the Southcentral Foundation, a group that has become the primary provider of health-care services to Alaska Natives in the state.
Right away, Ms. Gottlieb identified things that needed changing. “The gray metal desk I had was terrible,” Ms. Gottlieb recalls of her first day on the job. “It wasn’t for me I wanted it changed, but for the people coming in the door. What was their first impression when they were met with this horrible-looking desk?”
Journey to the Top
Ms. Gottlieb persuaded her superiors to provide her with a new, better-looking desk, the first of many she’d receive as she assiduously worked her way up the organization’s ranks while developing new ways to meet the health needs of people in her state. Along the way she attended night school and earned bachelor’s and master’s degrees from Alaska Pacific University.
Today, the erstwhile $9-an-hour employee is the foundation’s chief executive officer, with a sprawling cherry-wood desk in a corner office and an annual salary of more than $280,000.
“Katherine just didn’t understand why Native Alaskans should put up with health care that was second best,” says Douglas Eby, Southcentral’s vice president of medical services and an Anchorage doctor with more than 15 years’ experience treating such patients. “She presents a heartwarming story of a village girl made good, but to write it off as just that is to miss the real story: her tenacious efforts at making a health-care system that’s high quality and sustainable.”
A $127-Million Organization
Ms. Gottlieb’s personal transformation mirrors the big changes she has helped bring to Southcentral’s health-care mission. When she started in 1987, the foundation had 24 employees and a $3-million annual budget. Most Alaska Natives received their health care from an aged, federally managed hospital with “institutional green walls” and an assembly-line approach to care, Ms. Gottlieb says.
That building has since been replaced by a sprawling campus of state-of-the-art medical facilities that Ms. Gottlieb says provide a culturally sensitive approach to delivering health care to some 40,000 people. She oversees more than 1,000 employees and her annual budget is now $127-million.
The main building, for example, is “layered” to evoke the layout of a native village, complete with wings that protrude outward to appear as separate buildings. The colorful exterior brickwork incorporates design patterns from native baskets, and the lobby is a peak-roofed, round room that evokes traditional native “gathering spaces.” The walls and even the stairwells brim with native art, and plentiful windows look out onto the snowcapped Chugach Mountains to the east.
“We didn’t want a big, square building,” Ms. Gottlieb says. “We didn’t want an institution where you’re already frightened when you walk in.”
Adds Dr. Eby: “The healing starts at the front door of this hospital, because your pride is lifted.”
$500,000 ‘Genius’Prize
In awarding her one of its fellowships, the John D. and Catherine T. MacArthur Foundation, in Chicago, noted Ms. Gottlieb’s efforts to improve medical care amid “obstacles of poverty and geographic isolation.” She will receive $500,000 over the next five years to spend as she wishes.
Ms. Gottlieb says her upbringing played a key role in helping her find ways around the potential roadblocks of poverty and isolation, which are not uncommon in the large, rugged state of Alaska.
The daughter of a Filipino father, who had come north from Seattle to work as a cook in a cannery, and an Aleut mother, whose family lived off the land, Ms. Gottlieb grew up in Seldovia, a small village some 250 miles southwest of Anchorage. The waterfront town is accessible only by plane or boat, so trips to Anchorage were uncommon.
A principal reason to visit the city was for medical care at the original, federally managed Alaska Native Medical Center (since torn down and replaced by a facility run by the Southcentral Foundation). Longstanding treaties between tribal entities require the U.S. government to provide free health care to all American Indians and Alaska Natives.
Ms. Gottlieb gave birth to all her children at that hospital, and she recalls the building’s worn tiles and cracked walls.
“You felt like cattle moved through the system — a number, not a name,” she says. “Everything was by the book and there was no incentive to improve things or provide service beyond what regulations required.”
Her first foray into the health-care field came in 1987, when Southcentral hired her as part-time community health aide in Seldovia. She gave villagers basic health-care information and helped the village’s elderly people with light chores and meals. When Ms. Gottlieb relocated to Anchorage and took the receptionist job at the Southcentral Foundation’s headquarters, she says she wasn’t looking for a “prestige job.” But she did feel destined for bigger things. “I always thought I could be a CEO,” Ms. Gottlieb says. “In my heart and head, I just thought I could do it.”
Changes in Federal Law
Ms. Gottlieb says she was energized by a growing desire by Native Alaskans to take over the delivery of health care from the federal government. A number of federal laws, beginning with the Indian Self-Determination Assistance Act in 1976, gave Native Americans greater autonomy over their medical care.
Ms. Gottlieb enrolled in college and worked her way up the ladder at Southcentral, with stops at administrative assistant, contract compliance officer, and associate planner. In 1991 she took a seat at the CEO’s desk.
“The thought of assuming management of our own health care put a gleam in my eye,” she says. “I really thought if native people owned and operated their own health-care system, were able to control how it works, we could make it better.”
John Segura, Southcentral Foundation’s board chairman, cites Ms. Gottlieb’s “ambition,” “intelligence,” and “drive” when discussing what led the board to tap her for the top post. “Although she was fairly new to the foundation, we just felt she had the qualifications,” he says. “She had such passion, we just knew she had big plans.”
The new medical center was one of those plans. The handsome, $168-million building opened in 1997, making a splash in interior-design magazines and receiving rave reviews from patients.
But it had one problem: It was too small. Even before the facility opened, federal officials realized its capacity requirements were based on outdated census figures.
So Cook Inlet Region, one of 13 Native Alaskan regional corporations the federal government created in 1972 as part of the Alaska Native Claims Settlement Act, got involved and helped build a 100,000-square-foot, $31-million primary-care center across the street from the hospital, which Southcentral agreed to lease and manage. The center, which architecturally evokes the hospital’s design, opened in 1997, with a second wing added in 2002.
Ms. Gottlieb was in the front line of the money struggles that soon ensued over how to pay for the center’s services.
“When we first negotiated with the government to assume our own primary care for the region, they offered us $5-million,” she says. “We successfully negotiated that up to $45-million.”
Chasing dollars has increasingly become Ms. Gottlieb’s job — and forte.
She says the institution under her watch has become “very aggressive in going after Medicaid, Medicare, and private insurance money.” While a common source of revenue at many hospitals, she says that when government officials ran the hospital, they rarely sought such funds. This “third party” billing income now accounts for 35 percent of Southcentral’s operating budget.
In addition to seeking new funds, Ms. Gottlieb has played an integral role in figuring out how those dollars should be spent.
When she first started working at Southcentral, she says, medical services for Alaska Natives revolved around the emergency room. “If you had a cold you went to the emergency room, and if you were having a heart attack you went to the emergency room,” Ms. Gottlieb says.
Waits for service could be long, she adds, and patients saw whichever doctor was free at the time, instead of having a doctor assigned to them on an ongoing basis to take primary responsibility for their care.
But now Southcentral pairs every patient with a primary-care doctor. As part of its family-centered “access to care philosophy,” patients are promised appointments with their doctor the same day they ask for them.
“My doctor doesn’t know just me, he knows my family, my history,” Ms. Gottlieb says.
Alaska Natives, who once might have delayed or even shunned seeking medical care, are now more willing to make appointments. Emergency-room visits have been cut in half, and the hospital has compiled data showing that more people are receiving mammograms, pap smears, immunizations, disease screenings, and other preventive measures.
“It’s not just about reducing emergency-room visits,” Ms. Gottlieb says. “Our customers are gaining confidence in taking charge of their own health care.”
‘People’s Grandchildren’
Southcentral has also developed numerous programs and services to improve mental, behavioral, and spiritual health, including a Head Start program that offers child-development and early-education services to low-income Alaska Natives, as well as a comprehensive program for the elderly that provides transportation, meals, and assistance with basic chores.
It also runs Den A Coy — which in the Athabascan language means “the people’s grandchildren” — as a residential center for pregnant women who are addicted to alcohol. The program, which started in 1991 and moved into a custom-built, 16-bed facility in 2001, gives the women a place to live while receiving intensive therapy and counseling.
Ms. Gottlieb is particularly proud of the Pathway Home. “That’s my baby,” she says of the 36-bed home for troubled teenagers.
Pathway Home is modeled after Delancey Street, a residential program developed in San Francisco for adult felons and recovering substance abusers; she learned about it from a co-worker. “I liked their whole idea of each-one-teach-one and that the residents run the whole facility,” Ms Gottlieb says.
A few changes had to be made in adopting the Delancey system for adolescents, since so much of their time during the day is spent in the classroom. Pathway residents also receive vocational training, such as woodworking or mechanics, along with counseling and mental-health treatment. The teenagers do have some autonomy over the facility and are financially rewarded for good behavior.
“It functions like a transitional village,” Ms. Gottlieb says.
Hostile Stares
Some ideas have been easier for Ms. Gottlieb to carry out than others. For example, she knew her plan to have Southcentral hold conferences and develop educational materials about how to recognize and prevent child sexual abuse and domestic violence would run into resistance from some Alaska Natives.
“Growing up, my mother didn’t even want us to use the word ‘sex,’” Ms. Gottlieb says. Nevertheless, in 2001 she brought the proposal before a meeting of the Alaska Native Health Board, a statewide health-advocacy group, seeking both their endorsement and some funds to help pay for it. What she got were mostly hostile stares and disdain from the predominantly male board. One man said discussing such matters could bring “havoc and mayhem” to native villages.
Undaunted, Ms. Gottlieb brainstormed for ways to repackage her proposal to make it more palatable, particularly to native men. What emerged was the Family Wellness Warriors Initiative — same concepts, different name. She returned to the Alaska Native Health Board with the revised plan that same year.
“This time I told them I was looking for some warriors,” Ms. Gottlieb says with a sly grin. “I said I needed men, as in the old days, who were willing to step up in front of anything that harms his family or his community.”
The board members listened, and Ms. Gottlieb left with both their blessing and $300,000 in grant money. “Now we’re invited into communities I didn’t think we’d ever get into,” she adds.
Ms. Gottlieb was in Washington, D.C., when she got the call from MacArthur Foundation officials saying she had won a fellowship. She was there attending ceremonies for the opening of the National Museum of the American Indian.
“I burst out crying,” Ms. Gottlieb says. “To me it was like heaven had opened wide and blessings were being poured on my head.”
She says she hasn’t made any plans yet for what to do with the half-million-dollar windfall. “I’m praying for guidance,” she says.
One thing is certain: Her newfound wealth doesn’t mean she’ll be abandoning her desk at the Southcentral Foundation. Indeed, she hopes the prestige and notoriety that accompanies such “genius grants” opens the doors for further opportunities to improve the lives of Alaska Natives.
“I have a desire in my heart that our land and our people be healed in Alaska,” she continues after a reflective pause. “That’s my hope.”
History: Established in Anchorage in 1982 by the Cook Inlet Region, one of 13 Alaska Native regional corporations the federal government set up in 1972 as part of the Alaska Native Claims Settlement Act. The Southcentral Foundation initially focused on providing dental and optometry services for Alaska Natives. But the organization has assumed an ever-larger role in health care over the years, in part due to changes in federal laws that made it possible to take control of facilities and services once managed by the U.S. government.
Purpose: To improve the health and well-being of Alaska Natives and American Indians by developing and then managing comprehensive health-care services. The organization oversees the Anchorage Native Primary Care Center, a 100,000-square-foot outpatient facility serving 46,000 people. Southcentral also manages, with the nonprofit Alaska Native Tribal Health Consortium, the Alaska Native Medical Center, a full-service 150-bed hospital. It has also developed numerous health-related programs, most notably two residential substance-abuse facilities: the Pathway Home, a 36-bed program for teenagers, and Den A Coy, a 16-bed program for pregnant women designed to prevent fetal alcohol syndrome.
Finances: Southcentral Foundation’s annual budget is $127-million, with about 60 percent coming from federal-government grants. Medicaid, Medicare, and private-insurance payments for health-care services account for roughly 35 percent of the total. State funds, private grants, and other earnings provide the rest.
Key officials: Katherine Gottlieb, chief executive officer; Douglas Eby, vice president for medical services; James Segura, board chairman
Address: 4501 Diplomacy Drive, Anchorage, Alaska 99508; (907) 725-4955
Web site: http://www.southcentralfoundation.org
ABOUT KATHERINE GOTTLIEB, CHIEF EXECUTIVE OFFICER OF THE SOUTHCENTRAL FOUNDATION
Education: Earned a bachelor of arts degree from Alaska Pacific University, in Anchorage, in 1990, and a master of arts in business administration, with an emphasis on public health, from the same university in 1995.
Previous employment: After many years as a homemaker, Ms. Gottlieb was hired by Southcentral Foundation, which provides health care to Alaska Natives, to be a part-time community health aide in 1987. She later became the organization’s full-time receptionist and began working her way up the ranks, with stops at administrative assistant, contract-compliance officer, associate planner, and deputy director. She became chief executive officer of Southcentral Foundation in 1991.
Hobbies: Learning to fly. “I already have a plane, but not a pilot’s license,” she says.
What she’s been reading: Wild at Heart: Discovering the Secret of a Man’s Soul, by John Eldredge. She says she wants “to learn more about masculinity” to assist in developing programs to help prevent domestic violence and the sexual abuse of children.
