“Notes from the Field” is a special newsroom feature highlighting industry professionals working to transform healthcare. In this edition, we spoke with Bryce Akagi, Vice President of Finance at the Alaska Native Tribal Health Consortium (ANTHC).
1. Tell us about your role.
As the Vice President of Finance at the Alaska Native Tribal Health Consortium, I am responsible for finance, operations, and financial planning—our rolling forecast, which we update every quarter, and our capital plan. I also handle our decision support work, ensuring we bring good data to decision-making. For instance, we help with labor productivity and use accounting data to help bring insights to those decisions.
At the end of the day, there's a lot of discussion in healthcare finance around margin or mission. For us, it's margin management. I help determine if we are doing things we need to ensure we have a sustainable financial future.
2. What is one thing you've learned in the past year?
I have learned the importance of going back to the basics. Sometimes, we get carried away by all the new fancy things out there. All of that becomes a distraction. The basics are the foundation for everything. It's important to make sure that the foundation is solid.
Some of our core processes were broken. And so we had to step back and think about how to move forward. Continuing to piecemeal onto a system that's not working for us will not provide value and will only frustrate users and fail to serve the organization. It is important to take a step back and look at the whole picture, processes, and external factors.
3. What inspired you to pursue a career in healthcare?
My journey to healthcare is a happy accident. I was going to college to study finance. I wanted to go into investment banking initially and work on Wall Street. But as I was approaching graduation, I started thinking about what I wanted to dedicate my life to and began questioning whether I wanted to dedicate my life to making rich people richer. I found more meaningful intrinsic motivation in healthcare. My dad is a pharmacist, so there was healthcare in my background, which was another impetus for moving into healthcare.
4. What do you see as the biggest opportunity to improve healthcare?
There's so much knowledge in healthcare. But we're reinventing the wheel all the time. We're all trying to invent the same thing and facing the same challenges. It would be great if we could truly share all that information, knowledge, and processes – actions that have enabled leading organizations to succeed.
Many organizations are pleased to share the lessons they've learned and the tools they have developed to address problems, so one of the big opportunities, I think, is better sharing of lessons learned and how to make best practices more universally available.
5. What is the greatest challenge facing healthcare?
One of the biggest challenges is the system's fragmentation and somewhat contradictory incentives. Social determinants of health are also another area of challenge, such as where someone lives and what healthcare systems they have access to.
Suppose that the system is highly integrated and cutting-edge with technology and resources. In that case, that person has access to very different care and very different improvement processes compared to the person who doesn't live in an area with a health system with that infrastructure.
How do we get that high-quality care to every individual around the country? How does a rural health clinic or system bridge the gap when they don't have access to the latest technologies or resources? Yet, they're still trying to serve their community with the best quality of care. I see that as a significant challenge to solve.
6. How do you envision technology playing a role in addressing this challenge in healthcare?
Technology has the potential to be a great equalizer. Telehealth, for instance, may enable a small village in rural Alaska that isn't on a road system and must be accessed via a boat or plane to get healthcare services. That is one way in which technology can help bridge the gap.
Another way is the adoption of data and analytics and access to AI tools to support health systems that can't hire data scientists or practitioners who are very specialized in their field. These same resources can help drive improvements, identify opportunities, and determine when a process is broken or working as intended.
7. What best practices have your team employed over the past year that resulted in meaningful improvement or outcomes?
There are definitely gold stars to be handed out throughout our organization. We've made a lot of progress over the past few years. Healthcare has changed, and it's constantly evolving. We've faced a major pandemic, and new challenges around how healthcare is delivered and how patients interact with their healthcare system and providers have surfaced.
We've had to rely heavily on contract labor, such as travel nurses and others, to make sure we could meet the demands of the patients during that time. On average, we'd spend $200,000 per month on contract employees pre-pandemic. Then, at the height of the second wave of the COVID-19 pandemic, we were spending upwards of $3M monthly.
We were fortunate to have federal funds to cover those costs for a period of time, but that money was discontinued. Yet, our chief nurse made amazing progress, and we've significantly increased the number of nurses we're hiring. Now, we're down to about $1M per month in contract labor spending. We've demonstrated significant improvements over about a year. Thanks to operational benchmarking, we've come back down quickly.
We would look at our staffing levels compared to other healthcare organizations, other nursing stations, and other EDs through benchmarking. We are consistently high in those benchmarks. We knew there was some opportunity from the way we were staffing or the way that we were scheduling staffing and not fully aligning the patient needs with the staffing resource. We did some work on labor productivity. We partnered with the operations team to acquire real-time data and reporting. Our chief nurse sat down with frontline managers and directors to conduct training on calculating hours per patient day metric, what it means, and how to look at needs and staff alignment.
