After a roughly seven-month search, Unalaska's clinic has a new CEO.
Melanee Tiura signed a three-year contract with Iliuliuk Family and Health Services (IFHS) last month. She takes over the position from interim director Will Rodgers, who stepped in after the resignation of former director James Kaech.
KUCB's Hope McKenney sat down with Tiura to ask about the financial status of the island's nonprofit community health center — and where she hopes to take it.
MELANEE TIURA: I am a dietitian and diabetes educator by training, and I worked clinically for almost 13 years. So public health — community health — has always been my interest area throughout my career. I went into management sometime, I guess, in 2010. I became the health education director [at the Bristol Bay Area Health Corporation]. That was the time that we moved to Dillingham, Alaska. Shortly after being there, I became the community health services division manager. My home base was Dillingham, but we served the 34 villages surrounding Dillingham as well. That was a great learning environment. At that point, I also managed our HRSA [Health Resources and Services Administration] grant, which is the same grant that we have here at IFHS. And then in 2014, I received an offer to go back to our hometown [in Michigan] to the hospital that actually I had done much of my clinical work with. So we did that. I was there for five years, and then here I am.
KUCB: And what are your impressions so far? What do you think of this place?
TIURA: I love this place. The community has been great. You know, I've been asked that question a lot from family and friends back in Michigan. What's it like? And what are the people like? And what's the town like and the clinic? And it has been a delightful experience so far. My family is really excited to be here. The [community center] has things going on all the time, so it feels like we're busy every day. Last night, we were jelly roll quilting and tonight there will be soccer, so there's always something happening. And we love that. My husband and my five kids are here with me, and they're enjoying it as much as I am.
KUCB: What's the latest on the clinic's finances? Will you be planning on making another emergency funding request from the city?
TIURA: Finances with the clinic are an interesting history. Again, I've been here a month, so I've pieced together what I can so far. The last couple of years were hard for the clinic. They relied on a lot of locum providers — providers brought in from out of the area to cover the emergency calls. So it's not so much the clinic side of it, but it's the emergency response side of it that really does cost significantly for the clinic. They had had some turnover of providers. They had had some volume challenges. I believe [they had] some pricing challenges as well. But finances were hard. And, you know, that's not unique to rural health care in Alaska. That's everywhere. So figuring out how to improve is a difficult and rigorous process where you're turning over every stone. The city was gracious enough to offer a loan at the end of 2017. [Editor's Note: The city approved another loan in 2019.]We have dipped into it prior to my arrival — a small amount — but the clinic is doing well. Our volumes are continuing to improve. We hired two new providers, which is so exciting. So patients who want to plan their visits have somewhere to go. And I think that has been a challenge over time, where it turned into more of a walk-in service, and that's not the best way to proactively plan your health care. We want you to have annual visits. We want you to know what your cholesterol is. We want you to know what your blood pressure looks like, and we want you to manage those things before you need to go into the emergency side — before you have the heart attack, before you have the stroke, before you have an end stage result of not managing something earlier.
KUCB: Along those lines, I know the previous clinic director, James Kaech, wanted to increase the patient volume in order to finance the clinic and make it more stable. What is your philosophy on how to get the clinic stable and lower costs for patients?
TIURA: Yeah. James did do some nice steps to lower costs for patients. That doesn't address the overall stability issue of the clinic unless more people come, right? That's the point — that you've increased access. And he was right on the money. Volume is the way to do that. We have providers who have schedules that are open. Access is the goal so that patients who call today can get in — maybe today, hopefully tomorrow, even for planned things. And so, right now, our access is beautiful. Our patients can get in, and our planned volume is increasing. That is the way to a sustainable future. So now, that's on the practice side — on the clinic side. And then we have this whole other issue in rural Alaska, and that's the emergency care. Because we're not an emergency room, and we don't have trauma status, there are various pieces here on the billing side that we don't qualify for — or haven't qualified for in the past — that affect our revenue and our ability to sustain those services. So essentially, we're trying to grow one side of the business in order to pay for the other. Because the other is what people really know they need, right? If you twist your ankle at midnight and it's badly broken, what do you do? You need to have someone to call. If you have chest pain, you're going to need to call somebody. That kind of care is invaluable to patients. But if you're not using it, nobody's paying for it. So we are. And that's an important component of health care. The city has recognized that and has provided grants in the past and a loan most recently to support those efforts. I would expect we will continue to apply for the community support grant, because that's a service that our community needs that isn't being funded another way. But as far as emergency funds, we're going to try to stand on our own two feet.
KUCB: I know that so many people leave the island to go get usually less expensive care in Anchorage and other places. Is there a strategy? How would we get people to use the clinic and services that we have here in the community?
TIURA: We already took step one, right? We hired consistent providers so you can see the doctor of your choice. We also cover a wide variety of services. Our services are affordable. I'm very familiar with pricing structures in other areas in this state and also outside of the state, and we're comparable. We're doing cost-effective care as well, and you're not going to find better. I've been really, really pleased with what we're doing at the clinic so far. I've done physician recruitment and I've built practices for a long time now, and what we already had here upon my coming in was great. So this will be an easy way to build — to have good providers.
KUCB: You said you previously worked in rural Alaska and then you left. Can you talk about why you decided to return?
TIURA: Alaska has always had a special place in our hearts. Once you've lived here, there's a fondness that's not replaced by any other area. So I did move back to Michigan after living in Dillingham. We had planned to stay in Dillingham. A couple of years was our initial intent. That was a very different life for us, so we weren't sure how we would like it. But we loved it and we stayed for almost four [years]. You know, the position in Michigan did come up. It was a very nice position. That was an opportunity to get back closer to family and for my kids to spend time with their cousins, so that was great. That was a good time for us as well. And yet, everyone was quite positive about a possible transition back to Alaska. This position did come up, and it certainly looked like an opportunity in a community that we would like. I'm not so much about career or climbing the ladder. I want to be in a place where I feel like I can contribute, and my family wants to be in a community where they know they're a part of things. So this was unique in those aspects, because it is a community like no other that I've seen in Alaska — very close-knit and very kind people. I've never actually seen any demonstrations of kindness like I've seen already here in any other place.