Senior Voice -

We feature here selections from two interviews. The first is with Deborah Bear, Anchorage senior activist, who presents her experiences and views regarding access to primary health care as a senior with Medicare. The second is with Tamara Brown, chief executive for Providence Clinical Network, who explains how Providence is responding to the need. These interviews have been edited for length and clarity.

Weiss: Deborah Bear, how did you get started as an activist about the issue of access to primary care for Medicare recipients in Alaska?

Bear: A lot of people complain about things that seniors face, and healthcare is, I believe, paramount in those issues. Rather than moaning over the problems, I felt like, okay, this is something that I have a passion about. Let's do something to fix it. So that's why I decided that I would start a one-person campaign to start resolving the issue.

I contacted my legislators, both state and national. I spoke to The Older Persons Action Group (OPAG). I spoke to the Alaska Commission on Aging. I'm going to be working with the Anchorage municipal Senior Citizens Advisory Committee. Actually, my senator, Senator Kaufman, is the co-chair on the human and health services committee this session. He's the one that helped me come up with the problem list because he said he needed bullet points that he could present in committee.

Deborah Bear's Problem List sent to legislators

Hello, my name is Deborah Bear. My husband and I have lived in Anchorage over 44 years. We are in our 70s. As we get older, we find it more difficult to access primary healthcare because very few healthcare providers will accept Medicare patients. Recently our primary care provider told us that we would have to find primary care elsewhere because Alaska Regional Senior Healthcare Clinic is being forced to close their doors on Feb. 28, 2023. The reason given was that management could not fill key positions and support staff to keep the doors open.

Seniors are struggling to obtain primary healthcare in Alaska. Medicare is not adequately reimbursing primary healthcare providers to make enough to keep doors open. Many seniors are concerned and are considering drastic options. Some of these include leaving our long-time homes in Alaska or going Outside periodically to get necessary healthcare. The senior population in Anchorage is about 20% right now. It would be tragic for this population to try to obtain necessary healthcare Outside when it is cost prohibitive on a fixed income. Please contact me to discuss this important issue further. Thank you.

Weiss: Please discuss some of the issues you have encountered in terms of access to primary care for seniors on Medicare.

Bear: The sad thing about it is a lot of people that I've spoken with have said, "Hey, we might need to move out of state in order for us to access good health care, or go out a couple of times a year. Most of that is cost prohibitive because we all live on fixed incomes." For instance, my husband worked on the railroad for 25 to 30 years. If we go Outside, his pension is taxed. And we love Alaska. We have a homestead up here and I've lived up here for 45 years, and we don't want to leave here. it's our home.

[A staff person] at the senior health care clinic at Alaska Regional Hospital called and talked with me at length. She said a lot of the patients that they were caring for had cognitive issues where it was very difficult for them to go out and find another care provider because they just don't know how to navigate systems.

The other part of it is we don't have primary care facilities up here that will take Medicare recipients. There are two in our in our community. One is Providence and the other one is Anchorage Neighborhood Health Center. Those are the only two clinics that will take Medicare patients without a cap. Others will take Medicare patients, but they can only see so many a day and or week, or they can only take so many in order for their practice to flourish.

I spoke with Providence because I was referred over there. They told me that they're getting a flood of patients and we were lucky to get in. They're aware of it and they say they're trying to accommodate for it.

Weiss: Any final thoughts you would like to leave with the readers of this article?

Bear: I really would like to develop a task force that includes Medicare, health care providers, maybe somebody from the office staff, and patients, so that we can look at strategies and solutions. This problem isn't going to go away.

Tamara Brown, chief executive, Providence Clinical Network

Weiss: Tamara Brown, please tell us what your position is at Providence Alaska.

Brown: I'm the chief executive for what is called the Providence Clinical Network in Alaska. That includes the medical groups of Providence, which are all the outpatient clinics, including primary care.

Weiss: Back in 2010, Providence started up the Providence Senior Care Center where Medicare was accepted and where seniors could develop a relationship with a primary care provider. What happened to the Senior Care Center?

Brown: Around 2017 Providence converted the Senior Care Clinic to primary care clinics. What that resulted in was really just a name change and also an expansion of services. Providence found that it was difficult to recruit providers for a clinic that was limited in scope to senior care. By expanding services to primary care, we were able to expand our provider base and therefore expand access and services to both seniors and to the community as a whole.

Since that time, what started as one clinic for senior care has now expanded to have three locations of primary care. We have a clinic on Huffman, in midtown at the old REI location, and at Providence Alaska Medical Center -- all focused on primary care serving the whole family from birth to end of life.

We have really focused on expanding primary care access and expanding our services since the time of the Senior Care Center. We've added integrated pharmacy. We have both a pharmacist and a pharmacy technician located in each of our primary care locations. We have integrated behavioral health, social work, and expanded our nursing support. Our midtown location is co-located with urgent care as well as physical therapy. So, from our perspective we're expanding both access and services to the senior population.

Weiss: If I were to call a Providence primary care location right now and say, "I'm a new patient and I am on Medicare. I need a new primary care provider because mine just retired," would I get in?

Brown: You would be able to get in. It might take time to be able to get a first visit if you're not having an emergent need. But yes, we're doing our very best to care for the community. During this time of limited access, we realize that there is a shortage of Medicare providers in this community.

In the last two years, Providence added multiple ExpressCare locations as well as our urgent care location. All of those locations accept Medicare and are available for same-day immediate access. So, we encourage anyone with Medicare who is in this gap of having lost their Medicare provider and waiting to be seen, who has an illness or an injury and doesn't have an immediate available visit with a primary care provider, to visit our ExpressCare clinics or our urgent care clinic. They will be seen, and they will receive care. We have ExpressCare in the Mat-Su Valley and Eagle River, and in Anchorage at Tikahtnu Commons, in midtown and at Huffman.

Once patients are seen at an ExpressCare or urgent care, all of those locations have the ability to help those patients then be scheduled with a primary care provider if they don't already have one. They can help with that continuity of care, wraparound service. We can't be the immediate answer for everyone, but we are absolutely working to hire and meet the need in this community. It's going to take a little bit of time.

Weiss: I'd like you to comment specifically on the question of health care providers who can address the problems of seniors. Is there is there a shortage of these types of providers in the state of Alaska?

Courtesy Deborah Bear

Deborah Bear is concerned about access to doctors who will accept Medicare.

Brown: What we've experienced is difficulty recruiting frontline staff. What we've done at Providence to meet that need is we've started our own medical assistant apprenticeship program, so we're training our own. We've found that to be an effective way of both training from within to meet the need, and also meeting a need in our community by providing training and a source of employment. We're also doing our very best to keep up with the right pay scales and doing market surveys and making sure that we're able to meet the demand in that way.

We're accepting as many patients as we can during this time when expanded access is needed. We'll continue to hire additional providers and expand our services. We'll do whatever we can to provide health care for all, especially the poor and the vulnerable. Right now, the senior community is the most vulnerable. That's what we're going to do.