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By Dan Rudy 

Foraker Group initiates public discussion for new hospital


Proponents of constructing a new hospital facility in Wrangell hoped to revive conversation about the project with a pair of presentations and a group discussion last week.

Alaska Island Community Services (AICS) and Wrangell Medical Center (WMC) hosted Foraker Group founder and president Dennis McMillian at the Nolan Center the afternoon and evening of April 2. Based in Anchorage, Foraker is a nonprofit group specializing in assisting other nonprofits around the state.

Wrangell’s two medical providers invited the group to assist with getting a new hospital through the predevelopment stages.

McMillian explained that Foraker was founded at the turn of the millennium, during what he described as “a perfect storm” of resources coming into the state to make conditions right for nonprofit development.

Funding sources for nonprofits come in a pattern of “boom and bust” cycles, and he said Foraker began as a way to help them get on their feet during boom years so as to better weather the busts.

“It was an idea that had been incubating for a while,” McMillian said.

By his own account, McMillian travels 200 days of the year and has gone to 157 communities across Alaska, working with all manner of nonprofits as a “neutral” entity. This includes developing strategies, offering consultation and assisting with grant acquisition.

As part of its work, Foraker undertakes a nonprofit sector survey every three years. By 2010, it found Alaska had a disproportionate number of such groups, about 7,000.

“That’s twice the national norm,” McMillian noted, about one for every 100 people. In the state, nonprofits were 60 percent government-funded, also twice the national average.

By 2011, he said the group was noticing a substantial shift in government funding and predicted major structural changes ahead. Citing the state of Alaska’s finances and a changing tide in Washington D.C. against generous earmarks, McMillian predicted Wrangell would need to reassess the way its healthcare services would be provided in the future.

AICS executive director Mark Walker explained their new clinic is itself a result of federal stimulus money, and the Affordable Care Act continues grant funding to underwrite community costs.

“A lot of that federal funding now is drying up,” he said. And as funding starts to drop, Walker explained care costs continue to rise.

“We’re actually overstaffed in a lot of ways,” he said, citing an idyllic ratio of one physician per 2,500 people. This becomes an impossibility for Wrangell, as staff is needed to maintain the emergency room and provide other services.

“There has to be redundancy in Alaska to make things happen,” said McMillian, because communities in the state are relatively spread out and isolated. To address this reality in a future with less government funding while also sustaining viable healthcare provision, he advised that the manner of healthcare provision would have to be reconfigured.

For the sake of sustainability, the community would also need to examine the direction of its own demographic shift. Wrangell’s population numbers around 2,400, reversing a lengthy decline started in the 1990s. However, the average age in the community is 47.

Delivering a “short course on generational politics,” McMillian advised that Wrangell needs to foster a more multigenerational experience if it is to continue to grow. Part of this involves understanding and thus attracting the “Millennials” demographic, adults aged 35 and under.

“This is who you need to be thinking about,” he said. “These guys look for smaller— walkable, ridable...This generation is getting married later, they’re having children later. They want a community that works. They want a community that gets things done.”

He concluded: “Cultural competence is worth more than ever.”

That in mind, McMillian explained one needs to recognize organizational trends are shifting from top-down hierarchies to compartmentalized work clusters, from institutional structures to more fluid groupings, and from decision-makers to facilitators as leaders.

“That fear of being ‘taken over’ is hierarchical,” he said. “We are moving into a networked system.”

By the end of the discussion session, McMillian concluded the community would have to begin engaging in a broader discussion about what it wants from its health services. He recommended including Petersburg and other communities’ healthcare services in the conversation.

“You start drawing the network of who needs to be there,” he said. This included city governments, larger organizations such as PeachHealth and the patients themselves.

“I think mergers is the last resort,” he added. “Real collaborative partnerships is the first resort.”

The presentation’s afternoon session drew about eighteen Wrangellites, many of whom were from the public or medical sectors. A similar number attended the evening session.

Wrangell’s economic development coordinator Carol Rushmore was hoping to learn how WMC and AICS plan to work together, what their needs will be and what the bigger picture is. She was dismayed to learn the WMC and AICS governing boards have not met so far to discuss plans for a future hospital.

“To me they should convene a meeting immediately,” she said. “The boards, to me, can’t work in a void, opposite to each other or separately.”

“The next step will be for Mark Walker and myself to arrange for an opportunity for the boards of both of our organizations to get together,” WMC interim CEO Marla Sanger explained. “That seems like the first thing that should happen.”

She hopes to get together with him by month’s end to organize the collaboration. By that time, she is expecting Foraker Group will have additional information prepared on predevelopment for a new hospital.

“I’ll be reaching out to them after that time,” she said.

“We need members of the community to say ‘nothing is off the table,’” Walker commented. “There really isn’t a template for this kind of collaboration. We’re sort of making it up as we go.”

Of concern to some was the potential cost of building a new facility.

“Where are we going to get the money to do this?” asked Lovey Brock, attending the meeting.

“That’s the billion-dollar question,” McMillian responded. “Probably the vast majority is going to have to be bonded,” which is a city action. Wrangell voters previously approved $24.6 million for a Department of Agriculture loan toward the project, but Sanger has said costs could be higher than that.

“Even if you cut that in half and build a smaller hospital, that’s going to be a hard sell to the people,” Brock replied.

McMillian explained getting predevelopment work completed is the next step. Having a formal plan in place would make the future task of acquiring the funding possible.


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