Does this Alaska healthcare system have the blueprint to save the American healthcare crisis? Discover the story behind the health‑care system that Harvard, the Institute for Healthcare Improvement, and two U.S. Baldrige Awards all cite as living proof that American medicine can reinvent itself—even in one of the most rugged, under‑resourced corners of the map. In this feature‑length conversation, host Judson Howe travels to Anchorage to sit down with Dr. Doug Eby (Executive Vice President for Specialties) and Sonda Tetpon (Vice President of Dental Services), two architects of Southcentral Foundation's award‑winning Nuka System of Care. What began as a 25‑employee clinic has exploded into a 3,000‑person enterprise serving 65,000 Alaska Native "customer‑owners"…all while spending roughly two‑thirds of the U.S. per‑capita average—and outperforming national HEDIS benchmarks across the board. Why Watch? From "patient" to customer‑owner. One word dismantled medical hierarchies, shifted responsibility, and re‑ignited community pride. Guaranteed same‑day access—on a shoestring. Learn how Nuka funds 10‑person primary‑care teams yet slashes ER visits, specialist referrals, and hospital days. Complex Adaptive Systems 101. Six Sigma saves lives in an OR, but diabetes demands coaching. Dr. Eby illustrates why "throwing birds, not rocks" is now clinicians' guiding metaphor. Culture change at scale. Sonda reveals the recruiting, onboarding, and data strategies that keep mission and margin aligned—even after a 100‑fold staff increase. The burnout antidote. Hear frank talk on compassion fatigue, COVID's gut‑punch to same‑day access, and the hidden power of an Alaska Native case manager who can move HEDIS scores from the 75th to the 90th percentile. A blueprint for national reform. Could America close hospitals, shrink insurers, and redirect dollars to relationship‑based primary care? Doug and Sonda offer a policy starter kit for anyone brave enough to try. Episode Chapters 00:00 Intro 03:13 What Is a Customer-Owner? 06:55 Personal Healthcare Journeys: Sonda and Doug's Stories 14:52 Founding and Early Growth of Southcentral Foundation 19:21 System Redesign and Financial Transformation 26:13 From Exam Room to Smartphone: Rethinking Access 32:00 Measuring Outcomes Through the Customer-Owner Lens 41:56 Complex Adaptive Systems: the Bird and the Dartboard 52:52 Human-Centered Metrics and Multigenerational Impact 1:18:19 Challenges of Scaling and Sustainability 1:28:36 Future of Nuka: Vision, Workforce, and Medical Education What You'll Take Away Language creates accountability. Swap "patient" for "customer‑owner" and watch engagement—and outcomes—jump. Team over heroics. See why physicians become coaches inside Nuka's multidisciplinary "ballet." Data drives strategy. Advisory councils, micro‑surveys, and hallway chats feed a data lake that dictates strategy—not the other way around. Invest in people, not pills. Nuka spends several times the national average on behavioral health and recovers the cost in avoided ER and inpatient spend. Rewire medical education. Dr. Eby's six‑pathway model replaces debt‑heavy med school with learn‑work‑advance ladders that fit modern care. Who Is This For? Health‑system CEOs, hospital administrators, public‑health officials, frontline clinicians, investors in value‑based care, policy makers, students—and anyone tired of hearing that U.S. healthcare is "too broken" to fix. Press play, take notes, then forward this episode to the colleague who needs to hear it. Production Micah Buller, Todd Carpenter, Lindsay Swain Hunt Recorded on‑site in Anchorage, Alaska

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