Q&A: Jared Kosin, President & CEO of ASHNHA

Jared Kosin is the President and CEO of the Alaska State Hospital and Nursing Home Association (ASHNHA). ASHNHA represents over 65 hospitals, nursing homes, and health care organizations across the state. 

Kosin joins us in this Q&A to discuss Alaska’s response to COVID-19, lessons learned during the pandemic, unique challenges in the state, and the steps hospitals and nursing homes are taking to prepare for a potential second wave of cases. 



Emily Boerger: Starting broadly, can you tell me about how the hospital and nursing homes have responded to COVID? How would you say Alaska has done thus far?

Jared Kosin: “I think Alaska has done a really good job so far and I think a big reason for that is we were very quick to act early on. When this showed up in Washington and California, we followed suit pretty quickly in locking things down, encouraging social distancing, hand washing, and all those necessary steps. And I think that really worked in our favor.

The hospitals and nursing homes in particular, right away we were taking those actions. We have been partnering with the state, we developed individual surge plans for each facility for alternate care sites should there be a surge event so that we could handle any capacity needs that would arise. So, we immediately kind of made sure our infrastructure was as ready as possible. We obviously did a really good job as a general public in terms of social distancing and staying home.

But at the hospital and nursing home level one of the other things we’ve done, through ASHNHA, is we’ve really tried to partner directly with the state. We sent two of our staff members to the state’s Emergency Operations Center to help with data collection and to help with real time communication between facilities and Doctor Zink. We were hosting phone calls three or four times a week with Dr. Zink and all the facilities. So, we were really aggressive early on to respond.” 

EB: Through that process and those early stages, what were some of the lessons you learned?

JK: “I think a lesson learned is: acting early is certainly better than late. The other thing that we were very quick to do is to implement rigorous screenings and to the extent possible, we started setting up testing sights wherever we could. But I guess the lessons learned really are that testing is a super important aspect of all of this, and increasing testing capacity and testing as much as possible seems to be the answer to be able to really function with the virus until there’s a vaccine in place.” 

EB: What makes Alaska unique in its ability to respond to the pandemic? Perhaps both in terms of unique challenges or unique strengths.

JK: “I think there’s two pieces to it. The challenge going into it was our health care system from an access standpoint is pretty fragile. If you look at how our inpatient beds compare to the rest of the country, our ratio of beds per thousand people is on the lower scale. Only 8 other states have less inpatient beds per thousand people…So, we knew right away, from an inpatient standpoint we’re on the lower end of access to care. From a nursing home standpoint, we have the fewest beds per capita and fewest facilities. No matter which way you look at nursing home beds, we have the fewest in the country. So, we knew right away we have these access challenges.

And on top of that, we have geographical challenges as well. Twenty-one percent of our hospital inpatient beds, our acute care beds, are not accessible from the road system…So, how much can we really handle COVID, how much capacity do we actually have? Our market is extremely unique because our inventory is geographically spread out and isolated from each other. So, I think that is the new challenge going into this.

The benefit we’ve had with Alaska…I think our geographical isolation from the rest of the country really helps. You know, it’s hard to get to Alaska, so we’re kind of out on our own. We’re a spread-out population across the state so we have fewer dense population centers. I think we have a healthier population compared to many states. I think those factors have helped keep case counts lower. 

We at ASHNHA have been collecting capacity stats on a daily basis from all of our facilities to create real time situational reports for Dr. Zink and other folks to make decisions during the pandemic…Our ICU utilization is actually closer to 40% and our inpatient utilization has been closer to 49%. So, what that tells us is we have really good capacity right now and we have, you know, decent capacity going forward to continue to manage cases even if they start increasing.”

EB: What other steps are you taking to prepare for a potential second wave of outbreaks or cases? 

JK: “We’re in an interesting phase right now. Elective procedures just started resuming a few weeks ago and so we’re watching that really closely. We’re still talking to Dr. Zink and her team very regularly each week and we’re watching the case counts as things pick up or not.

But some of the things in particular we’ve been doing is testing. I kind of said that from the beginning, I think we all feel that testing is really critical. In Alaska right now, to get a procedure or surgery you have to be tested within 48 hours prior. And I think there might be some flexibility around that based on logistical concerns in different markets. But we’re basically making sure that we have adequate PPE in place to handle medical care that’s now being delivered. We’re making sure that testing is happening. We’re testing all new hospital admissions, all new nursing home admissions, and we’re watching our overall capacity. 

We’ve put a lot of investment in surge capacity. So, a lot of our markets, now individual hospitals basically created alternate care sites and have them ready to go should they need them. And that can look very different by community. You know, in Anchorage we stood up the Alaska Airlines Center so that we have beds there that we can shuffle around our patient populations to make sure we have the ability to respond to a COVID spike. And then in your smaller markets that might be a school building, that might be a church. There’s all of these different plans in place to basically add beds overnight should we need them. So, that’s some of the things we’ve been building on so that if or when there’s another wave, we’re able to kind of absorb it.”

EB: What are some the greatest challenges for the health care system moving forward? What are some future, long-term challenges you are preparing for? 

JK: “Well, right now the financial shock is big. Operations have declined so much…Basically we had a bunch of facilities sitting half open and all of their outpatient services were largely operating at zero percent compared to the prior year because we shut everything down. So, the impact on revenues has been substantial and recovering from that is a challenge. The federal aid coming in has been helpful, but making sense of what this is going to look like, how people are going to finish for the year, do facilities have adequate reserves to cover this, and what does that mean for maintenance and things like that,  that is all playing out right now.

“The other thing is, I think we’ve done a really good job at using telehealth and virtual visits and filling in on that. I guess the challenges we’re recovering from are the financial aspect for sure…And then even more so, understanding what health care is going to look like post COVID. Just like people have talked about in private business, so many people are now accustomed to working from home and you realize just how much you can accomplish virtually. How is that going to play out now? You know, you’re going to have a hard time bringing all of your employees back when you realize you can accomplish a lot of this out of the office. I think the same can be said for health care. We’ve been working to minimize patient contact and work on virtual alternatives and I’m very curious to see how we’re able to build on that going forward.” 

This interview has been edited for clarity and length.