Transforming Care in the Indian Health Service

The IHS mission, in partnership with American Indian and Alaska Native people, is to raise their physical, mental, social and spiritual health to the highest level. Since its establishment over 50 years ago, the IHS has done much to improve the health status of American Indians and Alaska Natives; however, we realize there is still much to be done. Health disparities continue for the population we serve, and access to care is still a challenge. When  I assumed the role of director of the IHS over two years ago, I set four priorities to address these issues and to guide our efforts to change and reform the IHS. Over the past year, we have made some significant strides in accomplishing these goals as we work to improve the health of American Indian and Alaska Native people. We still have much to do, but progress is being made.

Yvette Roubideaux, MD, MPH, IHS Director

Our first priority is to renew and strengthen our partnership with tribes. I truly believe the only way we are going to improve the health of our communities is to work in partnership with them. We have done a lot to improve tribal consultation at the national level – I held Area listening sessions with all 12 IHS Areas  again this year, either in person or by phone or videoconference. I have held more than 300 tribal delegation meetings to date and regularly meet with tribal advisory groups and attend tribal meetings.

We have implemented several tribal recommendations to improve the consultation process, including holding our first Tribal Consultation Summit in July 2011, where tribes could learn about several current consultation activities in a “one-stop shop” event. We also have developed a new website to increase access to all letters from the IHS director to tribal leaders.

We have been consulting with tribes on many important issues in the past year. For every decision we make, we always consider their input.

Our second priority is to bring reform to IHS. This priority has two parts, the first of which included  passage of the health-reform law, the Affordable Care Act (ACA). We are grateful for passage of the ACA because it will make quality and affordable healthcare accessible to all Americans, including our first Americans. It is designed to increase access to health insurance, help create stability and security for those who have insurance and reduce healthcare costs.

The focus of this past year has been on access to health-insurance provisions in the Affordable Care Act. Discussions have begun on two measures to begin in 2014: implementation of the State Affordable Insurance Exchanges and the Medicaid expansion up to 133% of poverty level. This could result in more health-coverage options for our patients. We also are pleased that funding requirements for the exchanges included a requirement for states to develop a plan to consult with tribes.

The ACA also contains the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), which modernizes and updates the IHS with new and expanded authorities for a variety of healthcare services. We are consulting with tribes on an ongoing basis on the implementation of these new authorities.

To help with outreach and education concerning these important new laws, the IHS developed a table summarizing current progress on implementation of the reauthorization of the IHCIA and sent it to tribal leaders in July 2011. National and regional tribal organizations help us with outreach and education to tribal leaders and our patients. 

The second part of this priority involves bringing internal reform to the IHS. Clearly, tribes, staff and our patients want change. Tribal priorities for internal reform included more funding for IHS and improvements in the contract health services (CHS) program, which is how we pay for referrals to the private sector.   

We are pleased that the IHS received a budget increase for FY 2011 when most other agencies had cuts, indicating continued strong support of IHS by this administration and the Congress. This included an increase in CHS funding that, along with the large increase in CHS funding in FY2010, for the first time allowed sites to approve more CHS referrals beyond Priority 1. Also, catastrophichealth-emergency cases were funded until mid-September, not running out of funds as early as June, as has happened. These much-needed resources mean more patients are getting the care they need. 

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