Healthier Washington American Indians and Alaska Natives:  Tribes, IHS, Urban Indian Health Programs.
  • Innovation CMMI grants.

  • Tribal Engagement
  • Join regional inter-tribal planning effort
  • IT Infrastructure:  Integrate Medical, Dental and Behavioral Health Services
  • Meetings; first Tribal,then agencies, then Govt to Govt.
  • No need to wait while state and federal government delay funding for case management and full integration of services.
Where do Community Health Representatives and other front line workers fit in?
Arizona includes over $4 million for AIAN  in SIM proposal.
  • HealthPath Washington is a multi-stage process of improving coordination of care and cost containment for Medicaid and Medicare dual eligibles. 
Sept 2014 letter announcing delay and the New July 2015 start date.
December 13, 2012 Congressional Dual Eligible Hearing, Testimony, Mary Ann Lindeblad and CMS(Bella).

Demographics of Duals  April 2013 start of phase 1.
Dual Eligibles
Data to Information:  Where will it come from?

How will Indian health programs get useable information from their electronic health care systems without additional funding from the CMS-funded Healthier Washington Initiative?

Can we turn medical visit/claims data into health planning information?  How will tribes with largely global budgets (IHS funds) combine EHR data with claims data?  Will an underfunded IT budget be able to keep up with others in ACHs?

Electronic Health Records (EHRs), even if they are linked to Health Information Exchanges (HIEs), do not have enough information to fill this need. The only truly comprehensive information about all of the healthcare costs associated with an episode of care or with a group of patients, particularly the prices being paid for the services delivered, comes from claims data maintained by payers. Consequently, providers would be more willing and better able to participate in new payment models if they could get access to claims data from health plans, Medicare, and other payers.

---source:  Center for Healthcare Quality and Payment Reform---

  • Phase Two of Health Care Reform 
  • Payment Reform driving Health Service Delivery Reform
  • 1.  $65 Million for 4-year Healthier WA (Innovation Plan).
  • 2.  Duals, Healthpath WA
  • 3.  Integration of 2 webportals?: 
  • 4. WA Healthplanfinder and WA Connections
  • 5.  Medicaid and WA Health Benefit Exchange Contracting
Oregon Transformation Center (Operations of CCOs)
  • Medicaid Transformation
  • ​Transformation Projects
  • ​Long Term Care and Support Services
  • Housing and Employment Support.
New Mexico's Centennial Managed Care has not worked well for tribes despite 3 years of consultation with Tribes.
CMS-approved plans have little evidence of 'success' to include Indian Health Programs with SIM funded 'innovation' or 1115a Waivers in Minnesota, Arizona, Oregon, New Mexico.
  • Minnesota tribes recently engaged (2016) in 3th year of MN initiative with added no cost extension 4th year to end 2017.
  • Other Tribal efforts align well.
  • Regional Planning and engagement
  • Regional inter-tribal planning effort has limited success (but some) in the past with Regional Support Networks (RSNs)
  • There are some examples of:
  • Tribes working regionally with other tribes
  • Tribes working regionally with tribes AND governments.
  • Strengths and Weak Links in the Healthier Washington Tribal Connection
  • 2016:  States with Indians Tribes have yet to successfully include tribes in their Innovation Grant-funded efforts.
  • Arizona seems to have made most progress with its SIM grant (see below) and 2016 DSRIP tribal option.
Suggested Citation: Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2017 Website.
Free and unlimited use granted with citation (suggested citation above).  
Thurston-Mason BHO plan.
Cascade Pacific Action Alliance Accountable Community of Health