Regional Referral Regional Referral Centers:Centers:

“Improving Access to “Improving Access to Specialty Care”Specialty Care”

Portland Area Facilities Advisory Committee (PAFAC)

Presentation Outline

PAFAC Charge & Recommendation Benefits of a regional referral center

in Portland Area Guiding Principles Pilot Study overview and findings Address questions/concerns on

moving forward

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PAFAC Charge

…to provide recommendations to the Director, PAIHS, on issues related to healthcare facilities and staffing. Initial Task:

Make recommendations to allow regional healthcare facilities and Area-wide medical centers to be ranked under the revised IHS Healthcare Facilities Construction Priority System (HFCPS).

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Fund a “Demonstration Project” or projects A multi-tribal specialty care referral facility

At least one in the Portland Area The 1st of 3 to be built in the Portland

Area To include planning, design, construction,

and staffing of regional referral center(s) that will provide secondary care referral services to Portland Area Tribes.*

*NPAIHB passed Resolution No. 10-01-04 on 10/22/09

The PAFAC’s Recommendation

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What is a Regional Referral Specialty Center?

A healthcare facility that provides culturally sensitive access to specialty care through referrals from primary care facilities operated by the participating tribes.

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Benefits of a Regional Referral Center

Decrease dependence on CHS resulting in cost savings

Increase access to all levels of specialty care

More timely access to care Reduce waiting period for contract health

Culturally-relevant healthcare Primary Care remains at, and is best

delivered at the local level

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Why this approach?

INNOVATION, CHANGE..The Demonstration Project would

Provide improved access to more comprehensive care for dispersed Tribal populations.

Have a “specialty care” focus that compliments community-based primary care.

Be based on multi-tribal partnerships. Make use of telemedicine when possible.

“…in order for us to get the support that is so desperately needed, we need to demonstrate a willingness to change and improve.”

-- Dr. Yvette Roubideaux, DirectorIndian Health Service

Open Letter to Tribal Leaders, June 2, 2009

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The Influence of Portland Area Tribes

Portland Tribes: Have a unique ability to collaborate Share common goal: provide

culturally-sensitive care to patients This sense of partnership guided the

Master Planning Process of 2005. These attributes carry over to the

PAFAC and their recommendations.

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Partnerships

Portland Area Tribes = Collective PowerExamples of successful partnerships that have resulted in better services for users:

Healing Lodge of the Seven Nations SDPI Consortiums (i.e., Southern Oregon) Northwest Washington Indian Health Board Northwest Portland Area Indian Health

Board

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Guiding Principles

Such a facility will bring new resources: Additional services on a direct care basis. Current local resources and services remain

unchanged. Full consultation among all involved Tribes

before any advancement of the facility. Governance will be with the consent of the

governed – the participating Tribes. Concept will be self-sufficient (revenue-

stream) Range and scope of services provided will

be determined based on the need of the participating Tribes and communities. Size, staffing, location, other pertinent aspects

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Why a Demonstration Project?

Current IHS healthcare resources do not fully address the needs of small, geographically dispersed Tribes. CHS is inadequate. Small, isolated populations do not justify

direct service Specialty Care. Current IHS methodologies for

healthcare facilities construction funding are inequitable. Areas that service predominantly small

Tribes have been left out.

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Terminology of the Pilot Study

CHSDA – Counties defined all or in part as the Contract Health Service Delivery Area for a particular Tribe.

Primary Service Area (PSA) – A group of communities and its population for which, at a minimum primary care is planned and resourced.

User Population – The number of Active Registrants in the healthcare system that have used the system in the last 3 years.

Workload – The number of annual Indian patient visits for primary care and/or specialty care at a service unit or Tribal clinic.

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Pilot Study Findings

Portland Area Regional Specialty Care Referral Centers must:

Rely on existing Primary Care at Tribal clinics and service units

Be near a population center that supports hospitals

For recruitment/retention of high skilled Specialists Be near a transportation hub

Facilitate Tribes’ access to the facility Demonstrate prelim. planning criteria for use by

IHS Sufficient to adapt the IHS facility planning process Determine facility workload and size

Travel Distance Alternate Resources

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30+ Hospitals8 Universities/colleges 1 Major Medical SchoolSeaTac International AirportI-5 Corridor

15+ Hospitals8 Universities/colleges 1 Major Medical SchoolPortland International AirportI-5 Corridor

8 Hospitals5 Universities/collegesSpokane International AirportI-90 Corridor

Possible Referral Services

Cardiology Orthopedic

procedures Endo/Colonoscopy Rheumatology

Dermatology ENT Pulmonology GYN “Scope” Surgery

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• Final range of services for the Referral Center will be determined during planning phase

**These services would be provided on a direct care basis within IHS system instead of utilizing CHS resources.

Why Telemedicine?

Improved Access It brings healthcare to patients in remote

location Cost Efficiencies

Better management of chronic diseases Shared health professional staffing Reduces/eliminates travel Fewer or shorter hospital stays

Improved Care Reduces travel and related stress to patients

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Telemedicine Specialty/Primary Care

Education/Information Continuing Education Education Seminars Peer-to-peer support

Imaging Radiology Pathology Cardiolog

y Remote Monitoring

Blood Glucose EKG

Cardiology Pathology

Dermatology

Ophthalmology

Mental Health

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• Final range of services for the Referral Center will be determined during planning phase

Initial Task Timeline

January 2008 Initial charge/task from Director, PAIHS

February – April 2008 Develop Pilot Study Concept

November 2008 Met w/ IHS Director Bob McSwain

Pilot Study approved and funded by IHS March – October 2009

Pilot Study contract finalized - Mar First Draft Pilot Study completed - Aug NPAIHB Supporting Resolution passed - Oct 22, 2009 Pilot Study Final Report completed - Oct 30, 2009

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Initial Task Timeline November 2009

Met with IHS Director Dr. Roubideaux

March – Sept 2010 Tribal-IHS Director listening Session - Mar

PAFAC participated PAFAC sent follow-up letter - Aug

requested $300K for initial planning ATNI supporting resolution passed - Sept

January 2011 Follow-up letter on planning funds to IHS Director

April 2011 Tribal Leader - PAFAC Forum, Ocean Shores, WA

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Why a Demonstration Project Now?

IHS HQ acknowledgement The current system does not address all

healthcare needs Smaller individual Tribes ≠ Specialty Care

IHS Priorities for innovation and increased access to care

National focus on healthcare reform and Affordable Care Act

Other Areas are eager to act on regional referral concept. (California, Nashville, Bemidji, Oklahoma)

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PAFAC Membership - 2012

Member Affiliation Status

Andy Joseph Colville Tribal Council, NPAIHB Chair DST

Pearl Capoeman-Baller

Quinault, NPAIHB Vice-Chair T-5

Julia Davis-Wheeler Nez Perce Tribal Council T-5

Dan Gleason Chehalis Tribal Council T-1

Mark Johnston Grand Ronde, Health Director T-5

Steve Kutz Cowlitz Tribal Council T-5

Marcus Martinez Spokane, CEO, Wellpinit Service Unit Fed

Angela Mendez – Alt. Shoshone-Bannock, Tribal Health Director T-1

Sharon Stanphill Cow Creek, Director, CCH&WC T-1

John Stephens Swinomish, Director, Social Services T-5

Ron Suppah Warm Springs Tribal Council DST

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“Health Care Funding for Pacific Northwest Tribes Is Seriously InadequateIHS funding is appropriated annually at the discretion of Congress and is not adequate to meet the health care need of Native American people. This ongoing funding deficit is a major factor in cancer-related and other disparities experienced by Native populations. The Institute of Medicine (IOM) has stated that closing the gap on health disparities for this population will require a national recommitment; especially in the form of increased Federal funding that would allow patients timely access to specialty care.”1

1Facing Cancer in Indian Country: The Yakama Nation and Pacific Northwest Tribes; President’s Cancer Panel, 2002 Report; U. S. Department of Health and Human Services, National Institute of Health, National Cancer Institute

Discussion?

For more information visit the NPAIHB web site under “Indian Health Policy” page

http://www.npaihb.org/policy/portland_area_facilities_advisory_committee/