American Indian Health Leaders Meeting Summary Billings September 21-22, 2017 Contents Next Meeting... 1 Overview... 1 Summary of Actions Taken During the Meeting... 2 AIHL Co-Chair Updates... 2 Health Director Updates... 2 Outside Speaker Updates... 4 T-HIP Work Group... 5 Appendix A: Agenda... 6 Thursday, Sept 21... 6 Appendix B: Attendee List... 8 Health Directors and Staff:... 8 Guests:... 8 Next Meeting December 14, 2017 Great Falls, Montana. Overview On September 21-22, 2017, the American Indian Health Leaders (AIHL) group including the leadership of six tribal health departments, Chairman Gray of the Little Shell Tribe, four urban Indian health centers, and Fort Peck s Health Promotion/Disease Prevention Program held a sixth quarterly meeting in Billings. The purpose of the meeting was to build a strong platform for collaboration to improve healthcare and health of American Indian people in Montana. The meeting agenda is in Appendix A. Meeting attendees are in Appendix B. Each tribal health program and urban Indian health center provided updates. This was followed by presentations and discussion with invited guests, including: Centers for Medicare & Medicaid Services (Dennis Wagner, Director of Quality Improvement and Innovation) Rocky Mountain Tribal Epidemiology Center (Mike Andreini, Director) Rocky Mountain Tribal Leaders Council (William Snell, Director) Montana Healthcare Foundation (Aaron Wernham, CEO; Tressie White, Senior Program Officer) North Dakota State University (Donald Warne, Department of Public Health Chair) The Montana Department of Public Health and Human Services (Sheila Hogan, Director; Lesa Evers, Tribal Relations Manager; Marie Matthews, Operations Services Branch Manager) Indian Health Services (Dorothy Dupree, Director)
The meeting on Thursday ended with a business session during which the health leaders spent time discussing the AIHL non-profit feasibility study next steps, and the possibility of an ANTHC visit. On Friday, the group had an extended T-HIP workshop during which they discussed progress and questions related to task orders, 638 agreements, selecting prevention programs, and outcome measures. These notes summarize the main priorities, opportunities, and action items identified during the meeting. This is not a complete record of the discussions that occurred during the day. Summary of Actions Taken During the Meeting The group agreed the next meeting will take place in Great Falls, Montana on December 14 th and 15 th. AIHL Co-Chair Updates LeeAnn Bruised Head Missoula Urban Indian Health Center: Part of the zero-suicide initiative. Clients are all tribal members and so they are establishing partnerships with the tribes. Working on models for becoming more trauma-informed and integrating care. Jessica Windyboy Rocky Boy Health Board: Currently working on expanding services (SBHC, 100% FMAP, FQHC) and at ways to bill for services. Received an IHS grant for nurse case managers to help mental health patients. New building will open Jan 2, there will be a grand opening in April 2018. Health Director Updates Health directors discussed current projects, progress, and challenges: Crow Tribal Health Department Rosella Holds: Rosella Holds let the group know that Crow is dealing with a large amount of crime. The community has held quiet protests and there is limited police presence. Dee Pretty On Top was not able to attend, and Rosella said that she is attending this meeting primarily to listen. Fort Peck Health Promotion/Disease Prevention Program Ken Smoker: There is progress on the wellness center which will offer a comprehensive care plan, provide jobs, and serve the community. They are still $3.5 million short on the $15 million project, and they are working on raising the additional funds. Construction will begin in October 2017 and will be finished late 2018. Work on the school based health center is ongoing and they just hired additional staff. They are working with Cornell University on a residency for dental which will hopefully be in place in the next year. The have a contract with Yale University for mental health care services. They have an AmeriCorps Vista working on a project looking at the demographics of health care professionals in the area. She is looking at how many jobs there are current and how many professionals in those jobs are native. The plan is to give the project to the local schools so that they can see the opportunity and potentially tailor their curriculum accordingly. Working on telehealth and trying to grow their own providers. Created a spending plan for T-HIP and are working hard on assessment. Little progress on their artificial pancreas for diabetic patients program.
Fort Peck Tribal Health Department Dennis Four Bear: The health department hired an RN to assist with home visits, and will be hiring an employee for the needle exchange program. The health department has also started an emergency awareness program, and has received approval for trailer for their diabetes program. The tribal DES office has started having meetings. North American Indian Alliance, Butte Dale Good Gun: Looking at hiring a medical director for approximately four hours a week. Had a site visit from IHS. Awarded several large grants, including a Montana Tech/STEM program, a life skills grant, and a community needs assessment grant. Fort Belknap Tribal Health Department Craig Chandler: Established their own billing department with a location and staff. Brought their new diabetics coordinator, Dr. Jennifer Show, who is a tribal member to this meeting. The tribe is experiencing a meth epidemic and there have been several suicides in the community. They are collaborating on a zero-suicide grant. Doing a feasibility study to look whether taking over their behavioral health service is a good fit for the tribe. Helena Indian Alliance Todd Wilson: They have 28 employees and are doing a minor reconfiguring of operations including developing a business office and looking at the best way to utilize their current space. They are doing a market analysis for a community block grant for expansion. They are eligible for state HIP (not T-HIP), he wants the urban Indian health centers to be funded for 100% FMAP. Little Shell - Kim McKeehan: Working on a tobacco program, wellness program, and community garden. They are also a part of the state s zero-suicide meeting and they have a council member on the Benefis Hospital board. Blackfeet Tribal Health Department Rosemary Cree Medicine: Completed their community health assessment and are putting out an RFP for the plan. They are going to the zero-suicide meeting. A couple of young women from the reservation are missing persons. They have received funding for several projects including a paramedic grant from MHCF which will send six EMT s to paramedic training. Working on getting a MAT clinic in place and are doing training. Confederated Salish and Kootenai Tribal Health Department Anna Whiting Sorrell: CSKT will be going live on EPIC, the new electronic health record on Dec 4, 2017. The move has been a lot of work; however, tribes need to put thought into what they are all going to do moving forward. There have been 19 completed suicides since last Nov, and Anna shared how one of the completed suicides affected her personally.
Northern Cheyenne Tribal Board of Health Joe Fox: They have started negotiations with IHS and there are several health care issues that they are concerned about. Joe is at the meeting to be eyes and ears. Outside Speaker Updates There were several presentations by outside speakers (see appendix A). These notes are not a complete summary of the meeting and presentations. Below are a few key points that were discussed by presenters and health leaders and you can download the PowerPoint presentations here. Dennis Wagoner Director, Quality Improvement & Innovation Group, CMS Dennis gave the group a presentation on working together to support patients and improve health outcomes. We need to find a model of care that works in Indian communities, and it is possible that this model of care will have independent standards. Leaders voiced their concerns about their dependency on third party billing and compliance. There is an overall lack of training and lack of proper compliance could cause audits and the tribes being required to repay funds. Dennis emphasized that there are successful models and that health centers need to focus on being very good at providing excellent quality care. Leaders asked that they be given examples of successful models so that they can emulate and make them applicable to Native communities. MPQHC will provide RMTEC and MHCF with models. Mike Andreini Director, Rocky Mountain Tribal Epidemiology Center Mike gave the group an update on RMTEC s activities and listened to leader s requests and concerns. William Snell Director, Rocky Mountain Tribal Leaders Council Bill addressed the group and emphasized that role clarification will be critical to the group s success. He acknowledged that health leaders want papers and policy and RMTLC is re-vamping their marketing and communications plans to improve communication between RMTLC and Tribal Leaders. Aaron Wernham & Tressie White CEO & Senior Program Officer, Montana Healthcare Foundation Tressie White let the group know that MHCF is available as a resource. Aaron Wernham let the group know that there is a rapid response grant opportunity open until Oct 6 th for anyone interested in applying, but MHCF funding is also available anytime throughout the year for this group to discuss project ideas for invited proposals. Contact: Tressie White, tressie.white@mthcf.org Donald Warne Chair, Department of Public Health, North Dakota State University Dr. Warne presented his research on existing models of tribally-led, health-focused non-profits whose function is to provide technical assistance, facilitation, collaborative grant and resource opportunities and assist in workforce development. His team will develop a model organization, and draft a business and operations plan. The model and plans will be presented to the group at the December meeting. Sheila Hogan and Marie Matthews Department of Public Health and Human Services DPHHS Director Sheila Hogan and Medicaid and Health Services Branch Manager Marie Matthews gave updates on DPHHS and the work that they are currently doing. Dorothy Dupree Director, Indian Health Services Dorothy Dupree gave a presentation on culture cures including quality focus, dimensions of quality, shoring up primary care, and trauma informed care.
T-HIP Work Group On Friday, September 22, 2017, the group reconvened to discuss T-HIP. Health leaders who are already working on T-HIP gave brief updated on where they currently stand: Blackfeet: They are working on getting prepared, but they need to know what the next step is. Northern Cheyenne: Their scope of work is an update and not a large change. They are moving forward with implementation, however there needs to be an effort to educate leadership. Rocky Boy: They have received their task order and did a legal review and an organizational restructure. They are planning for Tier 2 and 3 so that they can implement. Fort Peck: They have been on Tier 1 for a while. They are looking at how to manage their measures and outcomes. They want to move up the tiers. They hired some new staff and will be doing training on the Daphne program. Ken Smoker will be hosting a T-HIP training next week and will potentially do it in Billings so that health leaders can attend. MHCF will arrange a call with the Daphne Program and health leadership.
Appendix A: Agenda American Indian Health Leaders Meeting Agenda September 21-22, 2017 Billings, MT Radisson Hotel Billings Thursday, Sept 21 8:00 AM Breakfast 8:30 AM Introduction and Prayer Prayer Welcome and goals (Jessica Windy Boy and LeeAnn Bruised Head) Overview of the day (Aaron Wernham) 8:45 AM Health Leaders Updates Co-chairs updates Progress in priority areas Exciting news Challenges 10:15 AM Break 10:30 AM CMS Director of Quality Improvement and Innovation (Dennis Wagner) 11:30 AM T-HIP Workgroup Agenda and discussion topics for tomorrow s working session 12:15 PM Lunch 1:15 PM RMTLC/RMTEC Updates (Bill Snell and Mike Andreini) 1:45 PM MHCF Updates (Aaron Wernham and Tressie White) 2:15 PM Break 2:30 PM AIHL Non-profit Workgroup (Dr. Warne) NDSU update: findings from background research on model design Discussion of findings 4:00 PM Health Leader s Business Meeting AIHL discussion: deciding on preferred model, and planning next steps Possible ANTHC visit 5:30 PM Adjourn
Friday, Sep 22 8:00 AM Breakfast 8:30 AM T-HIP Workgroup Working discussion on progress and questions related to task orders, 638 agreements, selecting prevention programs, and outcome measurement. 10:15 Break 10:30 AM T-HIP Workgroup Wrap up discussion: any actions needed from each other, DPHHS, IHS, MHCF, or others? 11:00 AM DPHHS Updates (Sheila Hogan and Marie Matthews) 11:30 AM IHS Update (Dorothy Dupree) 12:00 PM Adjourn
Appendix B: Attendee List Health Directors and Staff: 1 Anna Whiting Sorrell CSKT Director Operations, Planning and Policy 2 Jessica Windy Boy Rocky Boy Tribal Health Director 3 Dennis Four Bear Fort Peck Tribal Health Director 4 Ed Bauer Fort Peck TEB 5 Terry Rattling Thunder Sr. Fort Peck Councilmember 6 Linda Azure Fort Peck T-HIP RN 7 Ken Smoker Fort Peck HPDP HPDP Director 8 L. Dale DeCoteau Fort Peck HPDP Mental Health Manager 9 Larry Burshia Fort Peck HPDP HPDP Board Chairman 10 Rosemary Cree Medicine Blackfeet Tribal Health Director 11 Craig Chandler Fort Belknap Director 12 Jennifer Show Fort Belknap Diabetes Coordinator 13 Lynn Cliff Jr. Fort Belknap Councilmember 14 Gerald Grey Little Shell Tribal Chairman 15 Kim McKeehan Little Shell Councilmember 16 Eugene LittleCoyote N. Cheyenne Health Administrator 17 Jace Killsback N. Cheyenne President 18 Joe Fox N. Cheyenne Tribal Council 19 Calion Jefferson Crow Health Ed. 20 Rosella Holds Crow MSPI Coordinator 21 Dale Good Gun NAIA Butte Executive Director 22 Arnie Salcido NAIA Butte Business Manager 23 LeeAnn Bruised Head MUIHC Missoula Executive Director 24 Todd Wilson HIA Helena Executive Director Guests: 25 Aaron Wernham MTHC CEO 26 Tressie White MTHC Senior Program Officer 27 Melinda Buchheit MTHC Communications Coordinator 28 Gretchen Dobervich NDSU Policy Manager 29 Cindy Stergar MPCA CEO 30 Olivia Riutta MPCA Outreach and Engagement 31 Sheila Hogan DPHHS Director 32 Laura Williamson DPHHS State Epidemiologist 33 Lesa Evers DPHHS Tribal Relations Manager Marie Matthews DPHHS Operations Services Branch Manager Michael LaValley Senator Tester Native American Liaison
34 Tina Jackson MT OPI 35 Stephanie Ironshooter MT OPI 36 Mike Andreini RMTLC RMTEC Director 37 William Snell RMTLC Director 38 Cheryl Ground CHR Admin Assistant 39 Terry Michell CHR Director 40 Johnathan Gilbert IHS CMD 41 Dorothy Dupree IHS Director 42 Katelin Conway MPQH Foundation QI Specialist 43 Barbara Pierson MPQH Foundation QI Specialist 44 Sara Medley MPQH Foundation QI Specialist 45 Dennis Wagoner CMS Director of Quality & Innovation