Answer: The decision point is that any "savings" must exceed the cost of relocation over 8. What to do with RIW Recommendations? Now that the RIW final report is completed, what is your next step in meeting the One-HHS goal? Do you plan to have tribal consultations on any new plans that are developed as a result of the final report? Answer: The IHS conducted two consultations on the work of the RIW. In June 2002, the preliminary report of the RIW was provided to Tribal Leaders for review and comment. All comments received were incorporated into the work of the RIW. In September 2002, Dr. Charles Grim, Interim Director, IHS, sent the final report of the RIW to Tribal Leaders for review and comment. In anticipation that the RIW's final report would not include recommendations specific to 9. What to do with savings? The RIW's final report urges that cost "savings" from IHS restructuring be reinvested into additional health care services to Natives. Q: Have you considered this recommendation or have you developed a plan to redistribute these savings throughout the I/T/U system? Answer: Cost "savings" resulting from IHS restructuring will be used to enhance Indian health care programs. 10. The One-HHS initiative proposes the consolidation of IHS human resources functions to the full department level. Q: Based on your study of the area-wide IHS human resources departments, would it be feasible to realign HR functions within IHS? Answer: The Tribal RIW proposed realigning HR functions within IHS. Although it would be feasible to realign the HR function with IHS, we believe that an internal realignment would not provide the same benefits as being fully engaged in the HHS-wide HR consolidation. Q: Do you think that is would be less expensive to make operational improvements than to physically transfer or eliminate IHS HR functions or positions? Answer: IHS could make internal operational improvements in HR that would be less expensive in the short term. However, we believe that the benefits of being part of the HHS-wide HR consolidation are greater than the cost to IHS. For example, HHS-wide HR consolidation with common business practices across the Department will provide greater flexibility to allocate HR resources to meet critical needs. Consolidation will also allow HHS to deploy automated systems for HR that are beyond the reach of the individual components. For IHS this will mean having automated systems for hiring staff, classifying jobs, and maintaining personnel files. IHS's share of these costs will be more than offset by increases in productivity and improved servicing ratio, freeing up resources to be devoted to IHS mission jobs. 11. Information Technology Consolidation. Q: What are some of the benefits that might be realized with the Information Technology consolidation? Answer: The Information Technology (IT) consolidation is two-fold. First, the IHS is considered one of the five "large OPDIVs" and consolidation will occur internally. The IHS has a modest IT program and is already predominantly centralized. All national IHS IT programs are supported and administered out of its Information Technology Support Center in Albuquerque, New Mexico. However, there are some independent activities occurring at the Area Office level that need to be reviewed for the feasibility of either centralization or regionalization. This would result in savings while not affecting local management or the delivery of patient care. Second, the IHS, as an OPDIV in the DHHS, can realize benefits by the ability to move data and information to and from the Department electronically over more compatible systems. This reduces errors resulting from re-keying data and information from one system to another. The consolidation in this instance is actually standardization (to the extent practicable). Another emerging and critical benefit is information and data security. The IHS can benefit enormously (economies of scale) from the protection from a larger system. 12. Alaskan Health Consolidation. For years now health care in Alaska has been delivered under ONE compact and it seems to me that the Alaska Native health group is a step ahead of the One-HHS initiative because, in a sense, they have already consolidated into nearly one unified health system. Q: Have you looked at how this consolidation was carried out in Alaska to see if there might be lessons learned for other IHS regions? Answer: Background. The concept of one compact and several funding agreements is an innovative method for providing health care in Alaska. The operation of the Alaska Native Medical Center, located in Anchorage, is the responsibility of the Alaska Native Tribal Health Consortium, representing all tribes in Alaska, and is under the direction of a tribally directed joint operating board. The individual funding agreements have accommodated the remoteness and isolation of the Alaska tribal governments by providing a mechanism to tailor funding agreements to meet the unique needs of each individual tribal entity. This further supports the government to government relationship that each Tribe has with the United States. The Alaska compact began with thirteen original funding agreements that included ten regional health entities and three tribes/villages. The funding agreements in Alaska have now grown to a total of twenty-one, all under one compact. The Alaska Tribes initially provided health services through their compact under the authority of the SelfGovernance Demonstration Project. Subsequently, the Alaska compactors, in concert with many other Tribes in the lower 48 states, helped to frame the language for P.L. 106260, the Tribal Self Governance Amendments of 2000 which made Self-Governance a permanent Tribal compacting option within the Indian Health Service. Alaska as a Model Compact. Alaska has been looked at by many Tribal Governments in the lower 48 states as a mechanism for the provision of health care. The All Indian Pueblo Council in Albuquerque, New Mexico and the Northeastern Tribal Health System (NTHS) in Miami, Oklahoma are examples of groups of Tribes that have looked at the Alaska compact as a model. While the All Indian Pueblo Council has, to date, elected not to compact; the Northeastern Tribal Health System, a consortia of ten (10) Oklahoma Tribal Governments, became a Self-Governance Compactor in 2002. Under the NTHS, three of the Tribes maintain individual funding agreements as well as participating in the NTHS compact while the remaining six (6) tribes have elected to receive their health services through the NTHS Compact exclusively. The three Tribes that maintain individual funding agreements are not located in close proximity of the NTHS but do have tribal interests, as well as tribal members, residing there. Therefore these three Tribes provide direct services for those tribal members living closest to the tribal headquarters through individual funding agreements as well as providing services for tribal members living in their northeastern Oklahoma districts through the NTHS compact. The IHS accommodates the Tribes by distributing the amounts designated by each tribe to their individual funding agreements and to the NTHS through the NTHS funding agreement. The Office of Tribal Self-Governance at IHS continues to receive inquiries about Alaska. Most recently a group of eight California Tribes have indicated their interest in compacting and using Alaska as a model. In summary. The provision of health services in Alaska has proven to be a model for the consolidation of the delivery of health care by Tribal Governments in the lower 48 states. It continues to serve as an example of how tribal governments might consider consolidation of limited resources to provide health services to their tribal members. Key to the consortium concept is that each tribal government must individually meet the requirements to enter Self-Governance as stated by P.L. 106-260 Testimony of Don Kashevaroff Tribal Self-Governance Advisory Committee Representative President and Chairman, Alaska Native Tribal Health Consortium Senate Select Committee on Indian Affairs April 2, 2003 Regarding Reauthorization of the Indian Health Care Improvement Act The Effects of HHS Consolidation On Narrowing the AV/AN Health Disparities Gap INTRODUCTION Mr. Chairman and members of the Committee, thank you for the opportunity to testify regarding the reauthorization of the Indian Health Care Improvement Act (IHCIA). I appear here today on behalf of the Tribes participating in the Self-Governance program. At the invitation of the Committee, I will also briefly touch upon the impact that Department of Health & Human Services (HHS) consolidation will have on the Indian Health Service and on tribes operating health programs trying to narrow the American Indian/Alaska Native health disparities gap. The Tribal Self-Governance Advisory Committee (TSGAC) is a committee of tribal leaders convened by the Indian Health Service to address the health care needs of all eligible American Indian/Alaska Natives (AI/AN), especially those served by tribal health programs operated through Self-Governance compacts authorized by Public Law 93-638, as amended. Self-Governance compacts: ?? Have been entered into by or on behalf of 279 Tribes; ?? Constitute 27.3% of the IHS budget; and ?? Serve 33% of the IHS user population. My experience proves the versatility of Self-Governance. My own tribe, Seldovia Village Tribe, is relatively small-only 414 members. Since taking over the tiny contract health services program in 1991, we have been able to expand our services to the point that we were able to open a small direct service clinic through which we have expanded culturally appropriate services provided as efficiently and economically as one can for a small population. I contrast this with my experience as President and Chairman of the Board of the Alaska Native Tribal Health Consortium, which is the largest Self-Governance program in America ANTHC manages over $125 million annually in IHS program and project funds. With another tribal organization we operate the only Level II Trauma Center in Alaska, the Alaska Native Medical Center, the premier tertiary care hospital in the Indian Health system. We also manage all of the statewide functions previously performed by the IHS Alaska Area Office, including construction of sanitation facilities throughout rural Alaska, operation of one of the three statewide Community Health Aide Training Programs, public health research, and a statewide telemedicine program to name just a few. Since the formation of the Alaska Tribal Health Compact of which Seldovia Village Tribe and ANTHC are both signatories, the Alaska Area Office of the Indian Health Service has downsized from 350 to 40. While the remaining functions of the IHS Area Office are critical to our success, the transition we have experienced in Alaska, represented by these two extreme examples, proves the importance of the Self-Governance and of the Indian Health Care Improvement Act. Thus we take very seriously both the reauthorization of the Indian Health Care Improvement Act, and also HHS consolidation, because both have a direct and significant impact on our operations. S. 556, INDIAN HEALTH CARE IMPROVEMENT ACT REAUTHORIZATION It has been over 25 years since the original enactment of the Indian Health Care Improvement Act. This latest effort at reauthorization, in which this Committee has taken a leadership role, truly proves how much has been accomplished. In 1999, tribes from around the country sent representatives to participate with the Indian Health Service and national Indian organizations, including representatives of the Urban Indian programs, in the National Steering Committee. Building on the strong base of existing law, these tribal leaders, supported by their staff and consultants, undertook to draft our own reauthorization bill one that would reflect the changes wrought by selfdetermination and self-governance and the changes that have come about in health care delivery. This product of an extraordinary effort in national consensus building was the base for S. 556, the bill you have before you. In the four intervening years, work has continued. We have had time to reflect on the 1999 National Steering Committee draft. We have had time to consider issues raised by this body and concerns expressed by the Administration. The National Steering Committee has met many times since 1999, and while we have not had perfect unanimity, we have maintained nearly complete consensus about how best to address these points of view and remain true to the principles that underlie the tribal draft of the reauthorization. We have had the good fortune to have the opportunity to work closely with staff of both houses, with the support of the House Office of Legislative Counsel, to try to improve upon our initial efforts to produce the best legislation possible. We expect to have a clean draft bill reflecting our latest work available in early April and hope this Committee will consider substituting it for the pending bill. In |