1. TRIBALLY-OPERATED HEALTH PROGRAM BUSINESS AND ADMINISTRATIVE OPERATIONS IMPROVING QUALITY OF CARE & TRIBAL PERFORMANCE IN HEALTH OUTCOMES Carolyn Crowder, Alaska GPRA Tribal Pilot Project Team Byron Jasper, United South & Eastern Tribes Tribal Health Program Support IHS Tribal Self Governance Financial Training ~ Tucson, Arizona March 28, 2012

2. Session Objectives…. Learn How the Government Performance and Results Act Relates to Tribally-operated Health Programs How to Use GPRA reports for Data Analysis and Decisions Making Discuss the Value of Networking and Partnering between the IHS and Tribes

3. GPRA is a Federal Law  Government Performance and Results Act of 1993  A Federal law  Requires Federal agencies to demonstrate effective use of funds towards agency mission  Measures negotiated with White House Office of Management and Budget (OMB)  Indian Health Service  Clinical measures  Non-Clinical measures (facilities, scholarships, etc.)  Revised measures requirements coming soon!

4. GPRA requires a Data-Supported Audit Trail from $$$$$ Agency’s Mission Customer Benefits & Outcomes PFSAs Programs, Function, Services, Activities Appropriated $$$$

5. GPRA Reporting  Federal Sites  Urban Sites Contract entities and not sovereign, so IHS requires reporting for GPRA  Sovereign Tribal Sites 130 Tribal sites currently report GPRA GPRA Tribal Pilot Sites  Chippewa-Cree Tribe of Rocky Boy's Reservation  Kaw Nation  Mississippi Band of Choctaw  USET  ANTHC

6. Alignment with President Obama’s Agenda “The question we ask today is not whether our government is too big or too small, but whether it works...where the answer is yes, we intend to move forward. Where the answer is no, programs will end. And those of us who manage the public's dollars will be held to account, to spend wisely, reform bad habits, and do our business in the light of day, because only then can we restore the vital trust between a people and their government.” Inaugural Address January 20, 2009 www.expectmore.gov

7. Priority 1:To Renew and Strengthen IHS Partnership with Tribes Priority 2: In the Context of National Health Insurance Reform, to Bring Reform to IHS Priority 3: To Improve the Quality of and Access to Care Priority 4: To Make All of our Work Accountable, Transparent, Fair, and Inclusive Alignment with IHS Director’s Priorities:

8. Alignment with Tribal Core Operating Principles  Focus on Continuous Efforts to Improve Health Status of American Indians/Alaska Natives  Tribes will be an integral & valued player with ownership in process & product  Input into GPRA measures  Friendly competition for successful results  Reporting & System of Reporting will be valued as a vital part of day to day operations & incorporated into organizational performance dashboards and Key staff performance evaluations  Strong collaboration & true partnership with the IHS & other Tribes for maximum national budget impact  Successes will be rewarded – locally & nationally  Support systems will be in place to achieve success

9. Data Analysis and Optimal Decisions Making  Networking Meetings of Tribal GPRA Teams + teleconferences  Include Results in Area Budget Formulation & THO Strategic Plans  Annual Area comparative report to Governance of GPRA results  Monthly GPRA progress reports to key Tribal staff - as identified by the Tribal health organization.  Develop Incentives & Recognition Awards  Demonstrate Ways to Use Data to make clinical and business decisions through sharing of best practices  Integrate measures into THO performance improvement targets  Market the benefits of sharing performance reports with patients to promote personal wellness.

10. Value of Clinical Measures Reporting for THOs  Optimizes Patient care and safety!  Addresses Regulatory requirements for accreditation  ORYX, IHPES-Indian Health Performance Evaluation System  Maximizes Capture of Third party Billing Revenues  Supports Compliance with Office of Inspector General regulations  Addresses Office of Management & Budget Requirements & contributes to IHS GPRA performance  Addresses Tribal Governance Requirements to Measure Quality & Performance Outcomes for leadership, providers & patients

11. Improving Data to Improve PUBLIC HEALTH Produce reports Provide analysis Prioritize AI/AN community health improvement actions.

12. Tribal GPRA Best Practices  Improving Local Processes A tool (CRS & iCare) is not a solution, it must be integrated with a process (such as the IPC) Using CRS & iCare to forecast patients needs CQI practices at the local level...using quarterly reports to monitor  Evidence-Based Outcomes There is strong evidence from our Tribal GPRA reports that adherence with national performance measures has improved quality of care to AI/AN and has helped decrease the disease burden in Indian Country. Patient Forecasting Measure of the Month Clinical Reminders Best Practice Vignettes

13. Best Practice: Measure of the Month  Calendar set by GPRA participating sites  Measures are those which are difficult to meet or which are of particular interest to sites (these are not always national measures)  Often tie to national health month celebrations (ex: Alcohol Awareness Month)

14. Best Practice: Learning Vignettes  Creating digital stories to share best practices across Alaska  Typically short – about 3-5 minutes – with some offered as a series  Also working on video vignettes for GPRA 101 and other staff training options  Developed videos include Clinical EHR Reminders, Using Run Charts for IPC, Using iCare, How to Run Selected Performance Measures in RPMS, Running GPRA Reports in CRS, and Assigning Primary Care Providers

16. GPRA Data Allows for Complex Analyses – Pop. Health Reporting

19. Leveraging Technology HITECH - Regional Extension Center (NIHB-REC) 19

20. GPRA Pilot Projects The Evolution of Patient Focused Quality Improvement Across the Tribal Health System Best Practices Budget Formulation Improving Patient Care Program Innovations in Technology Specialized Training and Support at the Local Level Achieve Vision to Improve the Health Status of All American Indians/Alaska Natives!

21. VISION : HEALTHIER COMMUNITIES!

22. The Strength of IHS/Tribal Partnerships & Networks  Expand Tribal Participation  High Visibility of Performance Outcomes & Friendly Competition  Population Health - Improving Local Decision Making Regarding Health Disparities  Solidify access to GPRA reporting tools: CRS/RPMS/NDW/REC  Continue collaboration on Tribal Best Practices Conference – July 22-26, 2012  Develop a National Federal/Tribal Network to advance Health performance measures, analysis & outcomes

23. President Obama’s Message “Native Americans have demonstrated time and again their commitment to advancing our common goals, and we honor their resolve in the face of years of marginalization and broken promises. My Administration recognizes the painful chapters in our shared history, and we are fully committed to moving forward with American Indians and Alaska Natives to build a better future together.” President Obama Proclamation on Native American Heritage Month November 1, 2011

24. Questions? Carolyn Crowder Health Director Aleutian Pribilof Islands Association (907) 222-4207 carolync@apiai.org Byron Jasper, D.D.S Deputy Director-Public Health Tribal Health Program Support United South & Eastern Tribes, Inc. email: byron.jasper@ihs.gov and/or bjasper@usetinc.orgbyron.jasper@ihs.gov bjasper@usetinc.org