1. Ready for Reform! Port Gamble S’Klallam Tribe Communicating the What, Why, Who and How of HealthCare Reform June 4,2015 University of Washington, School of Nursing Ed Fox, Health Director Port Gamble S’Klallam Tribe Port Gamble S’Klallam Tribe Communicating the What, Why, Who and How of HealthCare Reform June 4,2015 University of Washington, School of Nursing Ed Fox, Health Director Port Gamble S’Klallam Tribe

2. What, Who What? Health Care Reform (Phase One: Medicaid Expansion and Marketplace Health Plans) Phase 2 is delivery and payment reform Who? Tribal Community, Tribal Council, The Health Services Department (and other departments)

3. How, Why, How? Come to the Health Clinic to see which coverage option is best for you, your family, and the Tribe Why? If we all work together (We are One Tribe) we can increase revenues and increase services to build a comprehensive health care program so no one feels they do not have access to health care services.

4. S’Klallam Newsletter Articles First message in 2012…..On October 1, 2013 the state Health Care Health Insurance Exchange will be open for enrollment. If you are uninsured you will go to a website (often with one of our staff assisting) and we will determine your eligibility and enroll you in any of the publically-funded health insurance programs that exist If you are not eligible for public insurance we will explore private options or cover your health care needs through the regular health program of the tribe. Health Exchange-offered plans. One application will determine which program fits your income and family situation best. That’s it except for the details. Nearly every month (24 times) in the next two years, We plan to update you on the implementation of health care reform for the Tribe.

5. October 2012 S’Klallam View

6. January 2012

7. February 2012, S’Klallam View

10. Summer 2013

11. January, 2014

12. February, 2015

13. 6 Elements of Port Gamble S’Klallam Tribe’s readiness Staffing: Support current monitor need for additional Outreach and Education on Health Care reform tied to our Eligibility and Enrollment capacity Make the Accounting system produce needed information for decision making-which option--- buy insurance or buy ‘risk’ Continue to pay for health insurance develop premium sponsorship to guarantee full range of insurance coverage options. Electronic Health Record system development Work with other Tribes through other organizations.

14. May, 2015

15. Community Health Assessment Case Management: Hire 2 RN Case Managers, 1 Social Services Manager, 1 additional Community Health Representative Patient Portal Referral improvements IT improvements for Population and Chronic Disease Management Fitness Extended hours

16. State Health Care Reform Healthier Washington and Global Waiver for Medicaid Transformation Some is easy for us; hard for everyone else Integration of Behavioral Health with Medical Care – easy for us and we already do this What is hard for us is seeing how we can ‘fit’ into the world of Managed Care for all patients Oregon example-90% of Medicaid Patients are in managed care Tribes are excluded and now struggle to find specialists.