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
Session Objectives….
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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
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!

GPRA requires a
Data-Supported Audit Trail
from
$$$$$
Appropriated
$$$$
Agency’s
Mission
PFSAs
Programs, Function,
Services, Activities
Customer Benefits
& Outcomes
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
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
Alignment with IHS Director’s Priorities:
Priority 1:
Priority 2:
Priority 3:
Priority 4:
To Renew and Strengthen IHS
Partnership with Tribes
In the Context of National Health
Insurance Reform, to Bring Reform to
IHS
To Improve the Quality of and Access
to Care
To Make All of our Work Accountable,
Transparent, Fair, and Inclusive
Alignment with Tribal Core Operating Principles
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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
Data Analysis and Optimal Decisions Making
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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.
Value of Clinical Measures Reporting for THOs


Optimizes Patient care and safety!
Addresses Regulatory requirements for accreditation

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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
Improving Data to Improve PUBLIC HEALTH
Produce reports
•
Provide analysis
•
Prioritize AI/AN
•
Weight Distribution of
Tribal Children (2-18 yrs), 2007
community health
Normal Weight
46%
improvement
actions.
Overweight
19%
Underweight
2%
Obese
33%
BMI Categories
Underweight: <5%ile
Normal Weight: 5-85%ile
Overweight: 85-95%ile
Obese: >95%ile
Data Sources: Tribal electronic patient management system.
Notes: Includes data on only children that had appropriate measurements taken to calculate a Body Mass Index (BMI).
Tribal GPRA Best Practices

Improving Local Processes
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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
Best Practice: Measure of the Month
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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)
Best Practice: Learning Vignettes
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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
GPRA Data Allows for Complex
Analyses – Pop. Health Reporting
All Ages Age-Adjusted Diabetes Prevalence
Tribe X
Calendar Years 2006 - 2010
40
35.6
34.8
34.4
34.0
32.8
30
%
22.6
22.5
22.3
22.0
21.3
20
16.1
16.0
15.8
10.9
10.8
10.4
16.1
10.9
10
5.8
5.6
5.8
0
2006
2007
Tribe
StateX All Races
2008
Nashville Area
US All Races
2009
IHS Wide
2010
GPRA Data Allows for Complex
Analyses – Pop. Health Reporting
>= 65 Years Old Seasonal Influenza Vaccination Coverage
Tribe User Population vs. NA User Pop. vs. IHS Wide vs. State All Races vs. US All Races
Flu Season 2007-2011
80
73.6
71.8
69.6
70
62.0
59.0
49.4
47.0
45.0
% 40
66.6
63.4
62.0
59.0
60
50
68.5
65.3
48.0
50.0
48.4 49.0
44.6
43.0
37.6
30
20
10
0
2007
Tribe
2008
Nashville Area (NA)
2009
IHS Wide
2010
*State All Races
2011
*US All Races
Data Sources: For Tribe/NA/IHS, rates calculated from Tribal health data system (e.g. RPMSs) data. For IHS Wide, used IHS FY Performance rates reported in the
CRS ver. 12 logic manual. For US used CDC vaccination estimates. Notes: Tribal/NA/IHS rates based on clinical documentation data. State/US rates based on selfreports from persons >=18 years about themselves and/or others in their household >= 65 years old. *US/State data for some years was unavailable. Citation:
Tribal Epidemiology Center, United South and Eastern Tribes, Inc., 2012 Community Health Profile. Nashville, TN: United South and Eastern Tribes, Inc. (2012).
GPRA Data Allows for Complex
Analyses – Pop. Health Reporting
Age 19-35 months 4:3:1:3:3:1:4 Vaccination Combo Coverage
Tribe User Population vs. NA User Pop. vs. IHS Wide vs. State All Races vs. US All Races
2007-2011
90
78
80
67.3 66.5
79.0
75.9
75.0
72.2 73.0
71.1 72.0
70
79.0
78.0
67.2 68.4
70.0
68.4
71.9 71.5
70.0
63.6
60
56.3
47.3
50
%
44.3
40
30
20
10
0
2007
Tribe
2008
Nashville Area (NA)
2009
IHS Wide
2010
*State All Races
2011
*US All Races
Data Sources: For Tribe /NA/IHS rates, rates calculated from Tribal health data systems (e.g. RPMSs) data. For IHS Wide, used IHS FY Performance rates reported in the CRS ver.
12 logic manual. For US used CDC vaccination estimates. Notes: 4:3:1:3:3:1:4 Combo = 4 Diphtheria-Tenus-Pertusis, 3 Polio, 1 Mumps-Measles-Rubella, 3 Haemophilus
influenzae type b (HiB), 3 Hepatitis B, 1 Varicella, and 4 Pneumococcal vaccination series. Tribal/NA/IHS rates based on clinical documentation data. US /State rates based
on self-reports from persons >=18 years about children in their household . In 2009 and 2010 there were HiB vaccine supply and recommendation issue s that may have caused
19
Leveraging Technology
HITECH - Regional Extension Center (NIHB-REC)
The Evolution of Patient Focused Quality
Improvement Across the Tribal Health System
GPRA
Pilot
Projects
Best
Practices
Budget
Formulation
Improving
Patient Care
Program
Innovations
in
Technology
Achieve Vision to Improve the Health Status of All American
Indians/Alaska Natives!
Specialized
Training and
Support at
the Local
Level
VISION:
HEALTHIER COMMUNITIES!
The Strength of IHS/Tribal Partnerships & Networks
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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
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
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.org