RAPID CITY, SD - Today, the National Indian Health Board (NIHB) and Great Plains Tribal Chairmen's Health Board (GPTCHB) met in a historic joint meeting to discuss Health Systems Improvement for American Indians and Alaska Natives (AI/ANs). The meeting was called after a series of reports by the Centers for Medicare and Medicaid Services (CMS) found that certain facilities in the Great Plains Area of the Indian Health Service (IHS) are providing substandard care and failing to live up to the federal trust responsibility for health. Specific topics covered included how to increase the number of Native physicians in the workforce, ways to restructure the IHS in the Great Plains Area, increasing funding to the IHS, moving from direct service models to self-governance models of healthcare and ways to leverage existing relationships and federal Tribal advisory committees like the Secretary's Tribal Advisory Committee to get additional federal resources to Tribes.

During the meeting, participants heard presentations from the Association of American Indian Physicians (AAIP); the Veterans Administration; and Tribal self-governance experts.  In the morning, Gerald Hill, MD (Klamath/Paiute) immediate past President of AAIP, stressed the need to improve health systems by encouraging more AI/AN young people to attend medical school. He cited statistics from IHS that there is a 34% vacancy rate for physicians and 26% vacancy rate for dentists at IHS. This situation "makes it nearly impossible to run a quality health program anywhere," he said.  Dr. Hill adamantly stated that instead of continuing the same failed recruitment policies they have been employing for the last 30 years, IHS should more aggressively recruit young people in Indian Country. This means providing more scholarships for Native youth and building up direct support from Tribal governments for their young people to go into medicine. "No one will take better care of our own people, than our own people," said Brian Thompson, MD (Oneida) a member of the AAIP board of directors. Dr. Thompson also shared the alarming statistic that only 20 American Indian and Alaska Natives graduated from medical school in 2015. That number was down from already alarmingly low numbers of 26 and 25 American Indian and Alaska Native medical school graduates in 2013 and 2014, respectively. 

Don Warne, MD (Oglala Lakota), Chair of the Department of Public Health at North Dakota State University presented a model for the regionally restructuring of the entire Great Plains Area based on the framework utilized by the Alaska Native Tribal Health Consortium. He noted from his time working at IHS that the system failed to encourage creativity or innovation, making it more complicated to deliver quality care under the unique circumstances in Tribal communities. The alternative framework he presented empowers Tribes to overcome these challenges.

	NIHB Great Plains Area Representative Patrick Marcellais discusses health priorities at the joint meeting.

Michael Davies, MD, Director of Systems Redesign at the Veterans Health Administration (VHA) detailed the ways that VHA has reformed its culture and infrastructure since recent crises at the agency demanded dramatic improvement in quality care and patient satisfaction. NIHB Great Plains Area Representative, Patrick Marcellais encouraged the VHA to talk to IHS and collaborate on ways to improve patient health outcomes and leverage federal resources.

The board members also heard from Larry Factor, the Seminole Self Governance Administrator at the Seminole Nation of Oklahoma, who described difficulties getting information from the IHS as the Seminole Tribe explored self-governance. "If we're truly going to be treated as government-to-government we should be equals and be at the table," he said.

Jerilyn Church, Chief Executive Officer of the Great Plains Tribal Chairmen's Health Board, said, "We need to support both Self Governance Tribes and Direct Service Tribes. We need to hold IHS accountable to provide us with the correct information to make good decisions."

"NIHB has been standing with the GPTCHB and Tribes in the Area for more than a year to get a handle on this health care crisis. Today was another important step in affirming our unity and resolve to realize improved health care quality for our people," said NIHB Executive Director Stacy A. Bohlen. "Whether a Tribe exercises their sovereignty through self-governance compacts or contracts or they receive healthcare directly from IHS, NIHB will be here to support them and to fight for the necessary resources for American Indians to realize the quality health care that is their right."