Native groups hold up health care systems as a model for visiting Health and Human Services secretary

Several Alaska Native health groups got the chance to show off their integrated health programs with facility tours and presentations to Health and Human Services Secretary Tom Price on Friday during a brief visit to Anchorage.

Price said his tour of Native health facilities in Anchorage was meant to help him understand how the federal government can learn from and support Native health programs.

Price, who was a Georgia congressman before he was appointed to the position by President Donald Trump, said he was hoping to expand upon what he learned about the Indian Health Service in briefings after being sworn into his position.

"And so what I said to my team – I need to get out there and see what's going on. And so this is part of that process to get there and see how they're doing the kind of things they're doing," Price said.

On Friday he visited primary care, maternity, child care and addiction treatment centers run by the Alaska Native Tribal Health Consortium, the Southcentral Foundation and the Cook Inlet Tribal Council.

Price's trip through Anchorage was brief but busy, a stop on his way to China, Vietnam and Japan.

Representatives from the groups who met with Price said afterward that they spent less time pressing Price for improvements and federal changes than they did attaching faces and stories to the work and financing provided by the federal government.

Tim Blum, head of communications for the Cook Inlet Tribal Council, said that HHS is a critical partner for his group, and it was important to the organization to demonstrate to Price how they've used federal resources. It was a "good visit for Alaska," he said.

They aimed to talk not about problems but "how we might move the system a little bit and make things more efficient and more impactful," he said.

Price lauded his tour guides' "remarkable testimony to their sense of responsibility, their sense of commitment to their people and providing the highest quality care."

From that, he said he took a sense of "the incredible importance of the self-governance that they have the ability to take the resources that they have — limited resources that they have — and turn it into the kinds of facilities that are again providing just remarkable care for so many of their people."

Price said that those with whom he spoke implored him to keep regulations to a minimum, so as not to inhibit creative care.

"They know best how to care for their people, and that we need to facilitate that," he said.

In particular, Price said that he heard about the importance of the Indian Health Service's budget and of "decreasing the hurdles that they had to jump over in order to expand services."

"Oftentimes … they are held to the same kind of standard that health facilities in the states are, even though they're not subject to the same laws or the same regulations," Price said.

The secretary said he doesn't yet have specific plans for changes in how the federal government interacts with Alaska Native health programs. The tours Friday were part of an opening effort to listen and learn, he said.

"They've done so much with really limited resources," he said.

Price said he was impressed with the methods of care run by Southcentral Foundation, which focuses on a one-campus method of care for a variety of ailments, be it mental or physical health.

The secretary said Southcentral Foundation's efforts are a model for the rest of the United States and the world in the group's holistic approach and its impacts.

"They've decreased emergency room visits by over 50 percent in a remarkable way — again, it's addressing the entire person," he said.

Dr. Steve Tierney, a physician and director of quality improvement at Southcentral Foundation, joined one of Price's tours and presentations during his visit, and said that much of his time was geared toward orienting Price to a focus on delivering "high quality, timely, cost-effective health care," and not on how to pay for it.

At Southcentral, the system is integrated to avoid the process of sending patients from one doctor to another. Instead, the doctors come to them, moving from patient to patient, throughout the complex, Tierney said. The system has been in place for 16 years, he said.

It cuts down on paperwork and time, and avoids costly delays, he said. That frees up doctors, making appointments easier to schedule and consequently cutting down on emergency room visits, Tierney said.

Asked about interest in Washington for reforming Medicaid and paring back health care spending, and how that might affect Native health funding, Price said that "the goal of the administration — the goal of the president and our goal at the department — is to make sure that every single individual has coverage in some manner or fashion, whether it's through Medicare, or through Medicaid, or through their employer, or through the individual or the small or group market, or through IHS or through the (Department of Veterans Affairs)."

In Washington, much of the argument is about how to cut the cost of health care.

"Our argument is if you cut the cost of service that we deliver by 50 percent, premiums become no big deal" because they don't need to be as high, Tierney said.

While both the Native organizations and Price painted a largely rosy vision of the visit and the state of Native health care, Price did acknowledge areas where the groups could use additional help, which he said lines up with his department's priorities: managing growing opioid addictions, mental illness and childhood obesity.

The unique challenge for Alaska Native populations, Price said, is the many villages that lack access by road. That causes problems for obtaining care, and dramatically increasing costs for people to get it.

"That transportation is a real challenge. And they need to continue to work on that," he said.

Andy Teuber, president of the Alaska Native Tribal Health Consortium, said that he and other Native leaders from across the state discussed those geographically driven high costs with Price during the visit.

He said the secretary was "empathetic" to their plight, and was open to considering new flexibility in HHS grants to make sure that tribal operation of grant money wasn't so onerous and took into account the state's diverse geography.

They also discussed eliminating duplicative reporting requirements between programs, and boosting the funding threshold for approval of IHS-funded construction projects — currently set at $1 million. Teuber said that amount is low and adds a bureaucratic process that slows work.