Indian Health Service Strategic Plan Fiscal Year 2019-2023
| Published date | 28 February 2019 |
| Citation | 84 FR 6796 |
| Record Number | 2019-03486 |
| Section | Notices |
| Court | Indian Health Service |
Federal Register, Volume 84 Issue 40 (Thursday, February 28, 2019)
[Federal Register Volume 84, Number 40 (Thursday, February 28, 2019)]
[Notices]
[Pages 6796-6807]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-03486]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
Indian Health Service Strategic Plan Fiscal Year 2019-2023
AGENCY: Indian Health Service, IHS.
ACTION: Notice.
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SUMMARY: In follow-up to the Indian Health Service (IHS) request for
comments on the Draft IHS Strategic Plan Fiscal Year (FY) 2018-2022
issued in the Federal Register (FR) on July 24, 2018, (see 83 FR 35012;
July 24, 2018; hereafter ``July 2018 FR document''), the IHS is
announcing the final plan entitled: IHS Strategic Plan FY 2019-2023.
The IHS is also making available on the IHS Strategic Plan website, a
response to comments document that addresses comments received on the
Draft IHS Strategic Plan from the July 2018 FR document.
FOR FURTHER INFORMATION CONTACT: RADM Francis Frazier, Director, Office
of Public Health Support, IHS, 5600 Fishers Lane, Mail Stop: 09E10D,
Rockville, Maryland 20857. Telephone number: 301-443-0222 (This is not
a toll-free number), email address: IHSStrategicPlan@ihs.gov. In
addition, progress on the IHS Strategic Plan will be periodically
updated on the IHS website at: https://www.ihs.gov/strategicplan/.
SUPPLEMENTARY INFORMATION:
General Information
The IHS, an agency within the U.S. Department of Health and Human
Services (HHS), is responsible for providing federal health services to
American Indians and Alaska Natives. The provision of health services
to members of federally-recognized Tribes grew out of the special
government-to-government relationship between the federal government
and Indian Tribes. Established in 1787, this relationship is based on
Article I, Section 8 of the U.S. Constitution and has been given form
and substance by numerous treaties, laws, Supreme Court decisions, and
Executive Orders. The IHS is the principal federal health care provider
and health care advocate for Indian people. The IHS provides a
comprehensive health service delivery system for American Indians and
Alaska Natives.
The IHS Strategic Plan, covering FY 2019-2023, includes a mission
statement, a vision statement, and details on how the IHS will achieve
its mission through three strategic goals: (1) To ensure that
comprehensive, culturally appropriate personal and public health
services are available and accessible to American Indian and Alaska
Native people; (2) To promote excellence and quality through innovation
of the Indian health system into an optimally performing organization;
and (3) To strengthen IHS program management and operations. These
strategic goals are supported by objectives that reflect the outcomes
the IHS is working to achieve and strategies describe how the IHS plans
to make progress toward the objectives.
Background
The IHS Strategic Plan reflects the feedback received from Tribes,
Tribal organizations, urban Indian organizations, staff, and other
stakeholders. The IHS used a process
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similar to the HHS Strategic Plan FY 2018-2022 and gathered feedback
from key partners including staff, Tribes, and urban Indian
organizations. Informed by a variety of source documents, the IHS first
developed a draft initial framework and initiated Tribal consultation
and urban Indian confer on the draft initial framework from September
15, 2017, through October 31, 2017. During the initial framework
comment period, the IHS held listening sessions, presented at Tribal
meetings, and held conference calls with Tribal and urban Indian
organization leaders. Comments were also accepted after October 31,
2017, on an ongoing basis.
An IHS Federal-Tribal Strategic Planning Workgroup (workgroup)
reviewed the draft initial framework comments received from 150 Tribes,
Tribal organizations, urban Indian organizations, and IHS staff. The
workgroup suggested strategies during six meetings from November 2017
through February 2018 and made recommendations for the Draft IHS
Strategic Plan FY 2018-2022, published in the FR on July 24, 2018.
Workgroup membership included Tribal leaders or their designees, a
representative from the IHS Office of Urban Indian Health Programs, and
IHS staff from areas, service unit, and headquarters.
On July 24, 2018, the Draft IHS Strategic Plan was published in the
FR for a 30-day public review and comment period. The IHS provided
formal letters regarding the Draft IHS Strategic Plan release to Tribal
and urban Indian organization leaders and notification of two virtual
town hall sessions, one for urban confer and one for Tribal
consultation on August 3 and August 6, 2018, respectively. The IHS
received 123 comments, including questions, comments, and
recommendations on the specific elements of the plan and other comments
related to the terminology used in the IHS Strategic Plan,
implementation of strategies, measures, and the IHS strategic planning
process. The IHS reviewed all comments and carefully considered changes
before publishing the IHS Strategic Plan FY 2019-2023.
The IHS Strategic Plan FY 2019-2023 includes minor language updates
to the Vision, Goal 1, Objectives 2.2 and 3.1, and several strategies
to clarify intent and adds urban Indian organizations, where
appropriate. The IHS Strategic Plan timeframe is updated from FY 2018-
2022 to FY 2019-2023 since the plan is being released during FY 2019.
Significant changes to the IHS Strategic Plan include the following
additional sections: an introduction, strategic plan development,
performance, and appendices. These additional sections are in response
to the comments received. Several commenters recommended addressing the
unique government-to-government relationship with Tribal governments
and the provision of health services based on this relationship,
clarification about non-IHS participation in the development of the IHS
Strategic Plan, recommendations to include measures and track progress,
and to include more information about the alignment with the HHS
Strategic Plan FY 2018-2022.
The text of the final IHS Strategic Plan FY 2019-2023 is available
below and on the IHS Strategic Plan website at: https://www.ihs.gov/strategicplan/.
Indian Health Service (IHS)
IHS Strategic Plan Fiscal Year (FY) 2019-2023
INTRODUCTION
Overview
The Indian Health Service (IHS), an agency within the United States
(U.S.) Department of Health and Human Services (HHS) is responsible for
providing federal health services to American Indian and Alaska Native
(AI/AN) people. The IHS is the principal federal health care provider
and health advocate for Indian people.
Organizational Structure
The IHS organizational structure includes the Rockville, Maryland
headquarters office and 12 administrative area offices located
throughout the United States. The 12 IHS areas encompass a network of
hospitals, clinics, and health stations.
Serving approximately 2.3 million American Indians and Alaska
Natives from 573 federally recognized Tribes in 37 states, the IHS
provides a wide range of clinical and public health services, along
with community and facilities infrastructure services. Comprehensive
primary health care and disease prevention services are provided
through a network of hospitals, clinics, and health stations on or near
Indian reservations. These facilities, which are managed by the IHS,
Tribes, and Tribal organizations, are predominately located in rural
and primary care settings. In addition, the IHS contracts with urban
Indian organizations (UIOs) for health care services provided in some
urban centers. The Indian health care system strives to provide
comprehensive care through a network of IHS, Tribal, and urban health
facilities and by purchasing health care services from non-IHS
providers through the Purchased/Referred Care (PRC) program.
In 2017, the Indian health care system had more than 39,367
hospital admissions and almost 13.8 million outpatient medical care
visits. The Indian health care system also provides dental services,
nutrition services, pharmacy services, community health, sanitation
facilities (water supply and waste disposal), injury prevention, and
institutional environmental services.
A unique government-to-government relationship exists between
Indian Tribes and the U.S. Government. Consistent with the government-
to-government relationship and its statutory authorities, the IHS is
committed to ensuring that comprehensive, culturally appropriate
personal and public health services are available and accessible to AI/
AN people. Over 60 percent of the IHS appropriation is administered by
Tribes,\1\ primarily through Self-Determination contracts or Self-
Governance compacts. The IHS retains the remaining funds and delivers
health services directly to the Tribes that choose to have IHS
administer the programs. The IHS works closely with Tribal governments
as they assume a greater role in improving health care in their own
communities.
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\1\ IHS Profile: https://www.ihs.gov/newsroom/factsheets/ihsprofile/.
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Tribal Consultation and Urban Indian Confer
IHS implements Tribal consultation \2\ and urban Indian confer \3\
policies to facilitate the involvement of Tribes and UIOs.
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\2\ 25 U.S.C Sec. 1602 (5); 25 U.S.C 5301; 25 U.S.C Sec. 5381.
\3\ 25 U.S.C Sec. 1660d(b); 25 U.S.C Sec. 1602 (5); 25 U.S.C
Sec. 1631 (f); 25 U.S.C Sec. 1665k(a)(2)(A)(vii).
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The IHS Tribal consultation policy states that consultation occurs
to the extent practicable and permitted by law before any action is
taken that will significantly affect Indian Tribes. The IHS is
committed to regular and meaningful consultation and collaboration with
Tribes. It is IHS policy to confer with UIOs, to the maximum extent
practicable, whenever a critical event or issue arises, as defined in
the policy, in implementing or carrying out the Indian Health Care
Improvement Act (IHCIA). This policy is used to ensure that the health
needs of the urban Indian population are considered at the local, area,
and national levels when implementing and carrying out the IHCIA.
IHS Partnerships
The IHS has established partnerships to address AI/AN issues and
strengthen services. Partnerships include local
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communities, not-for-profit organizations, universities and schools,
foundations, businesses, and federal agencies such as the Department of
the Interior (including the Bureau of Indian Affairs and the Bureau of
Indian Education), Department of Justice, Department of Housing and
Urban Development, and the Department of Veterans Affairs. These IHS
partnerships impact AI/AN communities in critical areas, such as
housing, education, public safety, and health care for Veterans. It is
essential to continue to build upon these partnerships.
Strategic Plan Development
To develop the IHS Strategic Plan FY 2019-2023, the IHS used a
process similar to the HHS Strategic Plan FY 2018-2022,\4\ including
the use of goals, objectives and strategies, environmental scans,
Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis, and
workgroup participation.
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\4\ A crosswalk of the HHS Strategic Plan FY 2018-2022 and IHS
Strategic Plan FY 2019-2023 goals and objectives is available in
Appendix A.
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An IHS-initiated environmental scan reviewed strategic plans of
several IHS area and headquarters offices, and other available
documents. The SWOT exercise was conducted with IHS executive staff.
Informed by these documents and analysis, the IHS developed an initial
framework for review and comment of the Strategic Plan by Tribes,
Tribal organizations, UIOs, and IHS staff. The IHS first initiated
Tribal consultation and urban Indian confer on the IHS Strategic Plan
initial framework on September 15, 2017, and formed an IHS Federal-
Tribal Strategic Planning Workgroup (workgroup) to review all comments
and recommend a list of final goals and objectives for IHS leadership
review and approval.
During the initial framework comment period (September 15, 2017-
October 31, 2017), the IHS held listening sessions, presented at Tribal
meetings, and held conference calls with Tribal and UIO leaders.
Workgroup membership included Tribal leaders or their designees, a
representative from the IHS Office of Urban Indian Health Programs, and
IHS staff from areas, service units, and headquarters. The workgroup
reviewed comments on the initial framework received from 150 Tribes,
Tribal organizations, UIOs, and IHS staff. Subsequently, the workgroup
met six times over a four-month period to develop their final
recommendations on the IHS mission, vision, goals, objectives, and
strategies.
The workgroup prioritized strategies by importance, and not all
strategies were recommended. Quality as a Business Strategy (QBS) \5\
was used as a model for developing the IHS Strategic Plan. Strategies
were developed in alignment with defined goals and objectives to
continue current operations or improve the Indian health care system.
In doing so, the IHS Strategic Plan addresses quality throughout all
aspects of its clinical, operational, and administrative operations and
creates a plan for improvement across all three areas.
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\5\ QBS is a leadership framework and set of activities to help
organizations prepare to participate in system transformation and
continuous quality improvement. QBS guides strategic planning
through a vision of the system that operates in its present
condition (maintaining operations that achieve goals and objectives)
and improves to meet new needs through redesign of existing
conditions or design of new processes, products, or services. QBS
helps leaders plan to operate the system and plan to improve the
system.
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Feedback received from all stakeholders formed the basis of the
Draft IHS Strategic Plan 2018-2022 sent out for public comment on July
24, 2018. During the 30-day comment period, which ended on August 23,
2018, the IHS received comments from 30 entities, including Tribes,
Tribal organizations, UIOs, IHS staff, and national organizations. The
final IHS Strategic Plan FY 2019-2023 reflects changes made to the
initial framework based on consideration of all comments received. The
IHS Strategic Plan FY 2019-2023 may be accessed through the IHS website
at https://www.ihs.gov/strategicplan/.
The IHS intends to identify appropriate performance measures and
outcomes to achieve the mission and goals. The IHS is working to
develop an implementation process that will include measures to address
the strategies and objectives in the IHS Strategic Plan. The IHS will
review periodically the agency's progress in implementation of the IHS
Strategic Plan and will provide updates to IHS staff and to Tribal and
UIO leaders.
Priorities and Challenges
The IHS has historically established four priorities to guide
operations. The IHS Strategic Plan FY 2019-2023 incorporates these
priorities and builds on the important work being done throughout the
system.
The IHS four priorities are interrelated with the strategic goals
of the IHS Strategic Plan FY 2019-2023:
People--Recruit, develop, and retain a dedicated,
competent, caring workforce collaborating to achieve the IHS mission.
Partnerships--Build, strengthen, and sustain collaborative
relationships that advance the IHS mission.
Quality--Excellence in everything we do to assure a high-
performing Indian health system.
Resources--Secure and effectively manage the assets needed
to promote the IHS mission.
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The AI/AN population continues to face health disparities in
comparison to the national population. Over the past two decades, there
have been some important health improvements, such as reduced mortality
rates from tuberculosis and heart disease, among others. However, the
infant mortality rate for AI/ANs is 26 percent higher than the national
rate,\6\ and AI/ANs are three times as likely as the overall population
to have diabetes.\7\ American Indian and Alaska Native populations also
have disproportionately high rates of suicide, unintentional injuries,
and drug overdose deaths. The IHS Strategic Plan aims to strengthen the
overall health status of the AI/AN population.
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\6\ U.S. Department of Health and Human Services, IHS. (2014).
Trends in Indian Health: 2014 Edition. Retrieved from: https://www.ihs.gov/dps/publications/trends2014/.
\7\ Data comparing the AI/AN population to the U.S. general
population are documented and updated annually by the IHS. As of
April 2018, the most current IHS mortality data available is from
2009-2011. AI/AN mortality data accounts for misclassification of
AI/ANs on death certificates and there is a time lag in producing
IHS mortality data.
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In recent years, the agency has faced challenges related to access
to care, quality of care, and program management and operations. The
IHS Strategic Plan includes three strategic goals focused on access,
quality, and management and operations.
Access: Many facilities operated by the IHS and Tribes are located
in rural or remote settings and may be unable to provide comprehensive
health care services and/or acute and specialty care services. To help
meet the health care needs, the PRC program purchases services from
private health care providers for eligible patients. Although PRC
funding may meet the full patient need in some IHS areas, funding may
not be sufficient to meet the need in others. Some facilities also face
longstanding challenges in recruiting and retaining essential staff,
ensuring access to needed care and training resources, and maintaining
clinical proficiency of professional staff. Recruitment and retention
challenges are attributable to a variety of factors that include, but
are not limited to, the remoteness of some IHS facilities, rural
reservation communities, aging IHS facilities and medical equipment,
housing shortages, limited access to schools and basic amenities,
limited spousal employment opportunities, and competition with higher
paying public and private health care systems. The IHS Strategic Plan
Goal 1 aims to address some of these challenges.
Quality: Assuring that IHS hospitals and clinics are accredited is
a high priority for IHS. Meeting Medicare standards also allows IHS
facilities to be reimbursed for all eligible Medicare and Medicaid
services. The IHS monitors federal hospitals through area offices,
which have access to information about the quality of care and
oversight through a governing body process. Staffing and funding
shortages at area offices also have an impact on the clinical support
and guidance provided to service units. The IHS is working to
strengthen organizational capacity to improve our ability to meet and
maintain accreditation of IHS direct service facilities, align service
delivery processes to improve the patient experience, ensure patient
safety, establish agency-wide patient wait time standards, and improve
processes and strengthen communication for early identification of
risks.
Within the Indian health care system, quality is also impacted by
rising costs from medical inflation, population growth, increased rates
of chronic diseases, and aging facilities and equipment. These
challenges may be heightened at facilities located in rural,
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remote locations. The Indian health care system is also challenged with
balancing the needs of patients served in IHS, Tribal, and UIO health
programs. Goal 2 aims to address these challenges.
Management and Operations: The Indian health care system continues
to face management and operational challenges in the years ahead.
Communication and collaboration across the system requires improvement
and managers need tools and resources to make data-driven decisions.
Additionally, while some AI/AN communities have modern IHS hospitals
and ambulatory facilities, the average age of IHS facilities is 36
years. Many IHS and Tribal health care facilities and UIOs are
operating at or beyond capacity, and their designs may not be efficient
in the context of modern health care delivery. Information Technology
also continues to be a major concern with rising costs and increased
security threats. Goal 3 aims to address these challenges.
Performance
The IHS currently reports agency-wide performance measures.
Existing performance measures may be used to monitor progress on goals
and objectives included in the IHS Strategic Plan FY 2019-2023.
Additional measures for specific objectives or strategies may be
developed as the agency moves forward with implementation of the IHS
Strategic Plan.
The IHS is working to develop an implementation process based on
the feedback received during the open comment period and based on
action recommendations received during the 2018 National Combined
Councils Annual Meeting.\8\ Updates on the agency's progress in
implementation of the IHS Strategic Plan will be made available at the
IHS Strategic Plan website.
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\8\ The 2018 National Combined Councils Annual Meeting was held
in Portland, Oregon, on August 14-17, 2018. During the meeting,
breakout sessions were held by the IHS to develop action plans for
implementation of the objectives in the Draft IHS Strategic Plan.
For more information about the meeting, please visit: https://www.ihs.gov/forproviders/ncc/2018meeting/. The action plans
presented during the meeting are subject to the review and
recommendations of IHS senior leadership.
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Government Performance and Results Act (GPRA) and GPRA
Modernization Act (GPRAMA): For IHS, performance improvement is a
concerted effort by all members of the Indian health care system
working together to improve a comprehensive set of existing GPRA and
GPRAMA performance measures. Although not required by law, some
tribally managed health programs voluntarily submit performance data
for participation in GPRA/GPRAMA performance reporting. All UIOs report
on all GPRA/GPRAMA measures. The IHS performance measures are focused
on monitoring population health and assessing program trends and
management. The measures support the IHS's strategic goals and
improvement of AI/AN health outcomes. See Appendix B: GPRA/GPRAMA
Measures and IHS Strategic Plan Crosswalk. Progress on performance
measures is tracked annually and reported in the IHS Congressional
Justification and on the IHS Quality website. GPRAMA measures are also
reported in the HHS Annual Performance Plan and Report. The GPRA and
other National Reporting website includes additional information about
the GPRA and other clinical care performance measures.
National Accountability Dashboard for Quality (NAD-Q): The IHS
gathers and reports data on key quality measures to ensure compliance
with IHS policy requirements, accreditation standards, and/or federal
regulations at IHS hospitals and ambulatory health centers. Reports are
generated on a quarterly basis and available at the IHS Quality
website. The NAD-Q supports the agency's strategic goals and
improvement of AI/AN health outcomes. See Appendix C: National
Accountability Dashboard for Quality and IHS Strategic Plan Crosswalk.
Other: The IHS cascades performance goals and objectives and
performance-related metrics agency-wide. Agency leadership periodically
reviews progress in meeting these agency performance objectives,
holding regular discussions with senior executives to identify
challenges to success and determine feasible solutions. The connection
between performance objectives, performance measures, and employee
accountability enables agency leadership to direct the efforts of the
workforce more accurately, and to make more informed and effective
decisions. The impact is greater success in meeting the full array of
mission requirements.
IHS Strategic Plan FY 2019-2023
The IHS Strategic Plan FY 2019-2023 details how the IHS will
achieve its mission through three strategic goals. Each goal is
supported by objectives and strategies. The strategies are activities
to make progress on the stated objectives. The goals and objectives are
inter-related and success in one area may overlap and influence
successes in other areas. Multiple sectors across the Indian health
care system may contribute to the successful achievement of a goal or
objective.
Mission
To raise the physical, mental, social, and spiritual health of
American Indians and Alaska Natives to the highest level.
Vision
Healthy communities and quality health care systems through strong
partnerships and culturally responsive practices.
Goal 1: To ensure that comprehensive, culturally appropriate
personal and public health services are available and accessible to
American Indian and Alaska Native people.
Goal Explanation: The IHS provides comprehensive primary health
care and public health services, which are critical to improving the
health of AI/AN people. The Indian health care system delivers care
through health care services provided in IHS, Tribal, and Urban (I/T/U)
health facilities (e.g., hospitals and clinics) and by supporting the
purchase of essential health care services not available in IHS and
Tribal health care facilities, known as the Purchased/Referred Care
(PRC) program. Additional services include environmental health
improvements, as well as traditional healing practices and services to
complement the medical, dental, pharmacy, laboratory, behavioral
health, and other primary care medical programs. Expanding access to
these services in AI/AN communities is essential to improving the
health status of the AI/AN population. This goal includes securing the
needed workforce, strengthening collaboration with a range of public
and private organizations, as well as Tribal, and urban Indian
providers, and expanding access to quality health care services to
promote the health needs of AI/AN communities.
Objective 1.1: Recruit, develop, and retain a dedicated, competent,
and caring workforce.
Objective Explanation: Consistent, skilled, and well-trained
leadership is essential to recruiting and retaining well-qualified
health care professionals and administrative professionals. Attracting,
developing, and retaining needed staff will require streamlining hiring
practices and other resources that optimize health care outcomes.
Within the Indian health care system, staff development through
orientation, job experience, mentoring, and short- and long-term
training and education opportunities are essential for maintaining and
expanding quality services and maintaining accreditation of facilities.
Also, continuing education
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and training opportunities are necessary to increase the skill sets and
knowledge of employees, which enables them to keep pace in rapidly
evolving areas of medical science, prevention science, improvement
science, and information technology, as well as to increase
opportunities for employee career advancement and/or to maintain
necessary professional credentialing and accreditation.
Strategies--The following strategies support this objective:
Health Care Recruitment and Retention:
1. Improve and innovate a process that increases recruitment and
retention of talented, motivated, culturally knowledgeable, and
competent workers, including through partnerships with AI/AN
communities and others.
2. Continue and expand the utilization of the IHS and Health
Resources and Services Administration's National Health Service Corps
scholarship and loan repayment programs, as authorized by law, to
increase health care providers at I/T/U facilities.
3. Support IHS sponsorship of fellowship slots in certain
specialized leadership programs for recruitment of future clinical and
administrative leaders.
4. Evaluate new organizational structure options and reporting
relationships to improve oversight of the Indian Health Professions
program.
5. Expand the use of paraprofessionals, Advanced Practice Nurses,
and Physician Assistants to increase the workforce and provide needed
services.
6. Develop training programs in partnership with health
professional schools and training hospitals and expand opportunities to
educate and mentor AI/AN youth interested in obtaining health science
degrees.
7. Enhance and streamline IHS human resources infrastructure to
hire well-qualified personnel.
Staff Capacity Building:
8. Strengthen the workforce to improve access to, and quality of,
services.
9. Improve leadership skills, adopt a consistent leadership model,
and develop mentoring programs.
10. Improve continuity processes and knowledge sharing of critical
employee, administrative, and operational functions through written
communications and documentation within the IHS.
11. Improve workplace organizational climate with staff development
addressing teamwork, communication, and equity.
12. Strengthen employee performance and responsiveness to IHS,
Tribes, urban Indian organizations (UIOs), and patients by improving
employee orientation and opportunities for training, Graduate Medical
Education programs, and other educational offerings, including customer
service skills and cultural competency.
Objective 1.2: Build, strengthen, and sustain collaborative
relationships.
Objective Explanation: Collaboration fostered through an
environment that values partnership is vital to expanding the types of
services to improve population health outcomes that can be achieved
within the Indian health care system. These relationships include those
between Tribes, UIOs, states, communities, federal agencies, not-for-
profit organizations, universities/schools, foundations, private
industry, as well as internal cooperation within the agency and
collaborative project management.
Strategies--The following strategies support this objective:
Enhancing Collaboration:
1. Collaborate with Tribes and UIOs in the development of
community-based health programs, including health promotion and disease
prevention programs and interventions that will increase access to
quality health programs.
2. Develop a community feedback system/program where community
members can provide suggestions regarding services required and
received.
3. Support cross-collaboration and partnerships among I/T/U
stakeholders.
Service Expansion:
4. Promote collaborations among the IHS, federal agencies, Tribes,
Tribal organizations, UIOs, and states to expand services, streamline
functions and funding, and advance health care goals and initiatives.
5. Work with community partners to develop new programs responsive
to local needs.
Objective 1.3: Increase access to quality health care services.
Objective Explanation: Expanded access to health care services,
including individual and community health services, requires using many
approaches. Greater access is critical to improving the health of AI/AN
people and reducing risk factors contributing to the leading causes of
death. Among the needs identified are increased prevention, specialty
care, innovative use of health care providers, traditional medicine,
long-term and aftercare services (which may require advancing holistic
and culturally centered population health models), and expanded
facilities and locations. To assess the success of these efforts,
measures are needed to evaluate provider productivity, patient
satisfaction, and align improvements in support operations (e.g., human
resources, contracting, technology) to optimize access to quality
health care services.
Strategies--The following strategies support this objective:
Health Care Service Access Expansion:
1. Develop and support a system to increase access to preventive
care services and quality health care in Indian Country.
2. Develop and expand programs in locations where AI/AN people have
no access to quality health care services.
3. Overcome or mitigate challenges and enhance partnerships across
programs and agencies by identifying, prioritizing, and reducing access
limitations to health care for local AI/AN stakeholders.
4. Increase access to quality community, direct, specialty, long-
term care and support services, and referred health care services and
identify barriers to care for AI/AN communities.
5. Leverage technologies such as telemedicine and asynchronous
electronic consultation systems to include a more diverse array of
specialties and to expand, standardize, and increase access to health
care through telemedicine.
6. Improve team effectiveness in the care setting to optimize
patient flow and efficiency of care delivery.
7. Reduce health disparities in the AI/AN population.
8. Provide evidence-based specialty and preventive care that
reduces the incidence of the leading causes of death for the AI/AN
population.
9. Incorporate traditional cultural practices in existing health
and wellness programs.
10. Improve the ability to account for complexity of care for each
patient to gauge provider productivity more accurately.
11. Hold staff and management accountable to outcomes and customer
service through satisfaction surveys.
12. In consultation with Tribes, modernize health care facilities
and staff quarters to expand access to quality health care services.
13. In consultation with Tribes, review and incorporate a resource
allocation structure to ensure equity among Tribes.
14. Develop and coordinate environmental engineering, environmental
health, and health facilities engineering services to provide
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effective and efficient public health services and enable response,
recovery, and mitigation to disasters and public health emergencies.
Goal 2: To promote excellence and quality through innovation of the
Indian health system into an optimally performing organization.
Goal Explanation: In pursuit of high reliability health care
services \9\ and care that is free from harm, the IHS has implemented
several innovations in health care delivery to advance the population
health needs of AI/AN communities. In many cases, innovations are
developed to meet health care needs at the local level and subsequently
adopted across the Indian health system, as appropriate. The IHS will
continue to promote excellence and quality through innovation by
building upon existing quality initiatives and integrating appropriate
clinical and public health best practices. Recent IHS efforts have been
aimed at strengthening the underlying quality foundation of federally
operated facilities, standardizing processes, and sharing health care
best practices with federal, state, Tribal, and urban Indian programs.
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\9\ High reliability health care means consistent excellence in
quality and safety for every patient, every time. High reliability
in health care improves: Organizational effectiveness, efficiency,
culture, customer satisfaction, compliance, and documentation.
Additional information about High Reliability Organizations is
available online at https://psnet.ahrq.gov/primers/primer/31/high-reliability.
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Objective 2.1: Create quality improvement capability at all levels
of the organization.
Objective Explanation: Ensure that quality improvement is
operational in all direct care, public health, administrative, and
management services throughout the system. Quality improvement will be
achieved at all levels of the organization, including headquarters,
area offices, and service units. Quality improvement methods will be
made available to Tribes, Tribal organizations, and UIOs, as requested.
Creating quality improvement capability at all levels will require
training, resources, commitment, and consistency to assure that every
employee shares a role in quality improvement in all IHS operations and
services. This objective will build upon efforts of the 2016-2017 IHS
Quality Framework \10\ to strengthen quality improvement related to
data, training, and standards of care.
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\10\ The IHS Quality Framework 2016-2017 is available online at
https://www.ihs.gov/newsroom/includes/themes/newihstheme/display_objects/documents/IHS_2016-2017_QualityFramework.PDF. The
IHS Strategic Plan 2019-2023 is a longer-range plan and replaces the
short-term IHS Quality Framework.
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Strategies--The following strategies support this objective:
Quality Data:
1. Improve the transparency and the quality of data collected
regarding health care services and program outcomes.
2. Develop and integrate quality standards and metrics into
governance, management, and operations.
3. Standardize quality metrics across the IHS and use results to
identify emerging needs, share information on best practices and
performance trends.
Quality Improvement:
4. Provide training, coaching, and mentoring to ensure quality
improvement and accountability of staff at all levels of the
organization.
5. Evaluate training efforts and staff implementation of
improvements, as appropriate.
Standards of Care:
6. Develop and provide standards of care to improve quality and
efficiency of health services across the IHS.
7. Adopt the Model for Improvement in all clinical, public health,
and administrative activities across the IHS.
8. Adopt patient-centered models of care, including patient-
centered medical home recognition and care integration.
Objective 2.2: Provide care to better meet the health care needs of
American Indian and Alaska Native communities.
Objective Explanation: Key to improving health outcomes and
sustaining population health is culturally responsive health care that
is patient-centered and community supported. The IHS will implement
culturally appropriate and effective clinical and public health tools
to improve the health care needs of AI/AN communities. This objective
reinforces current efforts addressing culturally appropriate care and
supports dissemination of best practices.
Strategies--The following strategies support this objective:
Culturally Appropriate Care:
1. Strengthen culturally competent organizational efforts and
reinforce implementation of culturally appropriate and effective care
models and programs.
2. Promote and evaluate excellence and quality of care through
innovative, culturally appropriate programs.
3. Promote total health integration within a continuum of care that
integrates acute, primary, behavioral, and preventive health care.
4. Explore environmental and social determinants of health and
trauma-informed care in health care delivery.
5. Continue to develop and implement trauma-informed care models
and programs.
Sharing Best Practices:
6. Work collaboratively within the IHS, and among federal, state,
Tribal, and urban Indian programs to improve health care by sharing
best practices.
Goal 3: To strengthen IHS program management and operations.
Goal Explanation: This goal addresses issues of management,
accountability, communication, and modernized information systems. The
IHS is committed to the principles of improved internal and external
communication, and sound management. Assuring the availability and
ongoing development of a comprehensive information technology (IT)
system is essential to improving access to integrated clinical,
administrative, and financial data to support individual patient care,
and decision-making.
Objective 3.1: Improve communication within the organization with
Tribes, Urban Indian Organizations, and other stakeholders, and with
the general public.
Objective Explanation: This objective addresses the critical need
to improve communication throughout the IHS, with employees and
patients, with Tribes, UIOs, with the many organizations working with
the IHS and with the general public. Most important is to assist
Tribes, UIOs, and the IHS in better understanding Tribal and urban
Indian needs and IHS program needs, to encourage full participation in
information exchange, and to engage Tribes and urban Indian programs in
partnerships and building coalitions. This includes defining and
characterizing community and health-specific program needs, modifying
programs as needed, and monitoring the effectiveness of programs and
program modifications.
Strategies--The following strategies support this objective:
Communication Improvements:
1. Improve communication and transparency among all employees,
managers, and senior leadership.
2. Develop and define proactive communication plans for internal
and external stakeholders.
3. Enhance health-related outreach and education activities to
patients and families.
4. Design social media platforms that will ensure wide
dissemination of information to interested and affected individuals and
organizations.
Strengthen Partnerships:
5. Assure quality reporting relationships between service units,
area
[[Page 6803]]
offices, and headquarters are clearly defined and implemented.
6. Effectively collaborate with other IHS offices (e.g., the IHS
Loan Repayment Program) and HHS staff and operating divisions where
missions, goals, and authorities overlap.
Objective 3.2: Secure and effectively manage the assets and
resources.
Objective Explanation: This objective supports the delivery of
health care through improved management of all types of assets and non-
workforce resources. To elevate the health status of the AI/AN
population and increase access to medical care, the IHS must continue
to help ensure patients understand their health care options and
improve health care system business processes and efficiencies. The IHS
will also increase the effectiveness of operations and reporting, while
providing more assistance and infrastructure support to IHS areas and
facilities.
Strategies--The following strategies support this objective:
Infrastructure, Capacity, and Sustainability:
1. Enhance transparency of IHS management and accountability
infrastructure to properly manage and secure assets.
2. Promote collaboration among federal, state, Tribes, and local
health programs to develop the necessary health care and public health
infrastructure to effectively provide essential public health services.
3. Provide technical assistance to strengthen the capacity of
service units and area offices to enhance effective management and
oversight.
4. Apply economic principles and methods to assure ongoing security
and sustainability of federal, Tribal and urban Indian facilities.
Improved Business Process:
5. Routinely review management operations to effectively improve
key business management practices.
6. Optimize business functions to ensure that the IHS is engaged in
discussions on value-based purchasing.
7. Develop policies, use tools, and apply models that ensure
efficient use of assets and resources.
8. Strengthen management and operations through effective
oversight.
9. Develop standardized management strategies for grants,
contracts, and other funding opportunities to promote innovation and
excellence in operations and outcomes.
Patient Education and Resources:
10. Strengthen patient awareness of their health care options,
including Medicaid and Medicare enrollment, which may increase access
to health care and optimize third-party reimbursements.
Objective 3.3: Modernize information technology and information
systems to support data driven decisions.
Objective Explanation: This objective is to assure the availability
and ongoing improvement of a comprehensive IT system that meets the
needs of providers, patients, and I/T/Us by using technology to provide
improved, timely access to care and to reduce the need for transit.
This objective recognizes that qualified and capable IT staff and
leadership are fundamental to achieving the strategies listed below and
further reinforce the workforce objectives outlined elsewhere in the
IHS Strategic Plan.
An improved Indian health IT network fosters transparency,
integration, and access to the clinical, administrative, and financial
data necessary to support patient care, decision-making, and advocacy.
This will require the development of a system integrated with Tribal
and urban Indian programs that will address the current and projected
clinical, administrative, and fiscal data needs. Timely fiscal data
dissemination to all federal partners when developing budgets is
necessary to accurately address health care needs of AI/AN communities.
Data quality (i.e., accuracy, reliability, and validity) and quality
patient care will continue to play a highly visible role both within
and outside the IHS. Data quality is only partially dependent upon
technology. Improved data quality also reflects other sustained
initiatives, such as data entry accuracy, legibility of handwriting,
appropriate and timely data exports, and coding accuracy.
Strategies--The following strategies support this objective:
Health Information Technology (HIT):
1. Evaluate electronic health record needs of the IHS and the
ability for the health information systems to meet those needs, create
seamless data linkages, and meet data access needs for I/T/U health
information systems.
2. Develop a consistent, robust, stable, secure, state-of-the-art
HIT system to support clinician workflow, improve data collection,
increase transparency, and provide regular and ongoing data analysis.
3. Modernize the HIT system for IHS Resource and Patient Management
System or commercial off-the-shelf packages.
4. Align with universal patient record systems to link off-
reservation care systems that serve American Indians and Alaska
Natives.
5. Enhance and expand technology such as the IHS telecommunications
to provide access for consultative care, stabilization of care,
decreased transportation, and timeliness of care at any IHS-funded
health program.
Data Process:
6. Provide available data to inform I/T/U decision-making.
7. Act upon performance data and standardize data and reporting
requirements.
8. Assure system of data sharing to solidify partnerships with
Tribal and urban Epidemiology Centers and other Tribal programs and
UIOs.
9. Establish capability for data federation \11\ so that data
analytics/business intelligence may be applied to disparate data stored
in a single, general-purpose database that can hold many types of data
and distribute that data to users anywhere on the network.
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\11\ Data federation provides an organization with the ability
to aggregate data from disparate sources in a virtual database so it
can be used for business intelligence or other analysis.
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Note : The intent of the IHS Strategic Plan is to improve the
health of American Indians and Alaska Natives through better
management and administration of the IHS. It is not intended to
replace or create any right, benefit, or legal responsibility,
substantive or procedural, enforceable by law by a party against the
U.S., its agencies, or any person.
BILLING CODE 4610-16-P
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[GRAPHIC] [TIFF OMITTED] TN28FE19.005
Michael D. Weahkee,
RADM, Assistant Surgeon General, U.S. Public Health Service, Principal
Deputy Director, Indian Health Service.
[FR Doc. 2019-03486 Filed 2-27-19; 8:45 am]
BILLING CODE 4160-16-C
