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Can Telehealth Solve the Indian Health Service’s Problems?

Responding to criticism from the CMS and GAO, the health system looks to build a connected care platform in the Great Plains states.

By Eric Wicklund

- The Indian Health Service is turning to telehealth to improve access to more than 130,000 Native Americans spread out across the Great Plains states.

The national health system has put out the call for telehealth proposals to serve a seven-hospital region covering Iowa, Nebraska and the Dakotas following pressure from the Centers for Medicare & Medicaid Services to overhaul its practices and a federal audit that highlighted excessive patient wait times.

The IHS is seeking one- to four-year contracts for emergency services, specialty referrals and provider-to-provider consults in a number of fields, including behavioral health, maternal and child health and cardiology, with the potential to extend those contracts to multiple years.

“This new effort in IHS telehealth expands access to care, particularly specialty care that may be difficult to find in rural areas,” IHS Principal Deputy Director Mary Smith announced this past week. “IHS is committed to providing quality healthcare to our patients, who are our first priority, and integrating telemedicine with community-based services is an important part of the way IHS delivers on that commitment."

Through a federal treaty, the IHS provides free healthcare for enrolled Native Americans in more than 560 tribes around the country. Recently, CMS threatened to curb or end reimbursements to some hospitals in the Great Plains system, comprised of seven hospitals, 15 health centers and several clinics, after uncovering lapses in care.

The CMS action also prompted a review of the IHS by the Government Accountability Office. This past April, the GAO released results of an audit that found long wait times at several health systems. Until the IHS develops a way to monitor patient wait times, the report said, the GAO can’t tell whether the health system has improved healthcare for a population that suffers disproportionately from diseases like diabetes and chronic liver disease.

This prompted the IHS to look to telehealth for the troubled health system.

“This telehealth is going to be put in communities that don’t have clinics or services,” Kevin Steele, a spokesman for the Ogala Sioux Tribe in South Dakota’s Pine Ridge Indian Reservation, told the Associated Press. “We have communities that are 50 miles away in which people have to drive that far, but they have a school system and a small building capable to house telehealth.”

Telehealth isn’t new to the IHS. In the mid-1970s, the agency worked with NASA to equip a telehealth van that travelled to reservations across parts of the Midwest and West, connecting via two-way microwave radio with nearby health systems. Federal grant programs helped expand the network in the 1990s, and by the turn of the century telemedicine specialty programs were emerging in various locations.

“Telemedicine is part of the future,” Jonathan Gilbert, MD, clinical director for the HIS office in Billings, Montana, told the Billings Gazette in a recent feature on telemedicine services at the Lame Deer Health Center, the first IHS center in the country to use the technology in its emergency room. “It’s a fantastic way to bring board-certified specialists to a frontier community and to raise the bar.”

Because so many Native American communities are remote and underserved, they’ve been open to mHealth and telehealth programs from a wide variety of providers. Health systems in Arizona, New Mexico, the pacific Northwest and New England have launched programs for those communities. And in 2013, Salt Lake City-based TruClinic made news launching a telehealth platform for the Confederated Tribes of the Goshute Reservation, along the border of Nevada and Utah.

A telehealth platform for the Great Plains region could lead to more benefits. In South Dakota, Gov. Dennis Daugaard has said that if the state is able to improve its CMS reimbursements for IHS healthcare services delivered to Medicaid-eligible residents, thus reducing stress on the state’s budget, he would call a special legislative session to consider expanding the program.  

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