As some may know the Osage Nation is seriously interested in taking over the United States Public Health Service’s – Indian Health Service – that currently runs the health clinic in Pawhuska. This option was made possible by several laws passed by the United States Congress. The law allows tribes to contract or compact to operate federal programs like the Indian Health Service and the Bureau of Indian Affairs.
To date hundreds of tribes have chosen to contract/compact services that had been provided to them by the Indian Health Service. Tribes may choose to contract/compact all of the services the Indian Health Service provides or may choose only certain ones. For instance, some tribes have only contracted a clinic or hospital, while others have contracted clinics and hospitals and specialty services that the Indian Health Service provides like Contract Health Services (CHS), a program that pays for certain specialty health services the Indian clinic or hospital cannot provide. Contract Health Service pays for specialty care based on priorities, in other words not all the specialty care a patient thinks they need, will be paid for, unless the Indian Health Service approves. The reason is that the dollars Indian Health Service gets each year for Contract Health is limited.
In the case of the Osage Nation, the tribe could decide to contract the Pawhuska clinic, and/or the Contract Health Service, which in this case includes what is called the Pawnee Benefit Package Program (PBPP). The way it would work is the Osage Nation would negotiate with the Indian Health Service a dollar amount it would get to run programs it compacts. The amount could vary depending upon how the population of Indian patients served by the Indian Health Service is defined. Other factors will also influence the total dollars agreed upon, like dollars spent on IT and administration at the regional and national level.
Two things are critical to the success of a tribe contracting/compacting Indian Health Services. 1) Economic Feasibility: Will the dollars the tribe gets from the Indian Health Service and dollars and collections from insured Indian patients be enough to maintain the level of service patients now receive? Can improvements desired by the Nation be paid for by what the tribe gets from the Indian Health Service or will tribal money be needed? 2) Management Feasibility: Does the Osage Nation have the expertise to operate a healthcare system like that of Indian Health Service, particularly in an environment where growing numbers of Indians have a choice where they go for healthcare? Who at the Nation will decide who gets specialty care and who doesn’t when dollars are short?
Our company, Paradox Consulting has conducted feasibility studies such as these for several other tribes and in some cases our research determined the tribe could feasibly compact and in other cases we determined they could not. I hope the contractors now employed by the Nation will point our tribe in the right direction.
Dr. Joe L. Conner