Goal 1 - Utah Navajo Health System, Inc.

Report
Meeting the Healthcare Needs of the Navajo People
UNHS HISTORY & GROWTH
Donna Singer, RDMS & CEO
UNHS was incorporated and began management of the Montezuma Creek Clinic on January 1,
2000. The community has since been involved in its progression, and has insured the success
of UNHS.
UNHS now operates four Federally Qualified 330e Community Health Centers (CHC) and the
Blue Mountain Hospital (Critical Access).
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UNHS GROWTH
As a private, non-profit 501 (c)(3) corporation, UNHS provides medical, dental, and behavioral health services, and is directed
by a Navajo Board of Directors representative of all communities in which our clinics are located.
Wilfred Jones
Board Chair - Red Mesa
Robert Whitehorse
Vice Chair - Aneth
Jamie Harvey
Aneth
Edward Tapaha
Red Mesa
Lorrissa Jackson
Secretary - Oljato
Harriet Lansing
Aneth
Melinda Farley
Treasurer–TeecNosPos
Kenneth Miles
Navajo Mountain
Gloria Begaye
Blanding
Cassandra Beletso
Mexican Water
UNHS GROWTH
Goal 1: UNHS wants to bring
excellent quality healthcare to local
communities in the Utah Strip and
increase patient access to care.
Goal 2: To teach and train Navajos to
fully understand the daily operating
functionalities of the facilities while
offering quality patient care.
Goal 3: To expand levels of service
increasing access to specialty
services locally.
Goal 4: Expand access thru
assumptions of other local health
care facilities to coordinate and
collaborate in improving healthcare.
UNHS GROWTH
Patient Demographics
1%
20%
Native American
White
Other
79%
UNHS GROWTH
Revenue Source Ratios
24.62%
32.65%
2.35%
17.95%
22.43%
IHS
Medicaid
Medicare
Self Pay
Third Party
UNHS HISTORY & GROWTH
Fig. 1. As UNHS becomes more accessible and improves the quality of health services, the number
of patients seen has increased dramatically.
133,325
UNHS Accomplishments 2012
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Accreditation by Joint Commission and Patient Centered Medical Home
certification
Blue Mountain Hospital Joint Commission Accreditation
Clinical Pharmacy services for UNHS patients
Behavioral Health Program expansion
Tomosynthesis Mammography Units
Patient Navigation Program
Case Management
Information Technology
Patient Transportation program expansion
EMS Services
Navasew Building lease
Financial support for UNHS employees and local students for higher education
Board approval for acquisition of Dental facility and expansion of dental
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services to Blanding community
UNHS GROWTH
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Blue Mountain Hospital (BMH) is managed by UNHS and a collaborative
effort and is intended to make hospital services and renal dialysis more
accessible to communities located in the Utah portion of the Navajo
Reservation.
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Located in Blanding, Utah, Blue Mountain Hospital is a private, nonprofit
corporation developed and owned by the Ute Tribe and UNHS.
UNHS GROWTH
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Challenges
Disparate base or per
capita funding
Lack of funding and
services for public
health services
Navajo Nation police
security
Maintaining IHS and
Tribal communication
Historical nonpayment by IHS of
Contract Support cost
UNHS GROWTH
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Goals
Evaluate healthcare
needs and develop
needed services
Improve collaboration
with other state,
federal, and tribal
health agencies
Improve access and
quality of drinking
water through system
development
Complete process for
approval of operation
of Four Corners
Regional Health
Center (Red Mesa)
Daycare center for the
children of employee’s
and local workers
Behavioral Health Department
Behavioral Health
Value Statement:
UNHS is customer focused, responsive, respectful,
honest and committed to excellence through teamwork
in delivering healthcare.
Current Staff:
Stephen Hiatt, MS APRN
Nicole Olsen, CMHC
Roselyn Maryboy, LCSW
Jessica Stubbs, LMFT
Rex Harvey Sr., PSS
Behavioral Health
Services Offered:
1. Depression/ Sadness
2. Anxiety/ Fear
3. Grief
4. Alcohol or Drug Abuse
5. Emotional Problems
6. Thoughts of Death
7. Anger
8. Stress
9. Co- Dependency
10. Medication Evaluation
11. Evaluation for Inpatient treatment for Life Threatening problems
12. Court Ordered Services
13. Etc.
Behavioral Health
Family Counseling
(Clinical/ Traditional Prospectives)
1. Marital Conflicts
2. Family Problems
3. Domestic Violence
4. Alcohol/ Drug Abuse
Behavioral Health
Counseling for Children and Teenagers
(Clinical/ Traditional Prospectives)
1. Relationship Problems
2. Parenting
3. Drugs and Alcohol
4. Depression
5. Anxiety
6. Physical/ Sexual Abuse
Behavioral Health
Group Counseling (Clinical/ Traditional)
1. Healthy Relationships/ Substance Abuse Education
2. Domestic Violence
2. Parenting Skills
3. Parent Support Group
4. Peer Support Group with Chronic illness diabetes
Behavioral Health
Other Services
1. Referral to other agencies when needed.
2. Consultation services to agencies, including Medical
Facilities, Schools, Law Enforcement, Social Services,
Substance Abuse programs and other that may need our
assistance.
3. Educational services to organizations.
4. All services meet the needs of our community members in
both languages, English and Dine Language.
Meth
& Suicide
Prevention Initiative
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The Methamphetamine and Suicide Prevention Initiative
(MSPI) was implemented as an initiative to combat violent
and gang-related crime in Native American Country
UNHS Behavioral Health Staff continue to work hard each
year to provide interventions, assistance, awareness, classes
and outreach programs that inspire and educate our
community members.
Positive programs include our youth organization, Native
Youth Designs, and the annual Venture Utah Summer Camp
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MSPI
The department was created to:
- Provide education & increase community
involvement in prevention goals
- Reduce methamphetamine abuse
- Reduce suicidal ideations and activity
MSPI Goals
- Enhance community awareness, collaboration, and
response to drugs and suicidal related activities
- Increase number of youth participating in educational and
therapeutic groups.
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MSPI
Find healing and promoting constructive behavior through
science and culture based teachings that encourage balance
and self-awareness.
Learning to celebrate self and cope with life’s challenges
“Trust yourself, create the kind of self that you will be happy
to live with all your life. Make the most of yourself by fanning
the tiny, inner sparks of possibility into flames of
achievement.”
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Venture Utah Summer Camp
a two week, soft nature experience designed to put at-riskyouth in touch with the nature world, accomplished
counselors, native artists, native traditions, including food &
youth counselors who have also been at risk and have
overcome personal obstacles to be able to mentor the process
of creating resilience & personal accountability with their
peers.
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St. Christopher’s Mission at Bluff, UT
At risk youth are served by a large group of experienced
licensed counselors, therapists and medical personnel
(also Alternative Therapist)
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Venture Utah Summer Camp
Physical activities include: kayaking, swimming, hiking,
horseback riding, volleyball, bear dancing, dancing, ballroom
dancing lessons, service projects such as planting & clearing.
Regular counseling from licensed clinical social workers,
medical workers, native traditions, personal power
practitioners, holistic health workers, music therapist & team
building exercises.
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Venture Utah Summer Camp
Activities include: Native Arts, Navajo basket making, rug
weaving, beading, gourd painting and flute making.
Other traditions are also explored such as sheep shearing, the
butchering of a goat, and the process of preparing the animal
to eat along with traditional bread, ash bread, and fry bread.
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HUMAN RESOURCES
A. Byron Clarke, J.D.
Appreciated
Employees
Motivated
Guidance and
Administration
Excellent
Performance
Quality
Patient Care
Improved Results to
Customers
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UNHS Employees
Goals and Compliance
UNHS hires according to the NPEA
Long-term employment as a goal and upward mobility improves
efficiency.
Encourage education and maintain a scholarship fund for
employees
Paid time off and tuition payments to conferences and CME
courses
Community Involvement
Continuous Quality Improvement and regular performance reviews
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Upward Mobility: On-the-Job training and advancement
UNHS employees can request school scholarships in exchange for service commitment. To date, UNHS has paid over
$211,000.00 to employee Education Costs
Current Employees
Last Name
Bitsinnie
Holly
Juan
Oshley
Benn
Mose
Miller
Atene
Dance
Bennallie
Slim
Smallcanyon
Harrison
Cleveland
Blackgoat
Smallcanyon
Fox
Sagg
Begaye
Holliday
Frazier
Todachinnie
Lee
Brown
Harvey
Harvey
Yanito
Redhouse
Department
Year Hired
Finance & Accounting
2007
Finance & Accounting
2002
Finance & Accounting
2002
Finance & Accounting
2000
MCC - Dental
2004
MVC - Dental
2010
Administration
2006
Diabetes Control Project
2009
Diabetes Control Project
2008
MCC - Business Office
2004
MCC - Nursing
2010
NMC - Business Office
2010
Finance & Accounting
2004
Administration
2007
Medicaid Transport
2011
NMC - Nursing
2011
BFP - Nursing
2006
Finance & Accounting
2006
MCC - Dental
2008
BFP - Business Office
2006
Diabetes Control Project
2009
MCC - Facility
2011
Administration
2003
MCC - Nursing
2008
Administration
2006
Behavioral Health
2007
Pharmacy
2001
Nursing
2005
First started as...
A/R Data Entry
A/R Data Entry
A/R Data Entry
A/R Data Entry
A/R Data Entry
A/R Data Entry
Administrative Assistant
Americorp Volunteer
Americorp Volunteer
Behavioral Health Secretary
Dental Assistant
Eligibility Specialist
Finance Staff
Front Desk
Housekeeper
Intern
LPN
Maintenance
Oral Health Educator
Patient Registration
Patient Registration
Patient Transport
Safety Personnel
Screener
Women's Health
Lifeguard
Housekeeping
LPN
Currently Employed As...
Accounts Receivable Technician
A/R Manager
Billing Supervisor
Referrals Representative
Dental Patient Registration
Billing Technician
Human Resources Manager
Diabetes Control Outreach
Diabetes Control Outreach
Medical Records Technician
Medical Assistant- Public Health
Patient Registration
Accounting Manager
Veteran's Affairs Coordinator
Patient Transport
Medical Assistant
Clinical Nursing Director
Facilities Manager
Dental Hygienist
Licensed Practical Nurse
Registered Nurse
Mechanic
Public Relations and Emergency Response
Medical Assistant
Policy Development and Special Event Organizer
Domestic Violence/Traditional Counseling
Pharmacy Technician
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Working Toward Registered Nurse
UNHS Employees
Percent
Departmental Percentages
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Caucasian %
Native American %
Department
31
UNHS Employees
Departmental Numbers
30
25
20
15
10
Caucasian
5
Native American
0
Caucasian
Total Employees: 217, 73.5% Native American
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UNHS Employees
Redhouse, L.
Piotrowski, D.
Hurst, A.
Sheeran, G.
Dowell, S.
Oliver, L.
Hammond, D.
Lawrence, A.
Filfred, C.
Thomas, E.
Martin, S.
Vijil, B.
Dowell, H.
Thompson, B.
Jones, G.
Larsen, A.
Bryant, O.
Capitan, C.
Jones, R.
King, Y.
Poyer, C.
Yazzie, H.
Dayish, A.
Nielson, B.
Haycock, R.
Malan, A.
Tom, K.
Hanley, E.
Todecheene, Y.
Dan, P.
Administration
Behavioral Health
BFP - Business Office
BFP - Nursing
BFP - Pharmacy
CHIPRA
Finance & Accounting
Information Technology
MCC - Business Office
MCC - Facility
MCC - Nursing
MCC - Nursing
MCC - Pharmacy
MCC - Providers
MCC - Radiology
MCC - Radiology
Medicaid Transport
Medicaid Transport
Medicaid Transport
Medicaid Transport
Medicaid Transport
Medicaid Transport
MSPI
MSPI
MVC - Dental
MVC - Dental
MVC - Dental
MVC - Facility
MVC - Facility
NMC - Dental
Voluntary
Voluntary
Involuntary
Voluntary
Voluntary
Voluntary
Involuntary
Voluntary
Involuntary
Involuntary
Involuntary
Involuntary
Voluntary
Voluntary
Retired
Involuntary
Layoff
School
Voluntary
Voluntary
School
Layoff
School
Voluntary
Retired
Voluntary
Involuntary
Involuntary
Involuntary
Involuntary
Total Separations: 31
Total Employees: 217
Total Involuntary: 11
Total Voluntary: 12
Total School: 3
Total Program End: 2
Total Retired: 2
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Employee
Job Title
Nakai, B.
Accounts Receivable
Hire Date
12/26/2012
Nakai, L.
Accounts Receivable
12/10/2012
Ahtsosie, K.
Admin Assistant
12/17/2012
Dickson, D.
Behavioral Health
12/26/2012
Tortalita, K.
Case Management
6/24/2013
Begay, S.
Clinic Manager- MV
Pemberton, R.
Data Technology
Fowler, J.
Dental Assistant
3/4/2013
Tsosie, C.
Dental Assistant
12/10/2012
Tallman, R.
Dental Assistant
3/6/2013
Sampson, Y.
Diabetes Control
6/11/2013
Tolth, D.
Eligibility
4/29/2013
Sloan, S.
Front Desk
Crank, S.
Front Office
6/3/2013
Simpson, K.
Front Office
3/25/2013
Olsen, N.
Hourly Worker
4/15/2013
Judy, M.
Housekeeper
4/17/2013
Atene, L.
Housekeeper
5/29/2013
Greyeyes, B.
Housekeeper
3/11/2013
Torres, A.
IT
9/24/2012
Blackwater, K.
Maintenance
5/2/2013
Bandis, K.
Mammo Tech
9/26/2012
Whitehorse, T.
Med Lab Tech
12/11/2012
Denny, W.
Medical Assistant
Blackhorse, T.
MSPI
Billie, T.
Navigator
5/28/2013
Stewart, J.
PA
11/7/2012
Talker, R.
PA
10/1/2012
Benally, T.
Patient Transport
5/8/2013
Capitan, A.
Patient Transport
10/24/2012
Clark, C.
Patient Transport
10/3/2012
Cly, E.
Patient Transport
10/3/2012
Etsitty, E.
Patient Transport
5/1/2013
Juan, L.
Patient Transport
1/28/2013
Mose, N.
Patient Transport
1/28/2013
Yazzie, E.
Patient Transport
11/5/2012
Yellowman, C.
Patient Transport
10/24/2012
Gilson, T.
Pharmacist
5/1/2013
Hunter, E.
Pharmacist
6/3/2013
Morgan, N.
Pharmacy Tech
3/25/2013
Bonds, J.
Physician
3/18/2013
Singer, S.
Radiology Tech
Yanito, B.
Speciality Services
3/26/2013
Nakai, M.
Speciality Services
10/24/2012
6/3/2013
2/11/2013
9/4/2012
12/3/2012
10/16/2012
UNHS Employees
Total Separations: 30
Total Hires: 44
Total Employees: 217
Turnover 2013: 16%
Turnover 2012: 11%
Turnover 2011: 15%
U.S. RN turnover rate: 14%*
¼ of Hospitals had 20% turnover
*Am. Org. of Nurse Execs.
One ONLR investigations for the past 25 months.
Zero ONLR violations in UNHS history.
11/26/2012
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UNHS Employees
Investing in Employees – Local Economic Impact
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•
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Every Full-time employee is eligible for benefits –
5% gross income to retirement 403b
Full Premiums for Health Insurance
Eye and Dental coverage
Salaries aligned with the
-National Association of Community Health Centers Survey
2,000+ similarly situated clinics
-State, Regional, & Market Demand
• PTO, Vacation, Bereavement, CME, Bonuses
• Largest private employer in San Juan County
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UNHS Employees
UNHS Hiring Practices are governed by the NPEA, EEOC & Title
VII, ULC, FLSA, ADA, ICPFVP, FMLA, VPA, ADEA, USERRA
Credentialing Standards established by HRSA and JCAHO
UNHS Employees
2012 &2013 Interns and Training sessions
A. Redhouse
N. Whitehorse
B. Palmer
T. Warren
N. Dance
A. Taylor
J. Yowell
S. Bettwiseser
M. Stewart
D. Hamilton
A. Shaw
J. Adams
E. Holiday
D. Atene
C. Benally
J. Harvey
C. Nypaver
K. James
J. Marble
B. Kirk
R. Nielson
A Miller
S. Kelly
S. Haycock
S. Phillips
L. Edwards
M. Morton
O. Pierce
B. Miller
T. Martin
P. Rogers
M. Parrish
T. Warren
B. Palmer
H. Parker
K. Holly
L. Hadley
K. Hiatt
M. John
C. Low
B. Harmon
R. Miguel
S. Vowles
D. Pratt
R. Yanito
J. Wilson
D. Jones
S. Harvey
P. Drake
P. Little
V. Hicks
W. Begaye
J. Allmon
V. Ketchum
D. Yazzie
C. Benally
K. Rivera
Easter Seals
NNDWD
NNDWD
NNDWD
Volunteer
M.A. Student
M.A. Student
M.A. Student
M.A. Student
M.A. Student
M.A. Student
M.A. Student
X-Ray Student
M.A. Student
M.A. Student
M.A. Student
CNM
M.A. Student
M.A. Student
M.A. Student
M.A. Student
General
General
IT intern
General
M.A. Student
M.A. Student
General
M.A. Student
M.A. Student
X-Ray Student
Dental student
General
CHS
M.A. Student
Phys Therapy
General
BH
General
General
General
M.A. Student
M.A. Student
M.A. Student
General
General
M.A. Student
M.A. Student
M.A. Student
M.A. Student
M.A. Student
M.A. Student
M.A. Student
M.A. Student
M.A. Student
M.A. Student
General
Local education system collaboration
Whitehorse High School & Elementary
Monument Valley High School & Elementary
Navajo Mountain High School
San Juan High School & Elementary
College of Eastern Utah
University of Utah
Other Universities
ACCREDITATION
UNHS is Joint
Commission Accredited
Survey Completed August 2013
JC Mission Statement
"The mission of The Joint Commission is to continuously
improve the safety and quality of care provided to the public
through the provision of health care accreditation and related
services that support performance improvement in health care
organizations."
JC Background
History:
• Founded in 1951
• Nonprofit organization
• Establish standards to address a facility’s level of
performance in areas such as patient rights,
patient treatment, and infection control.
Purpose: Assure standards of care
Benefits of Joint Commission accreditation and
certification
• Strengthens community confidence in the quality and safety of
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care, treatment and services
Provides a competitive edge in the marketplace
Improves risk management and risk reduction
Provides education on good practices to improve business
operations
Provides professional advice and counsel, enhancing staff
education
Recognized by select insurers and other third parties
Fulfills regulatory requirements for UNHS
Joint Commission Function:
• Conducts onsite evaluations of facilities
“Accreditation Surveys”
• Issues a certificate of accreditation valid for 3
years
• Also provides ‘unannounced surveys’ to
encourage a system of continuous quality
improvement rather than preparation focused
specifically on a site visit
JA Requirements Include:
• 2 Patient Identifiers
• “Time Outs”
• Read Back of Orders
• Do not Use Lists
• Reporting of Problems
• Look Alike/ Sound Alike Drugs
• Complete List of Medications
Patient Centered Care
A Better Approach
PCMH
Have You Ever Been Confused While Getting
Healthcare?
 You Didn’t Know What Your Medications Were For?
 You Didn’t Know What the Next Steps Were to Get
You Healthier?
 Felt as Though Your Provider was Telling You What
to Do? Felt as Though You Didn’t Have any Say?
 Wished Someone Would “Hold Your Hand”
Through the Process?
PCMH
What is the PCMH?
A PCMH puts patients at the center of the health care
system, and provides primary care that is
“accessible, continuous, comprehensive, familycentered, coordinated, compassionate, and
culturally effective.”
(American Academy of Pediatrics)
PCMH Principles
Joint Principles of the PCMH
 Personal
Physician (Empanelment)
 Physician
Directed Medical Practice (Team
Approach with Patient at its Center)
 Whole
Person Orientation (Many support
services: Clinical pharmacy, Nutrition, Specialty
Services, Preventive Screenings, Dental,
Behavioral Health, etc.)
PCMH
Joint Principles of the PCMH
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Care is Coordinated and Integrated
o (Many support services: Patient Navigation, Referral Specialists,
Chronic Care Team)
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Quality and Safety are Hallmarks
o (Data supported patient care: Electronic Health Records,
Population Based Care)
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Enhanced Access
o (Extended hours and weekends, 24/7 access to clinical advice,
24/7 access to the patients medical record)
PATIENT NAVIGATION &
CASE MANAGEMENT
Road Map to
Best Practice in
Health Care
Patient Navigation & Case Management
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Next Presenter - End of Section
Goals:
o To ensure that our patients have access to the best comprehensive
health care services available to them, especially those who may
not have a strong family support system.
Patient Navigation & Case Management
RESPONSIBILITIES:
 Help patients and their families navigate thru health care system (Dr.
office, hospitals, payment systems, support groups, etc.)
 Identify possible barriers that could hinder treatment
 Facilitate communication among patient, family members and health
care providers
 Coordinate care among providers
 Ensuring that appropriate medical records are available at medical
appointments.
 Facilitate follow up appointments
 Provide emotional support
 Help patient and their families understand their diagnosis.
 Help arrange language translation/interpretation services
Patient Navigation & Case Management
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Patient Rights:
o Accurate and easy to understand health information
o Know their treatment options and make informed decision about
their care

Patient Responsibilities:
o Be responsible for their own health care (exercise, no smoking,
etc.)
o Provide accurate information about their health
o Be respectful
Patient Navigation & Case Management
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Examples of Barriers:
o No established PCP
o Transportation
o System problem with coordinating care
o Lack of access to a specialist
o System culture and practice/staff belief and attitudes
o Difficult to access appropriate food
o Unable to care for self at home
o Cost of supplies and equipment
o Anxiety of patient
o Habitual unhealthy lifestyle
o Health literacy/lack of information
o Language
Patient Navigation & Case Management
CLINICAL PHARMACY
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Presented By Andrew Bayless
Medication Therapy Management
Dr. Andy Bayless, PharmD, BC-ADM
UNHS Clinical Pharmacist
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Dr. C. Albert Noyes, PharmD, BC-ADM
Dr. Andy Bayless, PharmD, BC-ADM
Dr. Tyler Gilson, PharmD
Dr. Emily Hunter, PharmD
Plus 9 University of Utah College of Pharmacy doctoral
students trained in the past year, with an additional 12
doctoral students scheduled this year.
Clinical Activities
 Diabetes
care
 Patient education
 Treatment selection
 Follow-up care and monitoring
 High
risk medication
management
 Anticoagulation Clinic
 Chemotherapy coordination
 Medication
Consults
 Professional education
 Formulary management
Clinical Pharmacy
Meaningful progress...

Clinical case:
o A 60 year old Navajo woman
o Diabetes for many years with prescriptions for pills
o Her diabetes remained out of control and she refused
to change medicines
Clinical Pharmacy
Meaningful progress...
Clinical Pharmacy Contribution
o Education: “What options do we have?”
o Clarified misunderstandings about insulin and other
medications
o Explained the goals of treatment
o Helped patient gain understanding of her power to
control her health
Clinical Pharmacy
Meaningful progress...
Follow-up
o Started insulin therapy
o 2 days later her blood sugar was the lowest it had
been in years
o The patient is excited for and proud of her new
success
o Her clinical inertia is in the productive direction
CONTRACT SUPPORT COSTS
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Presented By Ron Demaray
Contract Support Costs
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Section 106(a)(1) of the ISDEAA authorizes Tribes to
contract for all programs, or portions thereof, that the IHS
would have otherwise provided.
Sections 106(a) (2) & (3) authorize Tribes to recover
additional “contract support costs.”
UNHS has historically negotiated with the Navajo Area
IHS, an amount for direct and indirect-type contract
support costs.
Contract Support Costs
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Historically, the IHS has not fully funded UNHS CSC due
to inadequate appropriations for that purpose.
In June of 2012, the U.S. Supreme Court, in Ramah
Navajo Chapter v. Salazar, ruled for the Tribes indicating
that the BIA and IHS must fully fund all Tribal CSC.
The Navajo Nation, UNHS and hundreds of Tribal
contractors across the country are pursuing claims
against the IHS for full funding of past CSC.
Contract Support Costs
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For FY 2014, IHS has proposed language in the 2014
Appropriations Bill to limit CSC to an amount identified on a
table listing all Tribes contracting with the IHS.
For UNHS, the amount identified is $3.1 million yet the IHS’s
own 2012 CSC Shortfall Report data shows UNHS’s total CSC
need to be $3.7 million.
For 2014, the IHS and UNHS will negotiate compact language
that identifies UNHS’s full CSC need and the amount the IHS
says is available.
o That compact language will preserve the right for UNHS to pursue a
claim against the IHS for any deficiency.
FINANCIAL DATA & AUDIT
William Harrison, Finance Manager
UNHS – Grants and Contracts
AS A 638 CONTRACTOR UNHS QUALIFIES FOR ADDITIONAL FUNDING
FROM FEDERAL AND STATE GOVERNMENTS:
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Association for Utah Community Health Center Grants
Outreach and Enrollment Primary Care Grant
Community Health Center Primary Care Grant
Community Health Center Mental Health Collaboration
Congressional Earmark Grants
Center for Disease Control Emergency Preparedness
Emergency Management Performance Grant
Medicaid Transportation Program
Meth and Suicide Prevention Initiative
Radiation Exposure Screening and Education Program
Special Diabetes Program for Indians
State Cardiovascular, DCP, and Oral Health Grants
Veterans Administration Contract Services
Patient Navigator Program
133,325
UTAH NAVAJO HEALTH SYSTEM
ACCOUNTS RECEIVABLE ANALYSIS
As of June 30, 2013
FINANCIAL
CLASS
CURRENT
31-90 DAYS
151-180
DAYS
91-150 DAYS
180+ DAYS
TOTAL
COMMERCIAL
206,976
33%
157,019 25%
76,617 12%
29,013
5%
149,503 24%
619,128 100%
-
MEDICAID
241,608
39%
154,793 25%
33,147
5%
18,788
3%
169,886 27%
618,221 100%
-
MEDICARE
145,973
39%
58,366 16%
42,508 11%
10,269
3%
118,849 32%
375,965 100%
-
17,702
11%
35,346 22%
22,846 14%
13,927
9%
71,793 44%
161,614 100%
-
612,259
34%
405,525 23%
175,117 10%
71,997
4%
510,031 29%
1,774,929 100%
PRIVATE PAY
TOTALS
UNHS – FINANCIAL RATIO
UNHS – FINANCIAL RATIO
Chart represents ratio of current assets to current liabilities
Industry Recommendation- at least 1:0
UNHS is > than 3:1
FINANCIAL CHALLENGES
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INCREASED STAFFING AND SERVICES HAVE CREATED A SHORTAGE OF
SPACE AND RESOURCES. MODIFICATION, RENOVATION AND EXPANSION OF
SPACE IS MUCH NEEDED WITHIN THE UNHS SYSTEM.
THE COST OF PROVIDING COMPETITIVE HEALTH BENEFITS TO EMPLOYEES
IS INCREASING – 20% INCREASE IN PREMIUMS FOR 2012-13
GOVERNMENT PROGRAMS AND REGULATIONS SUCH AS MEANINFUL USE,
PATIENT CENTERED MEDICAL HOME, THE JOINT COMMISION, AND ICD-10,
TO NAME A FEW, REQUIRES CONTINUAL TRAINING TO HEALTHCARE
PROFESSIONAL AND SUPPORT STAFF.
UNCERTAIN POLITICAL ENVIRONMENT AS IT RELATES TO HEALTH CARE
REFORM AND THE CENTER FOR MEDICARE AND MEDICAID MAKE FINANCIAL
FORECASTS AND PREPRATIONS DIFFICULT
UNHS FY 2011-12 AUDITED FINANCIALS AND 990’S ATTACHED
Emergency Medical Services
Presenter:
Dustin A. Coggeshell
Patient Transport Director
EMS Background
Utah Navajo Health System (UNHS) and
San Juan County (SJC) officials met
several times in 2008 and 2009 to
discuss the status of Emergency
Medical Services on the Utah portion
of the Navajo Nation. During the
discussion it was made aware that
certain areas of EMS needed
improvements, UNHS was requested by
SJC to assume EMS for the Montezuma
Creek and Monument Valley areas.
Improvements Needed
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Response time for 911 and interfaculty calls.
EMS staffing
Response time:
Current ambulance response time of 30 mins to 1 hr for
911 emergencies.
Ambulance response time of 45 mins to 1hr 30 mins for
interfaculty transports.
EMS staffing: Short staffed with volunteer paid EMT’s and
no increase in EMT/ EMS staffing due to students not
passing SJC EMS courses.
Transfer of EMS
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UNHS agreed to assume EMS with certain conditions in
place.
Transfer ownership of three ambulances with equipment's.
Continue dispatching services from San Juan Sheriffs
office.
UNHS provide inter-facility medical transports.
Changes Made
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UNHS and Mt Nebo Training of Provo, Utah provided two
EMT courses with one course each at Montezuma Creek
and Monument Valley site.
Mt Nebo changed teaching methods such as more hands
on and visual teachings. This helped with visual learners
and increased the passing rate for EMS courses in
Montezuma Creek and Monument Valley.
Montezuma Creek EMS gained 9 EMT’s
Monument Valley EMS gained 6 EMT’s
EMS Program Development
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UNHS has submitted application for state ALS and BLS EMS
license with support from the Utah Bureau of EMS. 08/14/13
Staffing of EMS being established or in place consisting of EMT’s,
ambulance drivers, training officer, course coordinator,
instructors, off-line medical director and EMS director.
UNHS purchased two additional ambulances making five
ambulances available for UNHS EMS for 911 and interfaculty
transports.
Mutual aid agreement’s in place with nearby EMS agencies.
Dispatch agreement in place with San Juan County Sheriffs
office.
UNHS EMS Operation
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UNHS will provide 24/7 ambulance coverage for the Montezuma
Creek, Aneth, Hovenweep, Hatch, Red Mesa, UT, Halchita,
Monument Valley and Oljeto areas.
Several EMT’s and paramedic currently are employed by UNHS
making response time faster during normal business hours
including nights and weekends.
UNHS has a fulltime mechanic to repair any ambulance in a
moments notice.
Monthly training and EMT courses will be provided for continuing
education and to advance EMT certification to provide higher
level of care.
24/7 Emergency dispatching from SJC Sheriffs Office
Provide and educate community members of EMS updates, injury
prevention and access of 911 services.
Conclusion
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Wilfred Jones, Board Chair

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