Native American tribe's new approach to primary care, population health

Native Americans have mostly been dependent on the Indian Health Service for their healthcare needs, but the newfound wealth from tribal casinos has been changing that—as well as the approach to providing primary care and other healthcare services.

Casino wealth has allowed North Carolina's Eastern Band of Cherokee Indians to construct an $80 million hospital on its tribal land. (It took over healthcare services from Indian Health 14 years ago.) The hospital has been designed specifically to address healthcare issues that confront Native Americans: alcoholism, depression, diabetes, heart disease and obesity, according to MedPage Today.

The organization has integrated primary care in the hospital, the article notes. Each patient works with a case manager, doctor, behavioral health specialist, nutritionist and pharmacist who all work out of the same office location. The approach is designed to strengthen the relationship between the primary care team and patients.

"We've completely redesigned the way we deliver primary care," Cherokee Indian Hospital CEO Casey Cooper told MedPage Today. "We're doing it more on a team-based approach, which we refer to as being more reciprocal interdependent, rather than sequential—just more patient centered."

The approach, which Cooper refers to as a "seven-generation strategy," is a departure from the travails of the Indian Health Service, which has been plagued with accusations of providing substandard care. A recently released report from the Office of the Inspector General for the U.S. Department of Health and Human Services said that the agency is lacking in resources across the board.

The tribe stockpiled money for years prior to the construction efforts in order to provide such services. As a result, healthcare spending swelled from about $16 million a year at the time of the transfer from the Indian Health Service to about $60 million today.