angie gorn, nshc president/ceo - metastarangie gorn, nshc president/ceo moved to nome, alaska in...

MetaStar Health Care Quality Symposium:

Overcoming Obstacles for the Health of Patients, Providers and Communities

Glacier Canyon Lodge Conference Center at the Wilderness

November 8, 2017

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Norton Sound Health CorporationProviding quality health services and promoting wellness within our people and

environment.

Angie Gorn, NSHC President/CEO

Moved to Nome, Alaska in 1997 (20 years)UW-Madison Graduate, 1997

M.B.A in Health Care AdministrationRegistered Dietitian (RD)

Certified Diabetes Educator (CDE)Licensed Nursing Home Administrator (NHA)




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Norton Sound Health Corporation Norton Sound Health Corporation (NSHC) is a Tribally owned and

operated, independent, not-for-profit health care organization. NSHC operates the Norton Sound Regional Hospital in Nome and clinics in the 15 villages within the 44,000 square miles that comprise the Bering Strait region.

Roughly the size of the state of Ohio –

BIGGER than 16 US states

102 miles south of the Arctic Circle

NSHC was established in 1970 to meet the health care needs of the Bering Strait region’s Inupiaq, Siberian Yupik and Yup’ik people (8,200).

Our Core Values




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Our Core Values

Who We Are• 18-bed Critical Access Hospital & Swing-bed Unit• Joint Commission Accredited• 18-bed Nursing Home• Emergency Department-Level IV Trauma Center• 16 Primary Care Clinics (HRSA funded)• Patient Hostel and Pre-maternal Home

“waiting area” for pregnant Women• Outpatient Behavioral Health Services• Health Aide Training Center, RN , C.N.A Training

Program• Operate the only pharmacy in region• Operate own air ambulance program




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Population served: 75% Alaska Native; 25% White/other

70 percent of the health care visits at NSHC occur in the villages

Serve 15 villages and 20 Tribes

Nearly all only air accessible, via small aircraft

Our Vision for the Future We will ensure that all patients receive quality and respectful health care.

We will educate our patients and communities to be proactive in caring for themselves and promoting wellness.

We will listen to, honor, and respect our elders, preserve their right to speak, and ensure they receive the best care in gratitude for their leadership.

We will increase wellness efforts to reduce addictive behaviors and to raise the quality of life among our people and communities.

We will advocate that our environment (air, land and water) will be clean, and our water and waste disposal systems are safe and affordable, in order to ensure our subsistence way of life.

We will assert and implement tribal self-governance to achieve our vision through effective leadership.

We will hire and support our tribal members to deliver and manage our services.

We will develop state of the art and efficient health care facilities throughout the region.

We will be financially strong through aggressive, effective and efficient financial management.

We will support and develop our youth to pursue higher education and health care careers to ensure there is future tribal leadership.




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A brief history……In 1994, Twenty federally recognized Tribal governments in the Bering Strait Region of Alaska agreed to participate in a self-governance compact with the Indian Health Services, to provide programs, services, functions, and activities related to the provision of health care, agreeing to allow NSHC to co-sign on their behalf in the amount of $16.2 M.

NSHC was one of the first Native health organizations in the country to assume responsibility for medical care of the people it serves.

Today, NSHC has over 700 employees and an annual operating budget of $147 M

Less than 50% of NSHC Revenue comes from Indian Health Services

In the spring of 2009, the NSHC Board of Directors’ dream for a replacement facility became a reality. The hospital was one of two “shovel-ready” projects nationwide selected for stimulus-bill funding.

The 144,000 square foot project replaced a 50-year old hospital, funded in the amount of $152 Million.

The State of Alaska Capital budget funded the construction of the replacement nursing home in a total amount of $18 M; both replacement facilities were under construction at the same time.

March 2013- NSHC moved into both facilities.




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On October 1, 2014, NSHC went live with the Electronic Health Record “Cerner”. For the first time, a universal health record was available to improve the continuity of care for patients in the villages and in Nome during visits at Alaska Native Medical Center.

The implementation was successful with no dip in cash collections observed.

Overcoming Health Disparities and Social Determinants of Health




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1 Reduce the cancer mortality rate per 100,000 population 221.3 162.0 215.4

2 Increase the percentage of adolescents (high school students in grades 9-12) who have not smoked cigarettes or cigars or used chewing tobacco, snuff or dip on one or more of the last 30 days 48.6%a 80% 60.5%

3 Increase the percentage of adults (age 18 and older) who do not currently smoke cigarettes 53.0% 83% 69.3%

4a Reduce the percentage of adults (age 18 years and older) who meet criteria for overweight (body mass index of ≥ 25 and < 30 kg/m2 ) 38.6% 36% 30.8%

4b Reduce the percentage of adults (age 18 years and older) who meet criteria for obesity (body mass index of ≥ 30 kg/m2 ) 27.0% 27% 34%

5ai Reduce the percentage of adolescents (high school students in grades 9-12) who meet criteria for overweight (age- and sex-specific body mass index of ≥ 85th and < 95th percentile) 16.5%a 12% 20.1%

5aii Reduce the percentage of adolescents (high school students in grades 9-12) who meet criteria for obesity (age- and sex-specific body mass index of ≥ 95th percentile) 12.2%a 10% 9.1%

5bi Reduce the percentage of children (students in grades K-8) who meet criteria for overweight (age- and sex- specific body mass index of >=85th and <95th percentile)

Statewide Only 15%

Statewide Only

5bii Reduce the percentage of children (students in grades K-8) who meet criteria for obesity (age- and sex- specific body mass index of >=95th percentile)

Statewide Only 15%

Statewide Only

6a Increase the percentage of adults (age 18 years and older) who report 150 or more minutes per week of moderate or vigorous exercise, where each minute of vigorous exercise contributes 2 minutes to the total. 57.9%b 61% 44.2%

6b Increase the percentage of adolescents (high school students grades 9-12) who do at least 60 minutes of physical activity a day, every day of the week 18.4%a 23% 19.7%

7a Reduce the suicide mortality rate per 100,000 population among the population age 15-24 years DSU 43.2 173.4+

7b Reduce the suicide mortality rate per 100,000 population among the population age 25 years and older 55.2+ 23.5 44.5+

8 Reduce the percentage of adolescents (high school students in grades 9-12) who felt so sad or hopeless every day for 2 weeks or more in a row that they stopped doing some usual activities in the past 12 months 27.0%a 23% 32.9%

9 Reduce the mean number of days in the past 30 days adults (age 18 and older) report being mentally unhealthy 2.0 2.9 2.9

10 Increase the percentage of adolescents (high school students grades 9-12) with three or more adults (beside their parents) from whom they feel comfortable seeking help 36.2%a 47% 46.7%

2010 Goal 2015

11 Reduce the rate of unique substantiated child maltreatment victims per 1,000 children (age 0-17 years) Statewide Only 14.4 Statewide

Only

12 Reduce the rate of rape per 100,000 population Statewide

Only 113.0++ Statewide

Only

13 Reduce the percentage of adolescents (high school students in grades 9-12) who were ever hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend during the past 12 months 10.5%c 8%++ 10.9%

14 Reduce the alcohol induced mortality rate per 100,000 population 25.3+ 15.3 DSU

15a Reduce the percentage of adults (age 18 years and older) who report binge drinking in the last 30 days based on the following criteria: 5 or more alcoholic drinks for men; 4 or more alcoholic drinks for women, on one occasion.

22.0% 20% 15.6%

15b Reduce the percentage of adolescents (high school students grades 9-12) who report binge drinking in the past 30 days based on the following criteria: 5 or more alcoholic drinks in a row within a couple of hours, at least once in the past 30 days

17.7%a 17% 11.7%

16 Reduce the unintentional injury mortality rate per 100,000 population 84.6+ 54.8 75.7+

17 Increase the percentage of children age 19-35 months who do receive the ACIP (Advisory Committee on Immunization Practices) recommended vaccination series (2013 AICP recommendation: 4 DTaP, 3 Polio, 1MMR, 3 Hib, 3 Hepatitis B, 1 Varicella, 4 PCV)

Statewide Only 75%

Statewide Only

18 Reduce the incidence rate of Chlamydia trachomatis per 100,000 population 2,340.7 705.2 1,735.7

19 Increase the percentage of rural community housing units with water and sewer services N/A 87% N/A

20 Increase the percentage of the population served by community water systems with optimally fluoridated water Statewide

Only 58% Statewide

Only

21 Reduce the percentage of women delivering live births who have not received prenatal care beginning in the first trimester of pregnancy 29.4% 19% 23.6%

22 Reduce the rate of preventable hospitalizations per 1,000 adults (hospitalizations that could have been prevented with high quality primary and preventive care) based on the Agency for Healthcare Research and Quality (AHRQ) definition

Statewide Only 6.7

Statewide Only

23 Reduce the rate of adults (age 18 years and older) reporting they could not afford to see a doctor in the last 12 months 17.9% 14% 15.2%

24 Increase the percentage of the population living above the federal poverty level (as defined for AK) 75.2%d 90% 74.4%e

25 Increase the percentage of 18-24 year olds with a high school diploma or equivalency 63.1%d 86% 77.1%e Notes: *Baseline 2010 and current data 2015 unless otherwise noted; DSU = Data statistically unreliable and

suppressed; +Rate based on fewer than 20 occurrences and statistically unreliable, but not suppressed; ++Modified

due to change in data collection methodology; a2009; b2011; c2013; d2006-2010; e2010-2015

For more detailed trend data on any individual indicator, go to http://ibis.dhss.alaska.gov.




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What’s Strong About You?

Employee Wellness Program- Over 700 employees, seven percent of population- Average household size in region: 3.7- Aim to reach 26 percent of population- Holistic wellness program: mind, body, spirit- NSHC self-insured until 2017- Health Insurance Costs continued to escalate




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Savignatugut- In 2013, implemented wellness exam for insurance premium discount (incentive)- 94 percent success rate first year; dropped to 37 percent- In 2015, added a tobacco cessation affidavit- Costs continued to increase- Effective July 1, 2017, switched to Federal Employee Health Benefit (FEHB) Plan- NSHC pays premiums for employee and qualifying family members

Strive to be in the top 100 Healthiest Employers

-Support 5 days of subsistence leave/year-Distributed Fitbits for participants-On-site workout facility-Recreation center and pool passes-Fat tire bikes and racks-Healthy foods in cafeteria-On-site educational workshops -Paid time to exercise-Paid time for tobacco cessation; Tobacco cessation aides offered for free




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Indigenous Peoples Day (Columbus Day)-Employee Wellness OpportunityList of Classes Offered− Food is Medicine− Power of Laughter− Nutrition and Weight Loss− Indigenous Spirituality− Financial Wellness− Yoga− Fitness and Total Wellness− Stress relief and tobacco use− Introduction to Dog Mushing− Improving the Patient

Experience

Employees enacting our values of sharing, hard work, and responsibility to tribe.

Opportunity for all employees to participate




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Intergenerational Trauma “Historical Trauma”

Intergenerational trauma is the transmission of historical oppression and its negative consequences across generations. There is evidence of the impact of intergenerational trauma on the health and well-being and on the health and social disparities facing Indigenous Peoples.

Examples of Historical Trauma in Bering Strait Region

Missionaries Arrived- late 1880’s and converted Inupiat’s to Christians

Native Language was forbidden in school- students scolded for speaking their own language

Native dancing forbidden

Replaced Inupiaq Sur Names- colors, presidents, first names




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Domestic Violence and Sexual Assault

A survey in 2015, found that one in two women in the Bering Strait Region had been a victim of domestic or sexual violence in their lifetime (51%) and 1 in 10 had experienced within the year.

Progress: In 2010, secured grant funding to develop a Sexual Assault Response Team.

- Dedicated on-call pool of personnel trained to deliver care to victims and to appropriately collect forensic evidence

- Funding encouraged high-level of community outreach and 276% increase in reported SART Encounters

NSHC’s SART Team- Recognized by National Indian Health Board

NSHC’s SART Team was on display at the National Indian Health Board Public Health Summit. Showcased as an example of an exemplary Domestic Violence Prevention Initiative (DVPI).• NSHC SART Project aims to maintain and improve the quality of care for victims of domestic

and sexual violence. • NSHC has created a “best practices” approach to the provision of care; employs a manager,

on-call nurses, and a medical director. • Policies and procedures were developed to address patient care after sexual assault for adults,

adolescents and children- Training provided for nurses and providers - Secured equipment necessary to conduct exams- Developed collaborative relationships within the community (have Memorandum of

Agreement (MOA) with other agencies)- Integrated care with Child Advocacy Center (CAC) at Kawerak, NSHC’s sister organization




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ACE’s: Adverse Childhood Experiences

“Adverse Childhood Experiences” (ACEs) are stressful or traumatic experiences, including abuse, neglect, witnessing domestic violence, or growing up with substance abuse, mental illness, or a parent in jail.

If children experience trauma, this undermines their ability to learn and cope, which in turn undermines their health and ability to earn a living.- Studies found ACEs can be genetically passed on from one generation to the next. This

relates to many of the health and social problems we wrestle with in Alaska- Studies also found, if children have positive influences in their lives, they can overcome

trauma.

In past two decades, learned important key components about Alaskans’ health:- Childhood trauma is far more common than previously realized; and- The impact of this trauma affects individuals over a lifetime and societies over

generations

Eight most commonly measured traumas

Abuse Household Dysfunction

1. Physical

2. Sexual

3. Emotional

4. Living with someone with mental illness

5. Living with someone with substance abuse

6. Separation or Divorce

7. Living with someone who went to jail or

prison

8. Witnessing Domestic Violence

A person who reports no exposure to any of the above categories has an ACE score of zero; a person who reports exposure to all eight categories of trauma would have an ACE score of eight.

Source: Adverse Childhood Experiences- Overcoming Aces in Alaska




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ACES are common, linked to health outcomes

-Higher ACE scores are linked to: higher incidences of disease, risky behaviors, and negative social outcomes

-The most striking is the suicide link

Source: Adverse Childhood Experiences- Overcoming ACEs in Alaska

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0 1 2 3 4

Percent Attempted Suicide (%)

Solutions: Trauma Informed Care- Behavioral Health Services staff screen for ACEs at every client intake prior to services;

70% have 4 or more ACEs (higher than studies done in AK)

- Screening tool: www.ihs.gov (includes an additional section, compared to standard ACE which provides an additional SUD score related to how much trauma is bothering client now

- Services are individualized based on this screening; assessments are tailored to capture trauma history

- Always broach topic of trauma; even with those who contend they are “trauma free” (most likely the majority of people they know are experiencing trauma)

- NSHC Trains providers in evidenced-based trauma approaches “Trauma-Informed Cognitive Behavioral Therapy”

- Several staff at NSHC are working on certification

- Take Away: Importance of prevention is critical to reducing adverse life consequences

http://www.ihs.gov/




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Opioid CrisisPer capita, Alaska is highest in opioid overdose-related deaths in Nation; quadrupled in past 6 years

In 2015, Alaska’s opioid overdose death rate was higher than the national rate: 11.0 vs. 10.4 per 100,000 population (source: www.epi.alaska.gov)

During 2016, 128 drug overdose deaths occurred in Alaska:95 (74%)involved any type of opioid (including prescription opioids, heroin, or other) 49 (38%) involved heroin

President Trump declared an Opioid Emergency- October 26, 2017

Alaska Governor, Bill Walker, one of six Governor’s invited by White House

Governor Walker declared Opioid Epidemic as public health disaster in February 2017

Alaska Project “HOPE”Project Hope: Harm reduction, overdose prevention, education

Goal 1: Stop unnecessary deaths from occurring- Distribution of Narcan kits

Goal 2: Prevent unused prescription medication from falling in to the hands of individuals who do not hold the prescriptions

- Drug Disposal Options

Goal 3: Education- Opioids.Alaska.gov




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Solutions: Prescribe less pills & manage pain differently

- Tribal Healers- Pain Management Committee- Training for Providers- Quality Assurance- The Alaska Prescription Drug Monitoring Program

(AKPDMP) is Alaska's solution for monitoring Schedule II-IV controlled substances dispensed in Alaska

- Requires that each dispenser shall submit, by electronic means, information regarding each prescription dispensed for a controlled substance

- Effective July 2017 in Alaska- Effective April 2017 in Wisconsin

Substance Abuse95-100% of law enforcement, correctional center (prison and halfway house), women’s shelter, and protective service cases involve substances.

June 2017: Emergency Room Visits




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Opportunity to Case Manage

2757

508 65 12

4126

2811

926411

1 TO 3 VISITS 4 TO 10 VISITS 11 TO 24 VISITS 25 OR MORE VISITS

FY17 Repeat ED/Acute Care Visits as of 8-15-17

Pt Count Resulting Visits

FY

2017

1st Quarter 2nd Quarter 3rd Quarter

Alcohol

Dependence/Abuse

Anemia Suicidal

Ideation

Essential

Hypertension

Pneumonia Hypertension

Suicidal Ideations OB Alcohol

abuse/

depression/

anxiety

Major Depressive Hypertension Anemia

Altered Mental

Status

Newborn Pneumonia

Many patients presenting with alcohol abuse are repeat offenders

FY2017 Top Ranked Inpatient Admissions

Suicide− Alaska’s suicide rate is double that of Nation− Bering Strait Region is six times greater than National Average− 74.5 to 12.6 & 4 times greater than State Average 74.5 to 19.6

Suicide attempts are the leading cause of injury hospitalizations and are the fourth leading cause of death in the region.




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Solutions: Liitfik Wellness and Training Center- “Liitfik”- Yup’ik word for “place of healing”; pilings for building in progress- Offer full continuum of counseling care: aftercare, intensive outpatient, day treatment, detox- Sobering Center: six-space social detox unit attached to the center; will accept ambulatory

persons in need of detox from the community, law enforcement officers, and/or from NSHC emergency department.

- Second level will be Health Aide Training Center

Diabetes− Diabetes Prevalence has increased over past fifteen years by 68 percent; Wisconsin 76

percent (1989-2008) *Wisconsin Dept of Health Services, November 2016

− Bering Strait Region’s Prevalence rate 2013: 22.1 per 1000 (190 cases) − Prevalence of Alaska Natives is one half of American Indians(Source: Metabolic

Syndrome in Yupik Eskimos: The CANHR Study, 2007)− Alaska’s Prevalence rate 2016=7.5% compared 2.2% Bering Strait Region− There is a shift in region from the Traditional Native Diet to Western Foods




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Top Ten Highest Rates of Type 2 Diabetes (2016)

State/Location Percent of Population with Diabetes

Bering Strait Region-Alaska* 2.2%

Alaska 7.5%

West Virginia 15.0%

Alabama 14.6%

Mississippi 13.6%

Arkansas 13.5%

Kentucky 13.1%

South Carolina 13.0%

Tennessee 12.7%

Georgia 12.1%

Louisiana 12.1%

Oklahoma 12.0%

Wisconsin 9.8%

Minnesota 8.4%

*Source: The State of Obesity, a project of the Trust for America’s Health and Robert Wood Johnson Foundation2004-2017

Best Practice: Program

What is CAMP?

Chronic Care, Active, Management & Prevention

Started in early 2000’s with Special Diabetes Program for Indians (SDPI)

Focused on case management for chronic care coordination for diabetics and diabetes prevention for youth

Plays a vital role in helping sustain a culture of wellness in region




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Promotes Traditional Living

Started award-winning “SummerciseProgram” in 2000

Step-by-Step Program (8-week fitness program measuring lipid profile, weight, and blood pressure, offers pedometer and free pass to recreation center)

Health Fairs

Sponsorship of Iditarod Dog Mushers- Stop the Pop Health Promotion Campaigns

CAMP’s Mission: To empower people and communities to promote healthy lifestyles and to improve the quality of life for people living with chronic illness

Traditional Foods




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Traditional Living Keeps you Strong- Long may you Run!

• Alaska Native Foods contribute a high proportion of healthy nutrients: iron, Omega-3-fatty acids, and protein

• Mean intakes of omega-3 fatty acids, from fish and sea mammals, are over twenty times greater than those of the general U.S. population.

(Source: International Journal of Circumpolar Health; 2009)

• Studies link high intakes of healthy fats, Omega-3-polyunsaturated fats to high HDL levels and lower prevalence of diabetes

(Source: Diabetes Care, Metabolic Syndrome in Inuit; June 2004).

HDL’s= 100

Cancer Prevention Strategies- Lung, Colon, Breast

Cancer Mortality Rate: 215.4 compared to 173.7 (Wisconsin)- Added first 16 slice CT Scan in 2009- Upgraded to 64 Slice in 2013- Accredited Mammography Program- 3D Imaging- 2 Colonoscopy Clinics/month on-site at NSHC- IFOB Test-Hemasure (Immuno Flourosencent Occult Blood Test)- Low-Dose Chest CT Exams- Case Managers- “putting prevention into primary care”- Hired Tobacco Cessation Counselor- 2013- Improved Documentation in Electronic Health Record for smoking status and cessation

counseling- Prevention Education- Adding MRI Machine- new construction addition to ER Department ($3.8 M project)




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Smoking is the biggest risk factor for lung cancer and contributes to an estimated 85% of cancers diagnosed, according to the U.S. Preventive Services Task Force. The risk of developing lung cancer increases with the amount a person smokes and the length of time a person smokes.

− NSHC partnered with State of Alaska for smoking prevention activities

− Mini-grants & movie days




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Results 0f Group Medical Visit(Smokers)

June 20176 patients registered; 3 from village1) BP’s and Weights2) Education by providers: Dentist, Administrator, Nursing, Tobacco Counselors, Provider3) Low-dose CT Exam and oral health screening/exam4) Group Sharing

Results: 2 patients had nodules identified2 patients had identified emphysema1 patient had pulmonary artery hypertension1 patient had finding on oral health screening requiring follow-up

Colorectal ScreeningColorectal cancer is the third most commonly diagnosed cancer in the United States, and the second among Alaska Native people, in whom it occurs at almost twice the rate of the U.S. White population.

Alaska Native patients should begin screening for colorectal cancer (CRC) at age 40 years rather than age 50.Justification:• Colorectal cancer is the leading cause of cancer among Alaska

Native people, in whom it occurs at almost twice the rate of the U.S. White population. • Alaska Native people have the highest incidence of CRC among racial/ethnic groups in the United States. • Incidence is higher at every age group, and as high in 40-49 year old Alaska Native people as in the U.S. White 50-59 year old age group.




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One of several residents who had their colonoscopy procedure completed in 2016.

David Alvanna, stands proud in front of Nolan the Colon.

Received HRSA (Health Resources Services Administration) Award for “Increased Colon Cancer Screening Rates”.

Breast Cancer- Mammography Program & Outreach

- Halogic Dimensions Mammography Machine- FDA & MQSA Accredited

- Perform 3D Imaging- similar to CT of Breast- Use Teleradiology for reads (no on-site radiologist)- During month of October, offer free mammograms for

uninsured and no out-of-pocket co-pays - Group Medical Visits(fly in for exams)- Case Management- Nordstroms Bra and Prosthesis fittings




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Infectious Disease- Tuberculosis• Leading cause of death until 1950

• TB Epidemic in Alaska started in late 1700’s to mid-1800’s; arrival of white explorers, fur traders

• In 2016, AK’s TB rate was nearly three times the national rate

Challenges: -Crowded housing conditions-Excessive alcohol use is complicating factor for treating people with TB- Need to “think TB” to “find TB”

*delayed diagnosis- Treatment is expensive, $100,000/yr

* Source: State of AK Epidemiology Bulletin, April 2017

TB- Best Practices- Mandatory TB Screening in school; every level- Train staff to “think TB”- Patient who presents in ER, coughing- Implemented Direct-Observed-Therapy (DOT) Aides; ensure patients with

TB diagnosis take medications- Implemented Quantiferon test (blood test) - Routinely screen at homeless shelter- Follow-up with contacts: Case Study (last month); 1 patient=35 contacts- Aggressively treat TB through Outpatient Therapy - Some inpatient admissions (hospital versus jail)= 6 weeks in isolation room

Table: NSHC TB Inpatient Admissions




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Environmental Health Concerns

In Bering Strait Region………………

441 households (16.8%) do not have running water350 households (13.35%) do not have running water or waste disposal systems

Five villages remain unconnected to water and sewer(Diomede, Wales, Shishmaref, Stebbins, and Teller

-Funding has declined for water systems; $660 M to fund “waitlist”

Lack of Water and Sewer = Infection

In Alaska……

Infants in communities without adequate sanitation are:• 11 times more likely to be hospitalized for respiratory

infections• Five times more likely to be hospitalized for skin

infections• One in three infants require hospitalization each year

for lower respiratory tract infections

Category Immunizations Hypertension Acute Pharyngitis Acute Upper Respiratory Child Health Exam

Villages without running water Ranked #3 Ranked #4 Ranked #1 Ranked #2 Ranked #5

Villages with running water Ranked #1 Ranked #2 Ranked #5 Ranked #3 Ranked #4

Table: NSHC Top Ranked Diagnoses in Villages with and without water running water/sewer




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Sanitation Solutions

- Advocacy in Washington DC- Flint , Michigan Water Crisis- Office of Environmental Health Program- Integration of funding sources/programs- Started water and sewer workgroup for Tribal

Health- Focusing on scoring matrix (need to get

projects scored higher)

Best Practices- Remote Health Care-Telemedicine & Telepharmacy-Health Aide Training- lay medical providers-Air Ambulance Program-Nurse Call Line-Tribal Nursing Home, Quyanna Care Center, (one of sixteen in Nation)-Patient-centered Medical Home (PCMH)-Patient Lodging & Pre-Maternal Home-Patient Advocacy & Make a Patient Smile Fund-Workforce Recruitment- 2-year Registered Nurse Program & C.N.A Courses




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Telemedicine & Remote Pharmacy

• Pioneered Telehealth• Recipient of 5 year HRSA Telemedicine Grant

2012-2017- Important for village-based cardiology

clinics, dermatology, audiology- Capture reimbursement for preparing the

case (Health Aides) and for reading the case (Providers)

- Pickpointe Units- Medication dispensing machines; invested $1 M into pharmacy equipment for each village clinic.

- Dispenses medications in prescription bottles with labels

Air Ambulance Team- providing health care in an airplane




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Tribal Nursing Home- QCC-One of only 20 Tribal Nursing Homes in Nation-18 Residents-Replacement Home- 2013; $18M facility funded by State of AK-Homelike Environment-(single rooms w/ceiling lifts, fireplace, no visible nursing station).-Currently have 4 Star Rating- Cost-based Reimbursement- 2012, named one of Top 40 Nursing Homes in

Nation

Cultural Activities Offered- Employ Cultural Activities Specialist - Native Cook; cook 2 meals in kitchen every day- Offer Native foods every day- Offer 3-4 Certified Nursing Assistant (C.N.A) Trainings per

year to encourage local hire

Challenges- Cannot serve “all Native foods”; seal oil, a traditional staple, is not an “approved” food due to its high risk for botulism-More residents with dementia, need for one-on-one care has increased-No Assisted Living Facility in Region or home-care




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Any Questions?

www.nortonsoundhealthcorp.org

angie gorn, nshc president/ceo - metastarangie gorn, nshc president/ceo moved to nome, alaska in...

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