Exploring how to provide affordable, accessible, and equitable high-quality Indian Health Service-funded care for American Indians and Alaska Natives

The Foundation's initiative, Research in Transforming Health and Health Care Systems, was designed to: (1) sponsor four calls for proposals for investigator-initiated research on various topics in health care service toward transforming the health and health care systems; and (2) potentially commission a limited amount of additional research, if needed. The goal of this study, funded under RWJF's Research in Transforming Health and Healthcare Systems (RTHS) program, is to provide specific, community-driven, measurable, and tribally rooted recommendations needed for meaningful innovation in the Indian Health Service (IHS) that will result in more affordable and accessible care for tribal nations and that will improve health equity. The study seeks to create an estimate for full funding of IHS to inform how to improve affordability and access to high-quality, IHS-funded healthcare to achieve health equity for American Indian and Alaska Native people. To date, efforts by the federal government to honor the trust and treaty obligations for healthcare have been insufficient, as severe and persisting health disparities exist today among tribal communities. The project team will form an advisory group comprising sovereign leaders of federally recognized tribal nations and will collaborate with Area Indian Health Boards, Tribal Epidemiology Centers, and National Tribal Budget Formulation Workgroup meetings. The project's approach will provide detailed information on the existing disparities in health risks and service use for American Indian and Alaska Native populations. Individuals with different insurance types (Medicaid, uninsured, and Medicare, or dually eligible) will be analyzed within the distinct data sources associated with their insurance and/or IHS treatment system. That process will ascertain a comprehensive picture of current health risks and service use and provide insight into the types of care that individuals eligible for IHS services are traveling substantial distances to obtain. In partnership with Mathematica, the project team will estimate a risk score that indicates the funding needed to meet the healthcare needs of the individuals in the American Indian and Alaska Native populations as compared with the national average for non-Native individuals with the same demographics. Deliverables will include a project workplan and annual and final narrative and financial reports, as well as a range of products, to reach policymakers and other audiences for study findings.