The recent wave of concerns associated with health care services in Indian country raise a fundamental issue whether the status quo should be maintained at all cost or whether it is time to explore other options. For many larger tribes the question is a Shakespearian one: "To 638 or not to 638."
For the people living on those reservations, it may literally be the difference between life and death. The dilemma presents the tribal members with a choice between the Indian Health Service and their own tribal government to run their hospitals and accredited mental health programs. The fact that nowhere in the discussions, planning sessions or legislative process is the private sector represented, is a testimony to the tunnel vision dominating many tribal administrations.
A glance at the American health care industry reveals that a majority of the hospitals and behavioral health organizations are privately run entities. Many regional and county hospitals are also being managed by private organizations.
Our co-dependent attitude towards the federal government often prevents us from empowering private citizens, organizations and networks from providing high quality, professional, efficient and nationally accredited services. For all the community and economic development offices throughout just about any reservation, most do not fully understand or embrace the basic idea behind privatization: cut the red tape, find solutions, start providing services and bring in monies from off the reservation.
It is that simple. It does not require funding, just vision and the commitment. Most communities lose millions of dollars on a regular basis to border towns and other off-reservation providers simply because tribal bureaucracies and turf are designed to stifle internal solutions. They perpetually make it unbearable for entrepreneurs to implement businesses as a general rule, and health care is certainly no exception to that rule.
Specific to the behavioral health for children and adolescents, there are numerous tribal members in various acute psychiatric hospitals, residential treatment centers and group homes mostly in the major metropolitan cities. Since there are no options available on their reservations, case managers, probation officers and parents have no choice but to seek these services wherever they find professional, quality facilities. In doing so, we often risk providing disjointed services, apart from their support network.
Many visionary leaders during the past decade have realized the importance of dealing with these issues and thus began applying for federal funding to implement programs and services. These efforts included a rush to build inpatient and outpatient facilities on various reservations.
As they soon discovered, tribal departments lacked the expertise, consistency, flexibility or the professional standards needed to operate these facilities on a nationally acceptable, billable level. Many of these multi-million dollar facilities sit vacant, shrouded in controversy, used sparingly or for non-intended purposes.
As the CEO of a Behavioral Health organization specializing in treating Native American youth through a network of reservation and off-reservation based services, I encourage the tribal leaders to think outside the box:
Native American children should be entitled to the same health-care rights and options as any other child in any state. If our programs perform to the highest degree of qualifications and expectations, each and every child will receive all treatment available under the state law.
Below is an outline blueprint on how to achieve this task:
?Study the feasibility of privatizing the mental health system;
?Empower leaders within the community through training and financial resources to study the private health care systems;
?Hire reputable organizations currently providing these services with a proven record of sensitivity to Native American cultural and spiritual requirements for a limited number of years (five to seven years) to operationalize and manage the facilities. This will allow recruitment and training of professionals, implementation of strict professional and quality assurance standards, the obtaining of state and national licensing and accreditation and finally, the ability to bill the state or any other third party payer;
?If the corresponding state is unwilling to license facilities on the reservation, create your own regulatory commission based on HCFA standards;
?Once the facility or program is able to bill "fee for service," it will no longer require a financial commitment from the tribe or dependence on the feds;
?After these organizations are privately operated by private entities and all the wrinkles have been ironed out, tribes can assume the management and enjoy the benefits.
As with anything else, it is crucial to keep tribal politics away from the operation of such facilities and programs. Professional and objective direction based on standards will be the guarantors of success. This blueprint should not be limited to psychiatric hospitals but include a continuum of behavioral health services including residential treatment centers, therapeutic group homes, day treatment and intensive outpatient programs and many other services. Additionally, juvenile justice services such as management of correctional facilities can become turnkey operations.
This is particularly a unique time. Tribes are in the position of creating a stable, professional and high quality behavioral, as well as general, healthcare infrastructure to serve their membership as well as potentially bringing additional revenues into their communities.
Siamak Khadjenoury is the chief executive officer of Vista Springs Behavioral Health Network whose headquarters are located in Sierra Vista, Ariz. Vista Springs is a nationally accredited network of behavioral health and management services throughout the United States specializing in the treatment of Native American youth on or off the reservation. Vista Springs Traditions programs provide a continuum of behavioral health services throughout the Navajo Nation.