CDC and Tribal Epidemiology Centers: Working Relationship Update Victoria Warren-Mears Epicenter Director vwarrenmears@npaihb.org

Overview CDC historical relationship Granting of Public Health Authority Status Visit to NWTEC by Dr. Ursula Bauer Calls with Dr. Bauer Letter to Dr. Frieden Future Directions

NW TEC and CDC We have had funding from CDC for a variety of projects, including the Tribal EpiCenter Consortium and Data into Action, Comprehensive Cancer Program, and Tribal Community Survey (Tribal BRFSS)

Public Health Authorities of TECs In the Affordable Care Act Indian Health Care Improvement Act reauthorization TECs were designated at Public Health Authorities

Tribal Epidemiology Centers 2010 AFFORDABLE CARE ACT Permanently reauthorized the IHCIA TECs given “public health authority” status

Tribal Epidemiology Centers 2010 AFFORDABLE CARE ACT Health and Human Services (HHS) directed to give TECs access to HHS data systems and protected health information Centers for Disease Control and Prevention must provide TECs technical assistance Each IHS Area must have TEC access

Seven Core Functions of Tribal Epidemiology Centers Evaluate Delivery Systems Collect and Monitor Progress toward meeting health status objectives Assist Tribes and Tribal Organizations with Epi Data Make recommendations for service targets Provide TA to Tribes and Tribal Organizations Seven Core Functions of Tribal Epidemiology Centers Make recommendations to improve health care delivery Provide disease surveillance

Core TEC Functions Citations from the Patient Protection and Affordable Care Act (2010), which includes the permanent reauthorization of the Indian Health Care Improvement Act, that establishes (continues) the TECs (United States Code > Title 25 › Chapter 18 › Subchapter II › § 1621m). http://www.law.cornell.edu/uscode/text/25/1621m ). a. “Functions of TECs: In consultation with and on the request of Indian tribes, tribal organizations, and urban Indian organizations, each Service area epidemiology center established under this section shall, with respect to the applicable Service area— • collect data relating to, and monitor progress made toward meeting, each of the health status objectives of the Service, the Indian tribes, tribal organizations, and urban Indian organizations in the Service area; • evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; • assist Indian tribes, tribal organizations, and urban Indian organizations in identifying highest-priority health status objectives and the services needed to achieve those objectives, based on epidemiological data; • make recommendations for the targeting of services needed by the populations served; • make recommendations to improve health care delivery systems for Indians and urban Indians; • provide requested technical assistance to Indian tribes, tribal organizations, and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community; • provide disease surveillance and assist Indian tribes, tribal organizations, and urban Indian communities to promote public health.”

TEC Core Functions “In consultation with and on the request of Indian tribes, tribal organizations, and urban Indian organizations, each Service area epidemiology center established under this section shall, with respect to the applicable Service area: Collect data Evaluate data and programs Identify health priorities with tribes Make recommendations for health service needs Citations from the Patient Protection and Affordable Care Act (2010), which includes the permanent reauthorization of the Indian Health Care Improvement Act, that establishes (continues) the TECs (United States Code > Title 25 › Chapter 18 › Subchapter II › § 1621m). http://www.law.cornell.edu/uscode/text/25/1621m ). a. “Functions of TECs: In consultation with and on the request of Indian tribes, tribal organizations, and urban Indian organizations, each Service area epidemiology center established under this section shall, with respect to the applicable Service area— • collect data relating to, and monitor progress made toward meeting, each of the health status objectives of the Service, the Indian tribes, tribal organizations, and urban Indian organizations in the Service area; • evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; • assist Indian tribes, tribal organizations, and urban Indian organizations in identifying highest-priority health status objectives and the services needed to achieve those objectives, based on epidemiological data; • make recommendations for the targeting of services needed by the populations served; • make recommendations to improve health care delivery systems for Indians and urban Indians; • provide requested technical assistance to Indian tribes, tribal organizations, and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community; • provide disease surveillance and assist Indian tribes, tribal organizations, and urban Indian communities to promote public health.”

TEC Core Functions Make recommendations for improving health care delivery systems Provide epidemiologic technical assistance Provide disease surveillance to tribes Citations from the Patient Protection and Affordable Care Act (2010), which includes the permanent reauthorization of the Indian Health Care Improvement Act, that establishes (continues) the TECs (United States Code > Title 25 › Chapter 18 › Subchapter II › § 1621m). http://www.law.cornell.edu/uscode/text/25/1621m ). a. “Functions of TECs: In consultation with and on the request of Indian tribes, tribal organizations, and urban Indian organizations, each Service area epidemiology center established under this section shall, with respect to the applicable Service area— • collect data relating to, and monitor progress made toward meeting, each of the health status objectives of the Service, the Indian tribes, tribal organizations, and urban Indian organizations in the Service area; • evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; • assist Indian tribes, tribal organizations, and urban Indian organizations in identifying highest-priority health status objectives and the services needed to achieve those objectives, based on epidemiological data; • make recommendations for the targeting of services needed by the populations served; • make recommendations to improve health care delivery systems for Indians and urban Indians; • provide requested technical assistance to Indian tribes, tribal organizations, and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community; • provide disease surveillance and assist Indian tribes, tribal organizations, and urban Indian communities to promote public health.”

TEC Activities Collect and disseminate data… Provide analysis of health data Area/Tribal specific health status reports… Community Health Profiles Maintain/provide access to surveillance databases Conduct epidemiologic studies Support public health emergency response Assist Tribes in disease control and prevention Provide training… Epidemiology, Data Collection, and Public Health TECs play a critical role in building public health capacity among AI/AN regions and communities. Working with Tribal entities and urban AI/AN communities, TECs collect and disseminate data, including regional and tribal specific reports such as Community Health Profiles. TECS also perform various surveillance activities, epidemiological studies, public health Emergency response, disease control and prevention and training. Training includes building tribal capacity to use patient management systems such as the immunization registry and the diabetes registry. The NPAIHB NARCH Summer Institute is an example of epidemiologic and public health training that TECs provide. The Resource and Patient Management System (RPMS): A set of integrated computer applications designed to support the clinical and administrative functions of the IHS health care program.

Visit with Dr. Ursula Bauer

Recent Tribe and Tribal Organization Specific CDC RFP All TEC Directors call with Dr. Bauer to address needs from CDC TC from Dr. Bauer to suggest a letter to Dr. Frieden to elevate concerns to the Agency level Release of CDC RFP Letter sent to Dr. Frieden signed by all TEC directors Response received June 8, 2014 from Dr. Frieden

Recent Tribe and Tribal Organization Specific CDC RFP Two components Tribes Tribal Organizations Require letters of support from 50% of the area served plus 1

Conversations with Dr. Frieden

Future Directions Continue to dialogue with CDC Share movement with Tribal leadership

Questions and Comments