Dean M Seyler - Area Director July 09, 2013 Quarterly Board Meeting Northern Quest Resort & Casino

 Meeting With Direct Service Tribal Councils  Three Complete, Two More To Go  2005 Master Plan Discussions  Other Service Unit Related Topics  10th Annual Direct Service Tribal National Meeting  July , 2013 Crowne Plaza Hotel & Suites Minneapolis Airport Three Appletree Square Bloomington MN 55425

 Chief Medical Officer  CAPT Stephen M Rudd, MD  19 Years of Service With IHS  Chairman of the IHS National Pharmacy & Therapeutics Committee  Fellow of the American Academy of Family Physicians  Commission Corps Update  Six Officers Promoted  Three Tribal Sites  Three Federal Sites  New Western Region Commission Corps Liaison  CMDR Treat – Alaska Area Office  Effective June 17, 2013

 Fund Distribution Workgroup  Possible Dates in August - 13 th or 14 th - 19 th or 20 th  Review Updated Charter  User Pop Calculation Method  Existing Members Are:  Angela MendezJanice ClementsStella Washines  Dan GleasonMarilyn ScottLeroy Jackson  Judy MuschampMark JohnstonBarbara Finkbonner  IHS FY 13 Budget - Final  Agency  Portland Area  Projected funding for SFC projects FY13 - $5 million

FY 2013 Agency Summary FY 2012 Enacted, Discretionary $4,306,527,000 FY 2013 Bill Language $4,356,204,000 (+$50M or 1.2%) Rescission/Sequester -$225,356,581 FY 2013 Final Enacted $4,130,847,419 (-$176M or 4.1%)

FY 2013 Portland Area Summary FY 2012 Enacted, Discretionary $276,035,208 FY 2013 Bill Language $275,529,510 Rescission/Sequester -$13,872,201 FY 2013 Final Enacted $261,657,309 (-$14.4m or 5.21%)

 FY2014 President’s Budget Request  IHS - $4.4 billion ($124 million increase; 2.9% c/w FY2012)  Increases  $6 million for pay costs  $77 million for new facility staffing  $35 million for CHS medical inflation  $5.8 million for CSC shortfall  $85 million for health care facility construction  Kayenta, San Carlos, S. CA. YRTC  No decreases; greater increases compared to FY 2013

 VA/IHS Memorandum Of Agreement For Reimbursement Update  All Six Federal Sites Have Agreements  First Reimbursement Occurred with Billings Area  First Electronic Submission and Payment Completed  ACA Update  Approved exemption for all American Indians and Alaska Natives who are eligible for IHS services from the minimum responsibility payment related to the Affordable Care Act.

 Notice of a training course sponsored by the Environmental Health Support Center  Environmental and Health Consequences of Clandestine Methamphetamine Laboratories.  August 28, 2013 in Portland, Oregon  Course description and registration available through the EHSC website

 Portland Area Directors Recognition Of Excellence  August 21, 2013  1PM to 3PM  Gus Solomon Courthouse  Categories Are:  Direct Patient Care  Support in the Delivery of Health Care  Health Promotion/Disease Prevention  Excellence in Leadership

Portland Area JVN site diabetic eye screening  Mid-year 2012 GPRA results indicated IHS was “not on track” to meet the goal for diabetic retinopathy (DR) screening.  May 12, IHS Chief Medical Officer Memo:  Call to action to improve DR retinopathy screening, focused on four goals:  All Agency hospitals will be deployed with the IHS-JVN Program by the end of FY 2013  All other Agency sites with a diabetes population of more than 500 will deploy the IHS-JVN Program by the end of FY  All sites currently with the IHS-JVN Program must meet or exceed the GPRA goal AND maintain an annual DR exam rate at least 25% greater than pre-JVN deployment levels.  All IHS-JVN sites will report their JVN performance in their bimonthly accomplishment reports.

 This plan was designed to improve the Retinopathy Assessment GPRA performance measure and decrease avoidable blindness due to diabetic retinopathy.  Key element:  All sites currently with the IHS-JVN Program must meet or exceed the GPRA goal AND maintain an annual DR exam rate at least 25% greater than pre- JVN deployment levels.

 Area Chief Medical Officer(CAPT Miles Rudd, MD)  Provides Clinical Directors at each JVN site with results from quarterly JVN reports.  Process generates questions by CDs.  Allowed to address issues related to location of equipment, training needs for technicians, etc.  Initiated monthly Area Federal CD conference call  Agenda topic for JVN.

 Area Diabetes Coordinator (CAPT Donnie Lee, MD)  Provided sites with monthly goal to meet diabetic retinopathy screening GPRA objective.  Previously established bi-monthly conference calls with the JVN coordinators.  Evolved to bi-monthly written reports submitted by JVN sites  Reports address the following issues:  Number of exams  Update contact information  Local personnel (Coordinator, technicians)  Software issues  Hardware issues  Set-up (location of equipment)

 Benewah Medical & Wellness Center  Pre JVN GPRA eye screening rate (2004)  38%  GRPA eye screening rate (2013)  39%  Absolute # screening increase 30% (registry size increase 28%)  Colville Service Unit  Pre JVN GPRA eye screening rate (2004)  45%  GRPA eye screening rate (2013)  38%  Absolute # screening increase 79% (registry size increase 111%)

 Cow Creek  Pre JVN GPRA eye screening rate (2004)  27%  Diabetes audit eye screening rate (2013)  59%  Screening rate increase 118%  Klamath Falls  Pre JVN diabetes audit eye screening rate (2004)  32%  Diabetes audit eye screening rate (2013)  67%  Screening rate increase 109%

 Warm Springs Health & Wellness Center  Pre JVN GPRA eye screening rate (2004)  53.4%  GRPA eye screening rate (2013)  69.5%  Screening rate increase 30%  Ft Hall Service Unit  Pre JVN GPRA eye screening rate (2004)  60.7%  GRPA eye screening rate (2013)  57.4%  Absolute # screening increase 48% (registry size increase 63%)

 Native American Rehabilitation Associates of the Northwest, Inc. (NARA)  Pre JVN diabetes audit eye screening rates:  2004:44% ― 2010: 55%  JVN incept Sept 2010:  Eye screening: 81.5% Screening rate increase 48%  Western Oregon Service Unit  Pre JVN GPRA eye screening rate (2004)  46%  GRPA eye screening rate (2012)  78.2%  Screening rate increase 70%

 Lapwai  Pre JVN diabetes audit eye screening rate (2004)  33%  GRPA eye screening rate (2013)  53%  Screening rate increase 61%  Native Project  Pre JVN diabetes audit eye screening rate (2004)  24%  GRPA eye screening rate (2013)  30%  Screening rate increase 25%

 Wellpinit Service Unit  Pre JVN GPRA eye screening rate (2004)  29%  GRPA eye screening rate (2013)  58%  Screening rate increase 100%  Yakama Service Unit  Pre JVN GPRA eye screening rate (2004)  35%  GRPA eye screening rate (2013)  57%  Screening rate increase 63%

 Summary of Portland Area JVN site diabetic eye screening performance:  12/13 sites improved overall  12/13 reached performance goal (+25% over baseline)  8/13 reached GPRA goal (pending final 2013 update)

Last Minute Information Indian Health Service Tribal Self-Governance Funding Opportunities Fiscal Year (FY) 2013 Planning & Negotiation Cooperative Agreements  Key Dates: Application Deadline Date: Wednesday, July 31, 2013  Earliest Anticipated Start Date: Friday, August 30, 2013  Signed Tribal Resolutions Due Date: Wednesday, July 31, 2013

Questions or Comments Our Mission... to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. Our Goal... to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people. Our Foundation... to uphold the Federal Government's obligation to promote healthy American Indian and Alaska Native people, communities, and cultures and to honor and protect the inherent sovereign rights of Tribes.